MIPS Challenges for Small Practices

The Medicare Merit-based Incentive Payment System (MIPS) has its benefits for many practices, but there are some requirements that are hurting physician practices due to penalizations. 

MIPS has been designed with the intention of enhancing healthcare quality and providing financial incentives for improved performance. However, for many practices, particularly smaller ones, the requirements and penalties associated with MIPS can be burdensome. In this blog, we will discuss the goals of MIPS, the challenges faced by many practices, and how Chirpy Bird can help you navigate these complexities. We'll also highlight key points from the American Medical Association (AMA) regarding the need for improvements to the MIPS program.

The Goal of MIPS

MIPS consolidates three existing programs: the Physician Quality Reporting System (PQRS), the Value-Based Payment Modifier (VBPM), and the Medicare Electronic Health Record (EHR) Incentive Program, commonly known as Meaningful Use. By merging these programs, MIPS aims to create a singular and cohesive system that evaluates healthcare providers based on four performance categories: Quality, Cost, Improvement Activities, and Promoting Interoperability.

The intent behind MIPS is to improve the quality of care for patients, streamline administrative reporting for practices, and provide incentives based on successful feedback and outcomes.

Navigating MIPS Challenges

While MIPS has its benefits, many smaller practices face significant challenges due to its requirements. The higher minimum performance threshold and increased weight for the Cost category can be particularly difficult for smaller practices to manage. According to the AMA, the program's reporting requirements are often burdensome and clinically irrelevant, focusing more on checking boxes than on improving care (Henry, 2024).

The AMA's recent findings show that a disproportionate number of small and rural practices receive penalties under MIPS. Data given back to these smaller practices are incomplete and inconsistent, which makes it difficult to pinpoint exactly what areas call for improvement. For example, 27% of small physician practices and 18% of rural physician practices were penalized in the 2022 performance year, which affects payments in 2024. This underscores the need for changes to ensure that MIPS does not unfairly disadvantage these practices (AMA, 2024).

New Approaches to Improve MIPS

To address these issues, the AMA has proposed several changes to the MIPS program. One of the key suggestions is to replace the competitive "tournament" model with a more sustainable approach that ties payment updates to annual inflation and the rising costs of running a medical practice. This would provide physicians with steady and predictable payment increases each year, reducing financial instability (AMA, 2024).

The AMA advocates for freezing the performance threshold to avoid penalties for at least three years and eliminating the maximum penalty of negative 9%. These changes aim to reduce the undue administrative burden on physicians and increase the clinical relevance of the program (AMA, 2024)

Additionally, another proposed change is to improve how MIPS data is shared with physicians. They are recommending that data is shared in a timely error to identify gaps in care being given, which will lead to avoidance of unnecessary costs and penalties (AMA, 2023). 

How Chirpy Bird Can Help

Navigating the MIPS landscape can be complex and challenging, but Chirpy Bird is here to help. We offer personalized MIPS assistance through pay-as-you-go monthly subscriptions. Our services include incremental and strategic methodology to engage each month at a time that works best for you to:

🧾EMR Workflow Training: Helping you optimize your electronic medical records system.

☑️Measure Selection: Assisting you in choosing the most relevant performance measures.

📈Performance Monitoring: Tracking your performance in all MIPS categories.

📋Education and Submission: Providing ongoing education and support for MIPS reporting.

Our team of experts can help you address potential errors in your MIPS scores, ensuring accurate and timely submissions to CMS. We also stay up-to-date with the latest changes and improvements proposed by organizations like the AMA, so you can be confident that your practice is aligned with current best practices.

Contact us today with any questions or for a FREE quote by phone at 888-647-7247 or email at hello@chirpybirdinc.com. Let Chirpy Bird help you turn your MIPS management from a daunting task into a strategic advantage for your practice.