The modern healthcare atmosphere encourages the transition to a value-based care model. And for all MIPS participants, it’s been their paramount goal, as MIPS truly operates on this value-based care model. Throughout the MIPS reporting journey, providers perform different activities and measures. Later, CMS evaluates their performance and provides constructive feedback. Well, all this seems perfect at first glance, but there are stumbling blocks in the MIPS journey for providers. One of them is a lack of timely MIPS data.
In this blog, we will see how a lack of timely reporting creates hurdles for MIPS participants. Also, we see why it is important to have quick access to MIPS reporting data. What difference does it make in practicing value-based care and improving patient outcomes?
Issue: The Lack of Timely Access to MIPS Data
Let’s understand the issue hampering the doctor’s struggles first!
MIPS is a traditional reporting framework. Every year, eligible clinicians take part in the program, and the same is true for MIPS 2023. Despite all the changes in the MIPS 2023 final rule, some problems still require attention. Timely access to MIPS data is such an issue. It is causing obstacles to implementing value-based care systems in the healthcare system. This issue must have an appropriate solution; otherwise, MIPS 2023 will also take effect.
Congress, through the 2015 MACRA statute, explicitly recognized the pivotal role of data sharing with physicians. Therefore, it has mandated timely performance feedback for MIPS reporting. However, CMS has been sluggish in meeting this statutory obligation. So, it is impacting physicians’ ability to make informed decisions and improve patient care.
How Does Insufficient MIPS Data Hinder Doctors’ Value-based Care Efforts?
Timely access to accurate MIPS data is critical for healthcare providers and Medicare reimbursements. Unfortunately, this crucial information is not always readily available. So, failing to do so hampers their efforts to improve patient outcomes and reduce healthcare costs.
Here’s how the lack of timely MIPS data hobbles doctors’ pursuit of value-based care:
Incomplete Patient Information
The capacity to track patients’ health over time, spot problem areas, and offer preventative treatment is essential to value-based care. Doctors may lack thorough patient profiles if they do not have timely access to MIPS reporting data. Thus, it makes it difficult to provide tailored, patient-centered treatment.
Hindered Quality Measurement
One of the key MIPS components focuses on the quality of care provided. So, real-time data is required for physicians to analyze their performance. This helps in identifying areas for improvement. Thereby, physicians can make appropriate modifications to improve treatment quality. Anyhow, MIPS data that is insufficient or inaccurate may block these critical quality measures.
Slower Decision-Making
In value-based care, prompt decision-making is critical, especially when it comes to treating chronic illnesses and coordinating treatment across various providers. Without timely MIPS data, clinicians may struggle to make informed judgments. Thus, it could potentially result in delays in patient treatment and inadequate outcomes.
Missed Improvement Opportunities
MIPS reporting is more than analyzing current performance; it is also about constantly improving care delivery. Timely data is critical for spotting trends and gaps. Delayed information might lead to missed opportunities to improve care quality and save costs.
Increased Financial Risks
Value-based care models frequently include monetary incentives and penalties. MIPS scores have a direct influence on physicians’ Medicare reimbursements. Delays in getting MIPS data can lead to uncertainty regarding payment modifications. Thereby, it puts healthcare providers’ finances at risk.
Hindered Care Coordination
To achieve smooth patient care, value-based care necessitates excellent coordination among multiple healthcare providers. So, MIPS data collected on time matters for care coordination. It allows healthcare teams to share information and deliver integrated care.
AMA’s Objective: Fixing the Unsustainable Medicare Physician Payment System
The MIPS reporting program has a pronounced influence on the Medicare payments of physicians. However, lack of timely access to MIPS data has resulted in instability in Medicare physician payments. However, when there are problems, there are solutions too. That’s why CMS is trying to figure out a fine solution to resolve the issues in MIPS reporting.
In the past, AMA has pointed to a quick and applicable solution for fixing the issue. The AMA, therefore, emphasizes the importance of giving doctors access to timely information. It will serve the purpose of lowering costs for patients and the Medicare program in a variety of ways. For instance, it will provide opportunities for the following:
- Improving health outcomes
- Reducing variations in care delivery
- Eliminating avoidable services
This requirement for timely access to MIPS reporting data took effect in 2018 by AMA. AMA has provided a two-page explanation of MIPS data problems. Anyhow, the issue persists. The agency has never favored the idea of providing Medicare claims data to physicians.
AMA’s Action Plan
The US Medical Association (AMA) is encouraging Congress to adopt the following steps to address these issues:
- Instruct CMS to improve the timely availability of MIPS feedback reports and claims data by MACRA.
- Provide doctors who don’t get three or more quarterly MIPS feedback reports throughout the performance period a waiver from MIPS penalties.
Endnote
In conclusion, the lack of timely MIPS data poses a significant challenge to doctors striving to excel in value-based care. To overcome this hurdle, we need a combined approach. All healthcare organizations, technology vendors, and policymakers must work together. Only then can they ensure that physicians have access to the most current MIPS reporting data. Meanwhile, it would empower them to make data-driven decisions and enhance patient care. Ultimately, they could achieve the goals of value-based care more efficiently and effectively.
