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What’s Up With MIPS? New MVPs Framework Could Bring Sweeping Changes


The Merit-based Incentive Payment System (MIPS) – which is just one element of the government’s proposed alternative payment models (APMs) designed to reduce healthcare costs – has been a moving target since the concept was introduced in 2015.

Just last week, the Centers for Medicare & Medicaid Services outlined a new proposal to its Medicare Physician Fee Schedule and Quality Payment Program – all designed to reduce the administrative burden many physicians are feeling as it relates to tracking and reporting quality measures that currently help them qualify for MIPS incentives. Currently, many providers are frustrated by the many measures they are required to track and report – and some complain they’re having to hire administrative support just to keep up with it all.

Outlined in a detailed 1,704-page document, the proposed CMS framework is known as the MIPS Value Pathways (MVPs) and, if approved, would begin with the 2021 performance period. The MVPs proposal would allow clinicians to report on less measures that are more closely aligned with their specialty or the medical conditions they’re treating – making MIPS more “clinically-relevant.” For example, a primary care physician may elect to report on a specific set of quality measures related to the treatment of diabetes, whereas a surgeon may report on quality measures that are specific to surgery.

Proposed Changes Could Bring E/M Coding Changes, Too

Billing and coding for office-based visits, known as evaluation and management (E/M) services, hasn’t changed in nearly 20 years since it was introduced. Thankfully, CMS finalized some changes to simplify the process in 2019 and new, proposed updates for 2020 could bring sweeping changes that would allow providers to code accordingly for spending more time with patients – particularly those with complex health problems and/or multiple co-morbidities. Already, specialty groups such as the American College of Rheumatology, are lauding these potential changes claiming they will support adequate reimbursement for providers who are helping patients manage chronic, time-intensive conditions.

Other CMS proposed changes would support clinicians who help patients transition from the hospital to home, as well as those patients who need ongoing care management. Finally, providers who care for patients with opioid use disorder (OUD) through an accredited opioid treatment program (OTP) could qualify for bundled payments, supporting better care for patients affected by the growing opioid epidemic.

All in all, CMS states the proposed changes are projected to save 2.3 million hours per year in administrative burden. Officials recognize that providers are “drowning in paperwork and reporting requirements caused by cumbersome government rules and regulations,” and these changes could help improve these circumstances for providers.
CMS will be accepting public comment on these proposed rules between now and September 27, 2019.

GeBBS Healthcare Solutions offers a wide range of MIPS solutions to help organizations manage the transition from fee-for-service to value-based reimbursement. To learn more, Click Here.

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