Is the Merit-Based Incentive Payment System Successful?

Several studies show that the Merit-Based Incentive Payment System (MIPS) is not as successful as CMS had hoped in achieving its goals of accurately measuring and improving the quality of ambulatory care nationwide. CMS is now introducing alternative reporting frameworks, such as MIPS Value Pathways (MVPs), that are expected to replace MIPS moving forward.

The original goal of the MIPS program

MIPS was created under the Medicare Access and CHIP Reauthorization Act of 2015 and officially launched in 2017.

The program was created to shift the focus of ambulatory care in the United States away from volume-based care and towards value-based care. To do so, it provides clinicians with financial incentives for delivering high quality, cost-efficient care and improved patient outcomes as assessed by the program’s many performance measures.

MIPS scores are also publicly reported on CMS’s Care Compare site, further incentivizing clinicians to improve the quality of their care in order to protect their practice’s image and reputation.

Are MIPS scores an accurate reflection of care?

One of the primary concerns about the MIPS program is that its scores may not accurately reflect the quality of a provider’s care.

A 2022 study published by the American Medical Association evaluated the MIPS scores of more than 80,000 primary care providers and found overwhelmingly that the scores were not a reliable indicator of a physician’s clinical performance. The study attributed this largely to MIPS’ failure to adequately risk adjust for small, independent practices and those that care for more complex and socially vulnerable patient populations.

The administrative burdens of MIPS

Another concern about the MIPS program is that it can create a heavy financial and administrative burden on an industry that is already struggling with provider and staffing shortages, cost-cutting, and limited patient/provider time.

In 2021, the AMA published a study of 30 practices across the U.S. and found that MIPS compliance costs a practice $12,800 per physician each year. The same study showed that physicians spend 53 hours per year on MIPS-related tasks — essentially a week and a half of missed opportunities for patient appointments.

MIPS lacks a specialty care focus

Many critics of MIPS have also pointed out that nearly all of its measures and requirements fall on the shoulders of primary care providers and fail to hold specialty care providers accountable.

CMS is already working to remedy this with the introduction of the aforementioned MIPS Value Pathways (MVPs) framework. The MVP framework is organized by specialty and contains measures relevant to that specialty group.

CMS’s vision is to move everyone (except ACOs) to the MVP reporting framework and officially retire the traditional MIPS program. It has been hinted that this transition could happen as soon as 2029. Practices are highly encouraged to begin preparing for this shift now. To learn more, please read our guide to getting started with MIPS Value Pathways.

Get a head start on your MVP program

Don’t wait for CMS to sunset MIPS. Get ahead of the curve on the MVP framework with Medisolv’s MVP Reporting Package. It’s the industry’s only start-to-finish solution that includes specialty measure sets and sub-TIN reporting. It can even be paired with our MIPS Reporting Package for the complete QPP package. Contact us to learn more and schedule a demo.