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MIPS: The DOs and DON’Ts in choosing quality over value

Updated: Dec 22, 2021

The American Academy of Family Physicians has called the Merit-Based Incentive Payment System, or MIPS, “the first real opportunity for high-performing physicians to earn substantial bonuses, and for all physicians to avoid penalties if they meet prospectively established quality thresholds.”


The MIPS program is one of two tracks under the Quality Payment Program, which moves Medicare Part B providers to a performance-based payment system. It assesses physician performance under four categories to determine whether an individual qualifies for an incentive payment. The categories are: quality, cost, promoting interoperability, and clinical practice improvement activities.


Highlighting the importance of quality over value is ingrained in the framework of these models, but quality can be defined in different ways by various people. The six domains of healthcare quality, according to the Agency for Healthcare Research and Quality, are determining if the care is: safe, effective, timely, efficient, equitable, and patient-centered.

Safe

Patient safety is crucial to quality care. Measures such as preventable infections and preventable hospitalizations openly highlight patient safety as a critical quality measure.

  • DO prevent unnecessary hospitalizations;

  • DO follow proper steps to ensuring patient safety;

  • DON’T improperly bandage surgical sites, which can lead to infection and, therefore, unnecessary hospitalization.

Effective

Readmission rates are the most common quality measure that emphasizes effective care.

  • DO make sure patients receive proper care in the hospital;

  • DO counsel them correctly on care coordination after discharge, which should keep readmission rates low;

  • DON’T focus on process measures.


Timely

While it can be difficult to capture timely delivery for each patient, proxy measures help with this.

  • DO conduct patient-reported measures determining factors such as whether they were seen promptly or had to wait for an appointment;

  • DON’T avoid surveys such as those from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey which help capture timeliness

Equitable

Equity of care can be a challenging quality metric to capture, but population-health-reporting strategies can help understand if a plan and provider are delivering equitable care.

  • DO check to see if screening rates are similar across various demographic groups.

  • DON’T rely solely on value-based care deals.


Patient-Centered

Patient experiences are normally collected by providers through CAHPS surveys to measure a patient’s perceptions of the care they are receiving from their provider and their health plan.

  • DO leverage quality metrics depending on target population and stakeholder needs;

  • DON’T only use value-based care models as no single one can measure all aspects of quality.


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Whether you are a multi-specialty group or a solo practice, Catalyst Billing Solutions has deep, relevant experience that will help you navigate today’s world of medical billing, MIPS, and management services. Our energetic team is equipped with superior technology and operational brilliance to take your billing operations to the next level of profit and efficiency. Give us a call at 479.452.9416 to find out how!

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