Part 1 – Top 5 MIPS Issues for Specialty Clinicians

May 4th, 2017 by

As knowledge and impacts of MIPS continue to expand among organizations during this first performance year, specialty clinicians are increasingly realizing and sharing their thoughts and concerns about the program. In this five-part blog series, I will look at the top five common issues facing specialty clinicians.

Five common issues have emerged:

  1. My specialty’s needs are not being fully addressed by my multi-specialty organization’s MIPS execution plan.
  2. What is the most suitable Quality reporting method?
  3. How do I choose the best Quality measures for my specialty?
  4. How do I prepare for the MIPS cost measures coming in 2018?
  5. What, if any, Advanced APMs should I consider participating in so as to get out of MIPS?

In this blog, I will address the first issue and dive into how the previous one-size-fits-all program plans are not suitable for specialty clinicians trying to maximize their MIPS performance.

1. My specialty’s needs are not being fully addressed by my multi-specialty organization’s MIPS execution plan.

Under the legacy Medicare Meaningful Use (MU) and PQRS programs, multi-specialty organizations were generally able to meet the diverse needs of different specialty clinicians using a single, specialty-agnostic program plan.  For example, the all-or-nothing nature of MU compliance meant that once all clinicians were performing above fixed measure thresholds, then no additional improvement was needed for every clinician to be fully compliant. In addition, electronic clinical quality measures (eCQMs) reported for MU were strictly pay-for-reporting, without competitive performance ratings.  PQRS was a pay-for-reporting program where simply submitting at least the minimum quantity of quality data would yield full compliance. A key consequence of these facts is that multi-specialty organizations’ MU and PQRS execution plans were able to be largely agnostic to specialty and still be effective for and accepted by specialty clinicians.

Under MIPS, the situation has changed greatly, as MIPS introduces a competitive scoring system where every tenth of a point translates into proportional financial and reputational impacts.  There will emerge clear winners and losers.  As more specialty clinicians learn about how MIPS actually works, they are increasingly vocalizing to their organizations’ leaders that one-size-fits-all program plans may need specialty-specific customizations in order to properly engage and support specialists towards optimizing their MIPS performance. 

MIPS is changing the game especially for specialty clinicians.  Since MIPS will have a significant financial and reputational impact, it is important to create a plan geared towards optimizing a specialty clinician’s performance. In the rest of the blog series, I will explore some of the related underlying issues.

You can access the rest of the blog series below:


Tom S. Lee
Founder and CEO

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