Latest / Off the Chart: A Business of Medicine Podcast / S1 Ep134: MIPS update, with 'MIPS Geek Guru' Holly Black of Sightview
Transcript
- 0:00 You hear the old saying, it takes a village to raise a child Well, I tell my clients, it takes a village to do well in MIPS, welcome 0:18 to off the chart of business and medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. My name is Austin Luttrell. I'm the associate editor of medical economics, and I'd like to thank you for joining us today. In today's episode, I sat down with Holly Black, Project Manager for regulatory affairs and compliance at Site view software. Holly and I talk about what's actually changed for MIPS in 2026 what practices can still do right now to protect their Medicare revenue before the year gets away from them, and why MIPS is never really a one person job. Holly Black, thank you again for joining us, and now let's get into the episode. Holly Black, thank you for joining us 0:59 today. Oh, thank you for having me for 1:01 physicians who haven't really had time to dig into, you know, the entire rule text and every MIPS update for this year. Could you kind of walk through the most important MIPS changes for for 2026 and are there particular areas that you're seeing practices struggle so far over the first couple of months? 1:19 Sure, I'm going to kind of break it down by category. I think that's usually the easiest. So for the quality category, there are some new measures there, but nothing major. The biggest thing is for large practices, which are practices of 16 physicians or more, they have removed the three point scoring floor. So that is a huge impact to your large practices, because they potentially will get less points if they don't meet that 75% data completeness criteria before they get a minimum of three points. But that is no longer true for your large practices, small practices still get it though for your for the PI category, the biggest change there is that the security risk analysis, which is a requirement for that category before you could always just attach that yes, You completed a security risk assessment for your EHR product. However, starting this year, not only do you have to report that you completed that assessment, but you must have a plan of action documented and in place for any issues that are found. So it's not just a yes or no answer anymore struggles, what I often see is the practices don't pay attention to the quality measures that are topped out and and that, of course, gives them a lower performance score. So they need to focus on those measures that are topped out, avoid them if they can, and be careful of measures with very, very high benchmarks as well, even if they're not topped out. When you have those high benchmarks, you pretty much need 100% performance in order to get a significant amount of points. So it's things that practices often don't take the time to look at that all cost them in the end. And then again, just being aware of the documentation requirements for the safer guides, which is part of the PI category as well. Safer guides recently had an update last year, so practices need to be aware to use that 2025 safer guide version instead of the previous 2016 version. 3:40 So we're already a couple of months into 2026 here. Could you talk about kind of two or three adjustments that practices could still make now for the rest of the year, so they're not kind of scrambling when we reach the end of the year? Yeah. 3:52 Well, the good news is, at this time of the year is still early enough that you can make changes that are going to have a significant impact. And the biggest thing I try to recommend to my clients is create a MIPS team. You know, you hear the old saying, it takes a village to raise a child. Well, I tell my clients, it takes a village to do well in MIPS, you know, create that team. Have your point person to look at your rules and stuff, and then get your team involved. Let you know, help them understand the importance of doing those workflows and what it's going to mean, not only to the practice, but how it all trickles down to them. It really makes a difference in getting the team engaged and not leaving it on completely one person. And then the other big changes is run your reports. Run your internal reports, check and see how you're doing, even if you don't have the time to do it on a monthly basis, even just doing it quarterly, will make a huge difference, and will prevent all that stress and scrambling at the end of the year to try to correct mistakes that have been made all year long. Plus, if you're doing it throughout the year. Then your team gets in the habit of knowing what to do, and then you don't have those corrections to make at the end of the year. So it just makes makes life easier for everybody, and just take a few minutes to know your key dates and deadlines. For instance, very common. A lot of practices will use a registry for their MIPS reporting. Those registries have mapping deadlines, so you can, if you see a discrepancy in how they're mapping the data from your EHR, you can reach out to them and request the measure to be remapped. But there's a deadline, and it's usually September 30, so know those key deadlines so that you don't miss them. Same like with your MIPS attestation and stuff like that. Like right now we're in the window for MIPS attestation for 2025 that ends March 31 you want to make sure you get everything done, get that completed before that March 31 deadline, or you can't report. 