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MIPS Kicks Up More Headwinds for Practices

The new year brings new challenges for many community oncology practices.

With the sunset of the Oncology Care Model in 2022 and the expiration of the Public Health Emergency in May 2023, many practices have become subject to full participation in the Centers for Medicare and Medicaid’s (CMS) Merit-Based Incentive Payment System (MIPS) for the first time in almost seven years. And even though CMS has maintained the 75-point MIPS performance threshold (needed to avoid penalty) for next year instead of moving it to 82 points as was initially proposed, practices that do not possess sufficient expertise, sophisticated I.T. and data analytics capabilities are likely to find it more challenging to comply with reporting MIPS measures going forward.

At OneOncology, our platform approach rooted in a combination of analytics, tech, and optimized best practices, is designed to help our practices navigate their MIPS re-entry to succeed in performance and find themselves on the bonus side of the MIPS ledger. Our team doesn’t just help practices avoid penalties, but rather our expertise can turn MIPS reporting into bonus Medicare payments by highlighting areas where practices are performing well.  

Below are three major changes practices should expect in MIPS for the 2024 reporting year:

Payment Adjustment: Advanced payment model (APM) participants will no longer receive an automatic payment adjustment unless they meet Qualified Participant (QP) threshold. This is unlikely under the new EOM model due to reduced patient eligibility. APM practices’ meeting the QP threshold will see a reduction to their payment adjustment from 5% to 3.5% in 2023, and in 2024 it will be the conversion factor for anyone with QP status.

Promoting Interoperability: CMS increased from 90 days to 180 days the time horizon for practices to report on the promoting interoperability category. Previously many physicians could be excluded from a measurement around direct messaging of outbound referrals, but with a longer measurement period, more physicians may be required to use this as a quality metric. 

MIPS Value Pathways: While voluntary for 2024, CMS is transitioning traditional MIPS methodology to the new MIPS value pathways (MVP). This introduces an additional layer of complexity to understand the impact of measure-level increased weightings in MVP and to determine the most favorable reporting options. In 2026, multi-specialty practices reporting the MVP option will be required to track and report on quality measures specific to each specialty, increasing the total number of measures reported on and potentially requiring new measure implementations for the practice.

Continued downward pressure on drug margins, increased hospital and payer consolidation, and sustained reimbursement cuts are all ominous headwinds for practices. Adding MIPS requirements only increases the challenges practices must confront. OneOncology is providing the expertise, analytics and technology solutions to confront these headwinds and help practices continue to thrive.

OneOncology’s MIPS Solution

OneOncology’s dedicated MIPS team has built a comprehensive toolkit allowing us to pinpoint a practice’s specific MIPS failure points. Instead of wondering why a patient is failing a specific measure, our team leads supports OneOncology’s partner practices to exactly where in the EMR a practice is missing data required to close the gap and surface potential open gaps. Our experts and technology infrastructure help practices accurately capture data for the work already completed, which removes any guesswork.

With an expert team and comprehensive toolkit, OneOncology supports and reports on all available measures to ensure a practice achieves their best and most optimized score. Our strategy is to transition towards the most meaningful quality measure improvements while also preserving community oncology practice revenue in the process.