MIPS for Dermatology 2023
As dermatologists and dermatology practice managers, it is crucial to stay up to date with the latest developments in the Merit-based Incentive Payment System (MIPS). In this blog post, we will explore the intricacies of MIPS by category and discuss the financial penalties and incentives for the 2023 performance year.
MIPS Categories
MIPS is divided into four categories: Quality, Promoting Interoperability (PI), Improvement Activities (IA), and Cost. Each category is weighted differently, with Quality being the most heavily weighted. The breakdown for the 2023 performance year is as follows:
Quality (30%)
Promoting Interoperability (25%)
Improvement Activities (15%)
Cost (30%)
Quality
The Quality category requires clinicians to report on six measures, one of which must be an outcome measure. For dermatology practices, this may include measures such as melanoma reporting, biopsy follow-up, and patient satisfaction. In 2023, the performance threshold for Quality is set at 60 points out of a possible 100. Practices that score above this threshold will receive positive payment adjustments, while those that score below will face negative adjustments.
Promoting Interoperability
The Promoting Interoperability (PI) category focuses on the use of certified Electronic Health Record (EHR) technology to improve patient care. Dermatology practices must report on four objectives: e-Prescribing, Health Information Exchange, Provider-to-Patient Exchange, and Public Health and Clinical Data Exchange. In 2023, the performance threshold for PI is set at 100 points out of a possible 155. Like the Quality category, scoring above this threshold results in positive payment adjustments, while scoring below leads to negative adjustments.
Improvement Activities
The Improvement Activities (IA) category aims to encourage practices to engage in activities that improve clinical practice. Dermatology practices can choose from a list of more than 100 activities, such as care coordination, patient safety, and practice assessment.
To achieve the maximum 15 points* for the Improvement Activities score:
A clinician that works in a group with 15 or fewer providers billing with the same TIN may select either of these combinations:
1 high-weighted activity OR
2 medium-weighted activities
A clinician with a special status of Non-patient Facing, Health Professional Shortage Area (HPSA), or Rural may select either of these combinations:
1 high-weighted activity OR
2 medium-weighted activities
Clinicians working in larger groups (16 or more) will need to attest to more activities to receive full credit for this category:
2 high-weighted activities OR
1 high-weighted activity and 2 medium-weighted activities OR
4 medium-weighted activities
In the 2023 performance year, dermatologists can choose from a wide range of activities to fulfill their IA requirements. Here is a list of some of the best activities for dermatologists, along with brief explanations:
Care Coordination (Activity ID: IA_CC_4)
Establishing regular care coordination with other healthcare providers, such as primary care physicians, oncologists, and surgeons, helps ensure optimal patient care, minimize complications, and reduce unnecessary costs.
Implementation of Patient Safety Practices (Activity ID: IA_PSPA_6)
Implementing evidence-based patient safety practices, including infection prevention, wound care, and medication management, can lead to better patient outcomes and a reduced risk of complications in dermatology procedures.
Population Health Management (Activity ID: IA_BE_15)
Implementing a system for identifying and addressing the healthcare needs of patients at risk for skin cancer, such as routine skin cancer screenings and patient education on sun protection, can improve the early detection and treatment of skin cancer.
Important Reminder: Group reporting (reporting on the TIN level) requires that at least 50% of those in the TIN have completed the activity/activities being attested to.
Cost
The Cost category evaluates the cost of care provided to Medicare beneficiaries, aiming to incentivize healthcare providers to deliver high-quality care while reducing unnecessary costs. For the 2023 performance year, the Cost category's weight has been increased to 30% of a clinician's overall MIPS score, emphasizing its importance in the evaluation process.
Nuances for Dermatologists
In the 2023 performance year, dermatologists will be assessed based on two measures in the Cost category: Medicare Spending per Beneficiary (MSPB) and Total Per Capita Cost (TPCC).
Medicare Spending per Beneficiary (MSPB): This measure evaluates the average spending for a Medicare beneficiary during an MSPB episode, which spans from three days before a hospital admission to 30 days post-discharge. While dermatologists may not frequently admit patients to hospitals, they should be mindful of their role in the overall healthcare system and collaborate with other healthcare providers to minimize costs during the MSPB episode.
Total Per Capita Cost (TPCC): The TPCC measure examines the overall costs incurred by a dermatologist for the care of their Medicare patients. For dermatologists, this may include costs related to office visits, diagnostic tests, treatments, and procedures. To excel in this measure, dermatologists should focus on providing cost-effective care, reducing unnecessary tests or procedures, and implementing evidence-based practices.
Episode-Based Measures: Episode measures provide a method for evaluating resource use during the management of a specific clinical condition or treatment. They offer a more comprehensive view of a patient's care by capturing services provided by multiple clinicians and facilities involved in the patient's treatment. One such episode measure relevant to dermatologists is the Melanoma Resection measure.
The Melanoma Resection episode measure assesses the cost of care related to melanoma resection procedures. This measure captures the costs associated with services provided during a specific period, beginning from the date of the melanoma resection surgery, and extending through the subsequent 30 days. It includes all costs associated with the surgical procedure, as well as preoperative and postoperative care provided during the episode window.
For dermatologists, optimizing performance in the Melanoma Resection episode measure requires a focus on delivering cost-effective care while maintaining high-quality outcomes for patients undergoing melanoma resection procedures. Some strategies to improve performance in this measure include:
Implementing evidence-based practices: Adhere to established clinical guidelines and best practices for melanoma resection procedures to minimize complications and reduce the need for additional treatments or hospitalizations.
Enhancing care coordination: Collaborate with other healthcare providers involved in a patient's care, such as oncologists, surgeons, and primary care physicians, to streamline the care process and reduce unnecessary costs during the episode window.
Optimizing preoperative and postoperative care: Provide thorough preoperative assessments, patient education, and postoperative follow-up to minimize complications and ensure timely intervention if issues arise.
Understanding the Cost category's implications for patients is also essential for dermatologists. By providing cost-effective care, dermatologists can help reduce the financial burden on patients without compromising the quality of care. Furthermore, excelling in the Cost category can lead to positive payment adjustments, which can potentially lower the costs for patients in the long run.
As a dermatologist or dermatology practice manager, it is essential to understand the nuances of MIPS to optimize your practice's financial performance. By focusing on the four categories—Quality, Promoting Interoperability, Improvement Activities, and Cost—through the scope of your special practice, you can work towards achieving a higher MIPS score and securing positive payment adjustments for your practice in 2023.
Need more help with the MIPS program? Connect with us for a free quote.
