Innovative Strategies and Technologies Streamline MIPS Participation

Over the past decade and a half, CMS introduced various performance-based payment models that transformed into today’s Merit-based Incentive Payment System (MIPS). Under MIPS, clinicians receive payments based on a composite score across 4 categories—quality, cost, promoting interoperability, and improvement activities. After 7 years of working within the MIPS framework, CMS determined it is not operating as originally intended, as clinicians often report on measures that are the easiest to report and provide the most points, even if they are not specific to their area of specialty. Consequently, CMS is transitioning to a new version of the program, MIPS Value Pathways (MVPs),¹ which requires reporting on set measures that target specific areas of specialty care or health conditions to enable more meaningful participation in the MIPS program.

Like each new program, MVPs have generated a fair amount of confusion and a costly learning curve, potentially making participation burdensome for providers while taking their focus away from patient care. Fortunately, there are solutions that enable practices to successfully meet the challenges MIPS and new MVP reporting options present. The US Oncology Network (The Network), a network of independent, physician-owned community-based practices supported by McKesson, is utilizing a variety of strategies and technologies that are worth a closer look, as they simplify the complexities created by these programs while empowering practices to keep patient care their top priority.

Overcoming the Challenges of MIPS Participation

As CMS moves to MVPs, it has established a transitional MIPS phase to shift reporting toward more specialty-specific measures over multiple years. In this interim, CMS is allowing a large menu of confusing reporting approaches, creating daunting challenges for practices. Practices are struggling to identify which reporting mechanism will be the most beneficial from a performance standpoint, which distracts them from maintaining focus on the underlying tenets of the program—to provide enhanced, optimal patient care. Once practices have selected what they consider to be their best reporting option, they may still face difficulties meeting reporting requirements.

The Network and McKesson have developed a variety of solutions enabling practices to successfully overcome the challenges MIPS creates. These strategies allow practices to keep the focus on patient care while navigating the program requirements and ensuring successful participation:

Value-based Care (VBC) transformation leads provide guidance to practices.

Transformation leads are McKesson subject matter experts in VBC, oncology, and oncology business management who have a deep understanding of regulatory and commercial managed care VBC programs. These professionals provide specific, targeted advice and guidance to practices based on the practices’ profiles.

Team members have different strengths and expertise covering critical areas of VBC, such as patient experience, analytics, social needs and equity, education, and change management. Together, they create a constructive collaboration that enables practices to meet program requirements while staying focused on patients vs the administrative side of the programs.

A robust suite of technology solutions positions practices for success.

By leveraging health care technology, the administrative and technical burdens created by the MIPS program can be minimized and streamlined. Having an oncology-specific electronic health record (EHR) is critical for collecting the clinical content needed for reporting quality and specialty-specific measures. Having that information integrated directly into a reporting platform is a tremendous advantage, as it allows practices to see in real time how they are performing in various areas without additional manual data entry.

A reporting platform not only shows quality measure performance, but also provides specific tools that enable practices to see where there are gaps in patient care. A prime example is how reporting can enable improved patient surveillance, which is leading to better pain management. In the MIPS program, there are several pain measures, such as whether the care team asked the patient about his or her pain level, and then whether a plan of care for pain is documented in the medical record. With Practice Insights, a reporting platform by McKesson’s oncology technology business Ontada, a Pain Worklist Report is created that shows all patients seen that week who had an elevated pain score of 7 or above on a 10-point scale. This identifies patients who need follow-up to see whether they are still having pain issues. Outreach such as this is vital, as it will find those patients who should be recalled to the practice so other pain strategies can be offered or alternative interventions proposed. Lack of pain management not only impacts a patient’s quality of life, but there is evidence that pain is a significant contributor to avoidable hospitalizations.² Historic emphasis has been placed on documenting pain levels; however, it is imperative to address pain management to improve a patient’s quality of life. Assessing pain improvement as a key quality measure, or outcome, is critical to assessing the patient experience in overall cancer care.

Leveraging Practice Insights as a Qualified Clinical Data Registry (QCDR) streamlines MIPS data submission for MIPS program participation.

The Practice Insights reporting platform is a CMS-approved QCDR that enables direct submission of data to CMS for MIPS participation. This streamlines the reporting process, so practices do not need to extract their data from their EHR or engage a third-party vendor to submit data to CMS. With Practice Insights, the reporting and data submission capabilities are integrated, so anything documented in the medical record can be pulled for quality measure calculations and submitted to CMS on behalf of the practice.

Clinical data elements from the patient record within the EHR are leveraged to compute quality measures that are specific to the care provided by the clinician. For instance, performance trends can be viewed for cancer-specific quality measures such as the percentage of patients with stage IV non–small cell lung cancer who received biomarker testing along with appropriate targeted therapies based on their test results. Another example is a quality measure to determine the percentage of patients who have had their pain levels improved within 30 days, enabling clinicians to know whether they are truly impacting a patient’s pain management. With a QCDR, clinicians can develop novel, cancer-specific quality measures that not only improve patient care but can also be used as part of the MIPS program for more meaningful participation.

A dedicated VBC educator works with practices to demystify the MIPS program requirements.

A lead educator from McKesson provides simplified explanations, resource “tool kits,” and frequently asked questions documents on the MIPS program and other VBC models, simplifying content so practices can easily understand the programs. Webinars, newsletters, and other outreach activities are regularly employed to keep practices informed as VBC evolves with new requirements and program changes. Regulatory programs constantly change, and having a dedicated expert to translate updates into actionable steps is key to practice success.

A Good Start on a Long Journey

Although significant progress has been made, there is a long way to go before there is a robust VBC program through MIPS that will be meaningful and linked to improved patient care. As MIPS transitions to require reporting the new MVPs, McKesson and The US Oncology Network will continue doing their part, helping to move things forward through a combination of expertise, industry thought leadership, and innovative technologies. All stakeholders should commit to streamlining MIPS participation so practices can continue to focus on what matters most—improving patient care. 

Author Information

Erin Crum, MPH, is director, quality portfolio strategy, McKesson and The US Oncology Network.

References

1. MIPS Value Pathways (MVPs). Quality Payment Program. Accessed November 5, 2023. https://qpp.cms.gov/mips/mips-value-pathways
2. Alishahi Tabriz A, Turner K, Hong YR, Gheytasvand S, Powers BD, Elston Lafata J. Trends and characteristics of potentially preventable emergency department visits among patients with cancer in the US. JAMA Netw Open. 2023;6(1):e2250423. doi:10.1001/jamanetworkopen.2022.50423