The Centers for Medicare and Medicaid Services (CMS) introduced the MIPS Value Pathways (MVPs) as part of its ongoing revisions to the Merit-Based Incentive Payment System (MIPS) program, which was established in 2017 to encourage ongoing and consistent quality, efficiency, and improvement in medical practices. The MVP framework was designed to ease the burden imposed on clinicians and their administrators who participate in the MIPS program. Traditionally, MIPS scores have been calculated based on the evaluation of four factors: Quality, Cost, Interoperability, and Improvement.1
However, CMS recently recognized that the program was not working as originally intended as clinicians were reporting on the measures that awarded the most points, rather than those that might be more relevant to their specialty. Thus, MVPs have been developed based on individual specialties or specific conditions to better reflect progress in different practices so that specialty practices like oncology, for example, will be able to focus on the aspects of care that matter most to their patients, rather than what matters most for their scores. The new program is also designed to simplify and streamline reporting measures and performance feedback with the goal of reducing the administrative burden of participating in the MIPS program.2
But of course, with the implementation of a new system comes a steep learning curve and need for sophisticated technology solutions that could potentially undermine these goals in the short term, as practices try to adapt to new requirements and measures. Clinicians who have participated in MIPS since its inception have spent years adapting to its methodologies. MVPs are being implemented with a transitional period where the traditional reporting methods from MIPS can still be applied, but these methods will eventually be phased out in favor of the newer MVPs.2 Thus, this system will require oncologists to learn new sets of requirements and reporting measures, which despite best intentions, could pose a significant administrative burden on their practices. Moreover, participation in MVPs relies on additional technology support by EHR and registry vendors, which is often delayed until CMS mandates that these vendors comply with specific requirements to enable new features, functionality, and MVP-specific measures.
To promote a smooth transition to MVPs, expertise and innovation are required. With the help of expert-based provider organizations, like The US Oncology Network, and integrated technologies, it is possible to streamlinethe adoption of these new processes and reduce the burden of these programs.
Technological solutions to streamline processes
Within oncology practices, specialty-specific electronic health records (EHRs) can be highly beneficial to streamline MVP reporting. This is due to the ability of these types of EHRs to capture complex, specialty-specific clinical data used to compute quality measures that are meaningful to specialists and integrate that directly into a quality reporting platform. This eliminates the need for manual data abstraction, chart reviews, or other custom data extracts that are often time consuming and error prone.
Additionally, practices achieve the greatest benefit when these specialty-specific EHRs are integrated with a qualified clinical data registry (QCDR). Instead of being restricted to broad-based, traditional MIPS quality measures that cater more towards preventive care, QCDRs can develop specialty-specific quality measures to monitor patient care and services that are relevant to specialty providers. QCDRs that integrate EHR data can offer real-time analysis to rapidly identify gaps in patient care and adjust workflows to optimize care.
In addition to the benefits to improving patient care, QCDRs support direct reporting to CMS for MIPS participation. This eliminates the administrative task of extracting data from the EHRs to submit to CMS, or hiring third parties to perform those same tasks, once again reducing administrative burden for a program intended to focus on quality care improvements for the patient. As a result, not only do patients receive improved care, but practices benefit from leveraging specialty-focused QCDR quality measures to enhance overall performance associated with the MIPS program and MVP measure sets for more meaningful participation.
Qualified experts enhance new program implementation and capture technology needs
Expert-based provider organizations are excellent sources for dedicated professionals with proficiency in navigating novel MVPs and harnessing the full potential of emerging technologies. For example, Value-Based Care (VBC) Transformation Leads are subject matter experts in oncology and business management with substantial knowledge of regulatory and commercial managed care programs. Working side by side with clinicians and administrative staff, they give specific, targeted advice and guidance based on the profiles of individual practices to optimize efficiency and the transition to a new reporting system.
Similarly, dedicated VBC Educators equipped with toolkits and resources for explaining MVPs help simplify otherwise complex processes, like how to apply the overlapping implementation of MVPs while classic MIPS reporting is still in use. These professionals dedicate their time to staying apprised of the ever-changing regulatory programs and updating oncology practices with regular webinars, newsletters, and other forms of outreach that translate changes into actionable steps relevant to their specialty. In short, VBC Educators serve as expert liaisons for evolving regulatory programs to help practices adapt quickly and efficiently, thus maximizing their potential.
Lastly, VBC Practice Experience Leads serve to “connect the dots” between technology development and the practice end user to define gaps in reporting tools and technology needs based on the complexities of value-based care programs. These highly specialized experts work directly with the care team to understand workflow to ensure that technology is built to optimize care and to complement existing processes, avoiding unnecessary clicks or extra steps.
A focus on what matters
At the heart of regulatory programs like MIPS and MVPs, as well as specialty practices, is the goal of optimizing patient care. Providing the best VBC for each individual patient is what every medical professional aspires to, but there is a balance between actual practices and accountability where bureaucracy can appear to interfere. Tactical integration of practical technologies and dedicated expertise can help clinicians streamline the implementation of new programs. This can reduce the challenges of implementing these programs and instead help realize the most promising aspects of reducing the administrative burden of reporting practices and letting clinicians focus on the most important part of their practice: patient care.
About Erin Crum, MPH
As the Senior Director of Quality Strategy & Innovation with The US Oncology Network and McKesson, Erin creates alignment and a shared vision across McKesson business sectors to support advancements in value-based care models, transformational quality programs, and oncology payment arrangements. She oversees McKesson’s quality measurement strategy, in addition to technology development priorities, that are meaningful and impactful to optimizing patient care for community-based oncology practices. In collaboration with The US Oncology Network, Erin spearheaded the development of McKesson’s Practice Insights Qualified Clinical Data Registry (QCDR) and custom oncology-specific quality measures.
References
1. Traditional MIPS Overview. Accessed April 9, 2024.https://qpp.cms.gov/mips/traditional-mips
2. Learn About MVP Reporting Option. Accessed March 7, 2024. https://qpp.cms.gov/mips/mvps/learn-about-mvp-reporting-option