Compliance Series: Guide to MIPS Excellence in 2024 for Emergency Medicine Clinicians

By: Asya Handel, Director of Client Success

In 2024, Emergency Medicine clinicians are determined to not only meet the clinical performance goals but also maximize their potential for higher payment incentives. MIPS, as a significant component of the Quality Payment Program (QPP), continues to adjust and evolve, making it crucial for physicians, physician assistants, nurse practitioners, and clinical nurse specialists in emergency department settings to stay informed and proactive.

Understanding MIPS: A Brief Overview

It is essential to have a firm grasp of what MIPS entails. MIPS is designed to tie payments to quality and cost-efficient care, drive improvement in care processes and health outcomes, increase the use of healthcare information, and reduce the cost of care. As a composite performance score, it’s based on four performance categories:

  • Quality
  • Cost
  • Promoting Interoperability
  • Improvement Activities

Key Approaches for Emergency Medicine Clinicians

Having relied on the COVID-19 Extreme and Uncontrollable Circumstances Exemptions since 2019, many clinicians and clinician groups may not be adequately prepared for the high stakes of MIPS 2024. It is vital to understand that 2024 promises to be the first year since the launch of the MIPS program in 2017 that MIPS will fully function as intended.

Stay Current with MIPS Changes

First, stay updated with the changes for the 2024 MIPS performance year. This includes understanding the performance thresholds, any alterations to measures, reweighting of categories, updates to the scoring methodology and bonus structures, and what constitutes optimal performance. Staying aligned with these changes can help in prioritizing efforts throughout the year. The general approach involves staying informed, being adaptable, and focusing on areas within MIPS that you can optimize for better performance.

Optimize Quality Measures Reporting

Quality measures are the core of the MIPS program and Emergency Medicine clinicians should focus on those that align well with Emergency Medicine and best reflect your practice. In partnership with your dedicated Ventra Health MIPS experts, understand the benchmarks for each measure, strive to perform above the national average, and focus on the measures that not only fit the acute care environment in the Emergency Department but also have benchmarks that are achievable and prioritize high-performance measures that are likely to score higher. Promote full participation: report on as many relevel measures as possible to maximize the potential score.

Do not ignore Cost Metrics and Population Health Measures

Considering that all-encompassing Extreme and Uncontrollable Circumstances Exemptions are unlikely to be applicable in the 2024 performance year, the cost category could potentially have a higher impact on your total MIPS score. A new episode-based measure that is more relevant to Emergency Medicine added in 2024 may also make it harder to achieve a higher MIPS score, especially because of a certain level of ambiguity in how CMS scores cost and population health measures “in the background,” based on administrative claims. Understanding the measures that are being attributed to you or your group and implementing strategies to provide cost-effective care without compromising quality is vital. This could include adjustments in ordering practices, especially for diagnostics, and ensuring proper patient routing.

Embrace the Idea of Reporting Promoting Interoperability (PI) Data

Most Emergency Medicine clinicians and groups qualify for automatic reweighing of the PI category toward other MIPS categories, and yet seamless data exchange is vital for both patient care and quality outcomes. To excel in the Promoting Interoperability category, make sure that the Emergency Department’s electronic health record (EHR) system is up-to-date and fully utilized; ensure all staff members are trained in EHR utilization. Engage with IT specialists to improve EHR workflows that support the exchange of health information and patient engagement and to facilitate PI data collection.

Engage in Relevant Improvement Activities

Improvement activities offer an opportunity to earn points by implementing care models that suit Emergency Medicine. Select improvement activities that naturally fit into the Emergency Department’s workflow and can be implemented effectively; focus on activities that address care coordination, patient safety, and engagement, or measures that reduce hospital readmission rates. Be sure to document all efforts properly to receive full credit for your improvement activities.

Train and Involve Your Team

A well-informed and motivated team is critical for a successful MIPS strategy. Ensure that all members of the Emergency Department, from administrative staff to clinicians, understand the importance of their role in the MIPS performance, best practices, and outcomes. Foster a practice-wide culture focused on MIPS awareness, quality improvement, and patient-centered care.

Use Data to Drive Improvements

Data analytics is a powerful tool in the MIPS arena. Regularly review Ventra Health performance reports along with your MIPS registry dashboards, if available, to identify trends and areas of improvement. Use this data to make documentation adjustments and EHR template modifications to ensure that the practice is continuously aligned with MIPS objectives.

Take advantage of Ventra Health MIPS Expertise

The complexity of MIPS warrants leaning on the extensive MIPS expertise of your Revenue Cycle Management partner to help tailor a plan for your specific practice, analyze data, and suggest effective strategies. Ventra has extensive MIPS expertise across multiple specialties.

Aiming for MIPS Success in 2024

MIPS may present a challenge, but it is also an opportunity to refine the provision of emergency care and demonstrate value. By focusing on the areas that have the greatest impact on the MIPS final score—quality, cost, interoperability, and improvement activities—Emergency Medicine clinicians can not only achieve success in MIPS but also drive positive patient outcomes.

Remember, the end goal of participating in MIPS is not just to avoid a penalty but to position your emergency department as a leader in high-quality, cost-effective care. By implementing these strategies, Emergency Medicine clinicians can ensure their practice not only meets but exceeds the expectations set forth by the MIPS program in 2024.

As you embark on this journey, keep your MIPS goals aligned with your overarching mission to provide the best emergency care possible. Good luck, and here is to a prosperous year in both patient care and MIPS performance!

What’s Next and How Ventra Health Can Help

Ventra Health takes compliance very seriously. The guidelines put forth by various regulating bodies, while sometimes complicated or inconvenient, are critical to follow closely. Our Provider Education team has launched this Compliance Blog Series to help you navigate the complexities of compliance and coding changes. In case you missed it, check out our other posts in the series.

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Journey to 2024 MIPS Success: Strategies for Effective Participation in the CMS Quality Payment Program (QPP)

The Merit-based Incentive Payment System (MIPS) is one way to participate in CMS’ Quality Payment Program. CMS currently supports two types of MIPS reporting—Traditional MIPS and MVP (MIPS Value Pathways). If you’re not sure where to start, check out these strategies to achieve MIPS success in 2024.

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