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MIPS Value Pathways: A Worthy Effort, but More Cost Measures Needed for Success

In Health Affairs blog, VSSL team member Dr. Joshua Liao and VSSL Policy and Care Delivery Immersive participant Sophie Miller wrote an article about a key forthcoming change to Medicare's Merit-based Incentive Payment System (MIPS) program: MIPS Value Pathways.


Dr. Liao and colleagues write that MIPS Value Pathways represent a new "framework that CMS intends to use to modify its approach of engaging and evaluating MIPS clinicians." They highlight guiding principles for these pathways:

  • support Medicare’s overall emphasis on reducing clinician burden

  • support timelier, actionable data feedback that enables clinicians to improve care delivery and maximize their performance in MIPS

  • help reduce barriers to provider participation in alternative payment models (APMs) by prioritizing quality measures that align with improvement activities and cost measures

However, as Dr. Liao and colleagues point out, "while alignment across MIPS domains is a worthwhile goal, achieving it could be hampered by the overall lack of applicable cost measures."


"While alignment across MIPS domains is a worthwhile goal, achieving it could be hampered by the overall lack of applicable cost measures."

They expand on this point by writing that "to date, MIPS has evaluated clinician cost using total per capita cost (TPCC) and Medicare spending per beneficiary (MSBP), two measures that capture global spending and are limited in providing clinically relevant, episode-specific spending information" highlighting the contrast of using two measures for cost performance but a multitude of measures for quality performance.


The solution Dr. Liao and colleagues propose is "to prioritize the field testing, development, and scaling up of a wide range of episode-based cost measures that are applicable to clinicians from different specialties." Read more from the full article here.


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