MIPS Value Pathways: What You Need to Know

New value pathways and interoperability changes reflect an emphasis on streamlining healthcare management

The Centers for Medicare & Medicaid Services (CMS) revealed some updates to its MIPS Value Pathways (MVPs) program as part of recently finalized rules for 2024. The program launched in 2023 and was designed to help un-silo and build alignment across performance category scores and reporting. As a result, the overall MVPs process may become less burdensome to manage and more relevant to specialty providers than initial MIPS processes and may support improved patient outcomes at lower costs.

Participation is optional through 2025 and requires registration and selection of one of 16 current value pathways, although the scope of pathways may change in the future.

Reporting requirements include the same four performance categories that MIPS has always included, plus a foundational layer of promoting interoperability and population health measures.

With MVPs, you’ll likely have fewer measures to report, and many are specialty-specific. For example, orthopedic providers can report to the Improving Care for Lower Extremity Joint Repair MVP. They have eight quality measures to choose from (they pick four) and at least one measure must be an outcome measure. They also have 12 available improvement activity measures to choose from (they can pick one high or two medium). CMS uses administrative claims data to calculate performance in the cost category.

Read on to get an overview of how MVPs may impact your practice and how you can prepare for the future of value-based care today.

What Are MIPS Value Pathways (MVPs)?

MIPS Value Pathways (MVPs) are an updated set of measures and activities that physicians and clinics can follow to satisfy MIPS reporting requirements.

The MVPs program includes a few key changes:

• The four MIPS performance categories — Quality, Cost, Promoting Interoperability and Improvement Activities — still apply
• Quality, Cost and Improvement Activities are scored at the MVP level, meaning your practice would choose measures from a CMS list related to your value pathway
• Promoting Interoperability remains specialty-agnostic
• Population health measures are also part of a foundational, specialty-agnostic layer. Practices may choose one measure to score
• Multispecialty groups may divide into subgroups, submitting population health and interoperability data at the group level and quality, cost and improvement activity data at the subgroup level

These changes are intended to contribute to a larger evolution in approach. Under MVPs, quality measures must be reported in relation to cost and improvement measures. This is designed to help ensure scoring represents a meaningful and cohesive picture of a clinic’s performance.

The Evolution of MIPS Values

MIPS was created to help shift incentives away from fee-for-service payment models and toward higher quality care at a lower cost.

Within the MVP framework, CMS intends to create tighter alignment between measures and activities for different specialties or conditions. By considering population health and interoperability as foundational to the evolution of healthcare, MVPs may be able to promote the objectives of the industry as a whole, while ensuring the differences in specialty-specific care don’t fall between the cracks.

The inclusion of technology solutions to achieve these ends helps build visibility and efficiencies in cost and care. The focus on specialty-specific priorities and workflows within our EMA^® EHR and gGastro^® EHR can further these efficiencies:

• Centralized patient records make it easier for patients, providers and third-party partners to access data when they need it
• Purpose-built workflows may speed documentation with fewer clicks and taps for providers, helping to support accuracy and return physician focus to the patient
• Automation helps perform many downstream tasks and helps to promote consistency of data across workflows

Practices that optimize solutions may also experience other benefits, like improved patient engagement, reduction of administrative burdens on clinic staff, and attracting new providers to your practice to support growth.

New Value Pathways

For the 2024 performance year, CMS added five new MVPs and modified all previously finalized MVPs. There are 16 MVPs available for voluntary reporting in 2024:

1. Focusing on Women’s Health
2. Quality Care for the Treatment of Ear, Nose, and Throat Disorders
3. Prevention and Treatment of Infectious Disorders Including Hepatitis C and HIV
4. Quality Care in Mental Health and Substance Use Disorders
5. Rehabilitative Support for Musculoskeletal Care
6. Adopting Best Practices and Promoting Patient Safety Within Emergency Medicine
7. Advancing Cancer Care
8. Advancing Care for Heart Disease
9. Advancing Rheumatology Patient Care
10. Coordinating Stroke Care to Promote Prevention and Cultivate Positive Outcomes
11. Improving Care for Lower Extremity Joint Repair
12. Optimal Care for Kidney Health
13. Optimal Care for Patients With Episodic Neurological Conditions
14. Patient Safety and Support of Positive Experiences With Anesthesia MVP
15. Supportive Care for Neurodegenerative Conditions MVP
16. Value in Primary Care MVP

If you’re interested in helping CMS shape the future state of MIPS, they have also created guidelines to develop candidates for new value pathways. These guidelines mirror the components of current MVPs.

Changes to Promoting Interoperability

CMS has issued a number of changes to the interoperability category. Updates for 2024 include the following:

• A 180-day minimum performance period for the Promoting Interoperability (PI) performance category (previously it was 90 days)
• The Query of Prescription Drug Monitoring Program (PDMP) measure has been additionally modified to include not only Schedule II opioids but Schedule III and IV drugs
• CMS finalized the rule to state that you can claim an exclusion to the PDMP only if you have not electronically prescribed any Schedule II opioids or Schedule III or IV drugs during the performance period
• A “yes” response is now required to fulfill the Safety Assurance Factors for EHR Resilience (SAFER) Guides measure in 2024

Are MIPS Value Pathways Required?

Eventually, MIPS Value Pathways will be required as part of the transition to value-based care standards. The transition will be gradual with MVPs remaining voluntary in 2024 and 2025. In 2026, any multispecialty groups that would like to report MVPs must report as subgroups.

This transition also represents the phasing out of the traditional MIPS program, which CMS plans to sunset sometime after 2026. Once the transition is complete, practices may experience another significant shift in how they collect, track and report their performance data.

Preparing for MIPS Value Pathways

Physicians who underwent the transition to MIPS processes may recognize the value of preparing for MVPs now. Any change in rules and reporting may present a challenge to your business and its bottom line. With advanced preparation, you may be able to mitigate the risks of transitioning to new value pathways and maintain continuity in your practice’s day-to-day operations.

In the 2024 performance period, ModMed^® will support the orthopedic and ENT MVP measures within our EMA EHR. As additional measures are finalized, our teams will assess them and make them available in EMA and gGastro EHRs, when appropriate.

If you need additional MIPS support, we encourage our clients to take advantage of our MIPS advisory programs. With our MIPS Advisory Services options for EMA and gGastro clients, you’ll get a MIPS Advisor who knows both your EHR and your practice. They’ll monitor your performance and work with you to achieve your goals.

We’d also like to encourage you to attend our upcoming MIPS webinars. If you’re a current client, you can check ModMed Communities for additional MIPS resources, and we’ll be sending new communications as more information becomes available.

Need help with MIPS? Check out our solutions for our EMA and gGastro clients.

This blog is intended for informational purposes only and does not constitute legal or medical advice. Please consult with your legal counsel and other qualified advisors to ensure compliance with applicable laws, regulations and standards.

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