Evolution of Medicare’s Merit-Based Incentive Payment System: MIPS Value Pathways

PHILADELPHIA—As part of an ACR Convergence Expert Roundtable on Sunday, Nov. 13, William Harvey, MD, MSc, associate professor of medicine at Tufts University, Boston, and chief medical informatics officer at Tufts Medicine, Boston, discussed a new iteration of Medicare’s Merit-Based Incentive Payment System (MIPS), the MIPS Value Pathways (MVPs). He shared how and why rheumatologists may want to implement it next year, potentially using the ACR’s Rheumatology Informatics System for Effectiveness (RISE) registry.

Dr. Harvey

In 2017, the Centers for Medicare & Medicaid Services (CMS) introduced MIPS as a part of its Quality Payment Program. MIPS was created as a way to pay clinicians partly based on the quality of their services and not just under a strict fee-for-services model. Under this model, final reimbursement was partly dependent on how well participants had met certain prespecified goals.

MIPS Value Pathways

Beginning in 2023, physicians can opt to use MVPs rather than existing MIPS requirements to submit their information via MIPS.

MVPs were designed as an evolution of MIPS, Dr. Harvey explained. Using MVPs, clinicians can report on fewer measures and activities compared to those required by standard MIPS criteria. The idea is that reported measures would be more focused and meaningful in terms of specific specialties. MVPs were intended to “reduce complexity, remove clinician burden and foster a more cohesive patient experience,” Dr. Harvey reported. “That all sounds great, but as is often the case with the government, the devil is a bit in the details.”

This November, the CMS finalized the 12 different MVPs in which clinicians can opt to participate, including the rheumatology MVP. “We made a conscious decision at the ACR that, rather than have somebody else dictate what measures are going to be relevant to us, we worked to build our own MIPS value pathway,” Dr. Harvey said. “This MIPS pathway was designed by the ACR and is supported by a lot of the things the ACR does, such as the RISE registry.”

Reporting with MVPs

MVPs retain the same four MIPS categories of reporting: Quality, Improvement Activities, Promoting Interoperability and Cost. Each category contains multiple measures, and physicians can choose which they will report.

For example, to meet the Quality category, four different measures must be selected, including at least one outcome measure. Examples include: meeting serum urate targets for gout, performing disease activity measurement in patients with psoriatic arthritis and assessing functional status in rheumatoid arthritis. Dr. Harvey noted that the reporting system has some flexibility; for example, if a physician reports more than four different Quality measures, the CMS will use the best four when calculating reimbursement.