MIPS is a quality payment program established by the Centers for Medicare and Medicaid Services (CMS) in the United States. It aims to promote high-quality and efficient healthcare services through financial incentives.
Under the MIPS program, eligible healthcare professionals, including orthopedic physicians, are evaluated based on four performance categories: Quality, Promoting Interoperability, Improvement Activities, and Cost. Let's briefly explain each category:
Quality: This category assesses the quality of care provided by physicians. It involves reporting on various measures related to patient outcomes, care coordination, and patient safety. Physicians need to choose measures that align with their practice and report data to CMS. Orthopedists have the option to report for measures specific to their specialty.
Promoting Interoperability: This category focuses on the use of certified electronic health record (EHR) technology and the exchange of health information. Physicians need to demonstrate their effective utilization of EHR systems, patient engagement through online portals, electronic prescribing, and other interoperability measures.
Improvement Activities: This category evaluates physicians' participation in activities that improve patient care and practice processes. It encourages activities such as care coordination, patient engagement, population health management, and implementing evidence-based guidelines.
Cost: The cost category measures the total cost of care provided by physicians. CMS calculates cost measures based on Medicare claims data without requiring physicians to submit additional data. This category assesses the efficiency and resource utilization of healthcare services.
Participating in MIPS not only helps improve the quality of care but also provides financial incentives for orthopedic surgeons who meet or exceed performance standards. Based on performance in these categories, physicians receive a composite performance score (CPS) that determines their payment adjustment. The CPS is calculated using a scale of 0 to 100, with higher scores indicating better performance. The payment adjustment can result in positive, neutral, or negative payment changes for physicians.
It's important to note that MIPS requirements and measures may change over time, as CMS regularly updates the program. Physicians should stay informed about the latest MIPS guidelines and reporting requirements to ensure compliance and maximize their performance scores
Orthopedic practices that are working on their MIPS scores may find integrating Always Health to improve their scores. By focusing on shared decision-making and the patient experience, Always Health positivity affects performance on a handful of quality measures as well as improvement activities. If you are looking for ways to better explain surgeries such as Total Knee or Hip Replacement, consider adding Always Health to your toolkit of patient education options.