5:58 CMS has been pushing MIPS value pathways, or MVPs as the future of the program as of 2026 How is that actually playing out, and what does that mean for specialists, compared with maybe staying in traditional MIPS? 6:10 So the MVPs are as of this year, you actually can option, may have the option to do opt in from it for MVP reporting and what they're doing for practices right now, if you opt in and report both your traditional MIPS and the MVP, then CMS will take the higher of the two performing scores, and that will be what your performance score will be based off of. So now is the time to start looking at that and maybe opting in to see how you do get ready for it. They haven't set a finalized date yet, but they are looking at MVPs becoming mandatory, possibly as soon as 2029 so you know, while it's optional, while you don't have to report it, you know might be a good idea to look at. And many registries offer both the traditional MIPS and an MVP dashboard, so you can look at both and know you know what you want to do with that. As far as specialties are concerned, the good thing about the MVPs is they are geared towards a specific specialty, MVP. They just added six new specialty measure sets this year for diagnostic radiology, interventional radiology, neuropsychology, pathology, podiatry and vascular surgery. Those are your six new ones. But there's many, many more. The good thing is that with the MVPs for quality measures, you're only required to report on four instead of six measures, and those measures are specific to your particular specialty, so it is helpful in that regard. Where it can become difficult is your sub specialties. For instance, if you like, in ophthalmology, we have some sub specialties in ocular plastics, and there's not a ophthalmology ocular plastics, MVP, so it's very difficult for someone in that subspecialty to find those four measures specific to their specialty. So when you get into those very, very, very specialized practice, you could have some difficulty with MVPs in that respect. 8:36 So I guess, yeah, continuing on specialty reporting and how it's evolving again, I know obviously syphilu has experience with eye care practices, I guess, based on that, how has MIPS reporting for specialists changed in the last couple of years, especially with MVPs entering the picture, and what can other specialties learn from that? 8:55 So what we have found this year with opting in for the MVP is most of our practices that chose to opt in, they're actually scoring almost exactly the same as the traditional MIPS, some a couple points higher, but for the most part, we're not seeing a huge fluctuation, which that's the good news for you know any practice is if We're seeing that in ophthalmology, hopefully you'll see that across the board and other specialties as well, that they they set up these MVPs so that it makes it almost easier to report again, because you're only reporting four quality measures instead of six. So instead of trying to find six good ones. You're only signing finding four good ones to worry about reporting on. So that's the good thing. And like I said, the takeaway right now is, look, look at the MVPs. Now focus on the measures specifically for your practice and your patient demographics. And if you do that, that's how you're going to get those higher performance scores. 10:14 Hey there. Keith Reynolds here and welcome to the p2 management minute in just 60 seconds, we deliver proven, real world tactics you can plug into your practice today, whether that means speeding up check in, lifting staff morale or nudging patient satisfaction north. No theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before lunch. But the best ideas don't all come from our newsroom. They come from you got a clever workflow, hack, an employee engagement win, or a lesson learned the hard way. I want to feature it. Shoot me an email at K Reynolds at mjh life sciences.com, with your topic, quick outline or even a smartphone clip. We'll handle the rest and get your insights in front of your peers nationwide. Let's make every minute count together. Thanks for watching, and I'll see you in the next p2 management minute. 11:02 You MIPS isn't new anymore. I believe 2017 is when it really things started there. This far into the program, are there still specific compliance or reporting mistakes that you're seeing that are directly costing practices, and how can physicians and administrations, or administrators, it's rather right the ship. And, you know, catch those issues before the end of 2026 Yes. 11:27 Um, some things we see commonly is missing those reporting deadlines. Um, things like I said, with your mapping on your if you use a registry, keep on top of those mapping. Because sometimes it's not that your practice is using an incorrect workflow. It's just for whatever reason, the data that's being transferred to the registry isn't coming over correctly, and so you have to have the registry remapped. So know those deadlines same. If a practice is switching EHRs during the year, be aware of when those deadlines are to add the new EHR to the registry, because that can be huge. Or if you're using a registry for the first time and you're integrating the EHR, if you wait until the end of the year, you may not have a dashboard to be able to view to know how your measures are doing. So you want to do those kinds of things early in the year. Watch your promoting interoperability reporting. Make sure you're completing those security risk and safer guides as you're supposed to the important and focus for promoting interoperability is the sending health information that that that communication is the sole focus of the PI category, and that's where you want to focus your your attention for the PI category, and then just ignoring your data validation and failure to meet that 75% data completeness. And again, this is all easily avoidable. If you just take a few moments, couple of times quarterly, I'd say, a bare minimum quarterly, review that information, or preferably monthly, you know, take a look those measures. Make sure you're on track. Make sure those workflows are being done that you know you're tracking that data correctly. And again, the very often with MIPS, everyone just puts it on the practice administrator. And you have to remember a practice administrator normally isn't in the clinic, so they're not doing those workups to know how, how that data is being put into the patient exam. So if you create that team, and that team consists of your practice administrator, a physician, and then maybe like your clinical team lead, then you've got more than one person, so it's not all on one person shoulders, and you've got different people with different levels of knowledge involved to make sure that you're doing the best you can do for your performance. 14:08 I want to get into EHRs and documentation under the current rules. How much is the way that people are documenting in the EHR show up in MIPS performance? 