The Merit-based Incentive Payment System (MIPS) has undergone significant changes for the 2023/2024 performance year, with one of the most notable adjustments being the increase in the cost performance category's weight to 30% of the total MIPS score. This change is part of a broader strategy by the Centers for Medicare & Medicaid Services (CMS) to emphasize cost management and efficient resource utilization within healthcare. Practice leaders need to understand these changes and adapt accordingly to maintain or improve their MIPS scores and ensure the financial stability of their independent practice.
The pressure of working within the confines of consolidated health systems and PE contracts is palpable for physicians. The drive towards efficiency and cost-effectiveness forces doctors to see more patients faster, compromising the quality of care and the physician-patient relationship.
In stark contrast, doctors who maintain independence in their practice report a markedly different experience. Independent specialty practices offer physicians a degree of autonomy that is increasingly rare in healthcare. This autonomy leads to higher job satisfaction, significantly lower rates of burnout, and a greater sense of fulfillment from their work. The ability to practice medicine according to one's values and priorities, without undue corporate pressure, is highly valued among these doctors. It not only boosts career satisfaction but also helps to maintain a healthier work-life balance, making the profession more sustainable in the long term.
CMS's decision to increase the cost category's weight aims to incentivize healthcare providers to focus more on cost efficiency. By doing so, practices are encouraged to adopt measures that reduce unnecessary spending while maintaining high-quality care. This aligns with the goals of the Medicare Access and CHIP Reauthorization Act (MACRA), which mandates a gradual increase in the cost performance category to eventually account for 30% of the total MIPS score.
One of the advantages of the cost performance category is that it does not require additional data submission from clinicians. Instead, CMS uses Medicare claims data to assess performance, simplifying the reporting process and reducing the administrative burden on practices. This approach ensures that cost measures are based on actual healthcare utilization and spending patterns, more accurately reflecting a practice's efficiency.
The updated scoring methodology for the cost category aligns more closely with the quality performance category. This change ensures that improvements in cost management are reflected similarly to improvements in care quality. By promoting a balanced approach to performance evaluation, CMS aims to foster an environment where both quality and cost efficiency are important.
By now, independent practices have familiarized themselves with the new requirements and measures within the cost performance category. This understanding will enable them to identify areas where they can improve cost efficiency and align their practices with CMS's expectations.
TRIARQ Health encourages practices to implement systems to monitor and manage costs effectively. This includes analyzing Medicare claims data to identify trends and areas for improvement. By proactively managing costs, practices can improve their performance in the cost category and avoid potential penalties.
Continuous improvement in both cost and quality measures is essential. We work with our customers to regularly review their performance data, seek opportunities for improvement, and implement best practices to enhance care delivery and cost efficiency.
Educating staff and clinicians about cost management and efficient resource utilization is critical. By fostering a culture of cost awareness, practices can ensure that everyone is in alignment to provide high-quality, cost-effective care.
Navigating the complexities of MIPS requires more than just understanding the updates; it requires a partner equipped with the expertise and tools to facilitate success. The team of MIPS experts at TRIARQ Health guides our customers through these changes. With our support, practices can confidently select the most suitable measures/reporting methods, optimize workflows, and achieve successful reporting outcomes.
To gain valuable insights and strategies from our experts, click here to watch the video. With TRIARQ Health by your side, you can confidently navigate the MIPS program and achieve your reporting objectives.