14:19 So it's become very, very big in MIPS performance. Last year, CMS stopped allowing manual data submissions, so you have to have, pretty much have to have an EHR to be able to even report MIPS at this point and get anything you know, beyond a negative payment adjustment so you want and the data capture and EHRs, it's it's crucial for your high scores, right inefficient workflows, they lead to missing data, reporting errors, things like that. You want to use standard. Die structured fields rather than free texting. So so the more you can automate your system, the better it's going to be for your performance scores. And it's actually easier in a clinical workflow, because you can, you know, click that button for that pre populated data, rather than having to sit and type sentences out and then proper integration of MIPS into their daily task is going to improve the that performance as well. And then patient engagement in your patient portals and your communications tools, if you have those automated much easier to use, it's also going to increase your performance score for those important measures in the promoting interoperability category 15:44 for smaller practices, mid size practices, do you have practical strategies or tips that they can implement today to protect their Medicare revenue from MIPS penalties without maybe adding Extra administrative burdens or onto clinicians or staff? 16:01 So again, if use that EHR to its full capability and use those free set data input information options that they have, understand your category weights and then just validate and double check the data for accuracy. If you're using a registry, or even many EHRs have their own registry, but don't assume that it's okay. Just double check it. Just get in there and double check the data on that registry or on that dashboard. Make sure it's pulling in like it should, because there can be errors in that. So in that, I think, is where a lot of practices struggle is they don't take the time to look at those throughout the year, and then at the end of the year, they're scrambling, going, Okay, this doesn't look right. Why does it look right? And at the end of the year, it's kind of too late. And then focus on your highest weighted categories, which are your quality categories and your cost categories. Those are each worth 30% of your total MIPS score. 17:07 It's no surprise, obviously, that staffing is a problem, and a lot of healthcare practices, you know if, if they're in a pinch, they're short on clinicians, short of administrative staff, they might only have maybe a few hours every month to really dedicate like two MIPS planning. Could you kind of talk about priorities there? I mean, you know, what should they be prioritizing to have the biggest impact is that choosing the right individual MIPS measures or MVP option something else? 17:38 Yeah, it's choosing those measures. Again, you want to focus on the ones that are specific to your practice and your patient demographics. And if you only have maybe a couple hours a month, focus on tracking those measures, making sure that the workflows are correct. If the if you're doing the work, if the workflows are not being done correctly, then review it with the team and that you can absolutely do that in a couple of hours a month before I worked with this company, I worked for a medical practice, and I was their their MIPS coordinator and their staff and physician trainer, and I would spend maybe five hours a month at the Most looking at MIPS. And what I focused on was making sure those quality measures that I was looking at on my dashboard, one that they were being mapped correctly to the dashboard that I was looking at. And then if it was mapped correctly, but we weren't doing well, then I could look at the workflow and say, Okay, this is what we're doing wrong. And then take it back to the team and say, you know, and just have a quick meeting with the team, lunch hour, end of the day, and say, Hey, we're not doing well on this measure. This is what we need to do to improve it. And it only takes just a few hours a month, and that's going to be the easiest and fastest way to get that performance score up. Great. 19:00 Is there anything that you think we might have missed? Or anything else that you want to share, 19:06 just you want to make sure that you check the CMS website. It's the qpp.cms.gov and they have everything on that website you ever need to know about MIPS reporting. Granted, there's a lot of information there, but you can drill it down to specifically what you want to look at. You can look at specific measures to see if there's any changes. And remember that MIPS measures, even if the measure itself didn't change, is no longer topped out, or anything like that, there could be small, little nuance changes to the requirements. So don't assume that what worked last year is going to work this year, and the category where that we find that the biggest impact is on the improvement activities category, often the. Improvement activities. They don't change, but there'll be different changing in the wording, the description of the documentation requirements, that may change somewhat. And you'll be like, one year, you did fine, and then the next year you say, oh, I can report on this again. And then it's the documentation requirements are different. You're like, Wait, I didn't have to do this last year. So just be mindful of that. And again, I know, you know, with busy practice, it's hard to find the time, so once you pick that improvement activity, take a few minutes just to look at it and make sure that you understand what those documentation requirements are. 20:38 Great. Holly Black, thank you again, so much for taking the time today. Absolutely You're welcome once again. That was Holly Black, Project Manager for regulatory affairs and compliance at Site view software on behalf of the whole medical economics and physicians practice teams, I'd like to thank you for listening to the show and ask that you please subscribe so you don't miss the next episode. As always, be sure to check back on Monday and Thursday mornings for the latest conversations with experts, sharing strategies, stories and solutions for your practice. You can find us by searching off the chart wherever you get your podcasts. Also, if you like the best stories that medical economics and physicians practice published delivered straight to your email six days of the week, subscribe to our newsletters at medical economics.com and physicians practice.com off the chart, a business of medicine podcast, executive produced by Chris mazzolini and Keith Reynolds and produced by Austin Latrell. Medical economics and physicians practice are both members of the mjh Life Sciences family. Thank you. Applause. You.