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Startup Spotlight | Jul/Aug '16

Keeping an Eye on MIPS

By now, you may have heard about MIPS, or the Merit-Based Incentive Payment System, one of the latest initiatives in the shift toward value-based health care. If you haven’t, you need to be aware, as this program will directly affect your practice in the future.

MIPS is a subset of MACRA (yes, another acronym), the Medicare Access and CHIP Reauthorization Act of 2015, an effort by the Centers for Medicare & Medicaid Services (CMS) that changes how Medicare pays entities who give care to its beneficiaries. The three big changes in MACRA include (1) putting an end to the sustainable growth rate (SGR) that determines how Medicare pays us for services, (2) creating a framework to transition to value-based rather than volume-based care, and (3) combining the multiple quality reporting programs—including meaningful use—into one, more comprehensive program.1

But back to MIPS. MIPS is based on the principle that if you demonstrate higher quality and/or lower costs than your peers, you have the chance to make more money. If you perform below the threshold of your peers, you can lose money. Let’s be honest: None of us wants to lose money, so it would make sense to learn what we can do to gain a competitive advantage.

A recent Black Book Market Research report2 indicates that about two-thirds of physicians who have a large number of Medicare patients anticipate the end of their independence due to MACRA because they may not have the technology, capital, or staffing to sustain under the conditions of MIPS. The report is an eye-opening read, and, in general, it is interesting to observe that as the compliance and regulatory initiatives evolve over the years, technology gains an increasing importance to ensure the health of our practices. Think this is merely a coincidence? Think again. The plan from the beginning was to ease the health care system and its participants (yes, us) into embracing health IT. Why fight it and anticipate the worst when some of the tools out there will actually help us?

Electronic health record (EHR) systems. While many cringe at the mere thought of EHR, the right system can actually help your practice and make things more efficient. Cloud-based EHR systems that enable users to capture structured patient data during the exam are ideal. In case you are not familiar, structured data is patient information that is captured once during the exam and can then be used for a multitude of different purposes, such as the Physician Quality Reporting System (PQRS), meaningful use, and, yes, MIPS. For example, when I use my EHR system, I simply pull out my iPad to touch a 3D anatomic atlas to record the patient’s condition and diagnosis. This one interaction can then automatically create my exam notes, super bill, and patient education materials and supply all of the data I need for meaningful use, PQRS, and MIPS.

Did you note what I did not do? I did not have to ask my staff to sift through charts—digital or paper—to compile reports. The right EHR system is the key to efficiency.

Analytical tools built into the EHR system can also help us with MIPS. As physicians, we know what data we need to help our patients, but equally important is real-time comparative benchmarking of quality and cost to ensure the health of our practices. With this kind of insight into the financial aspects of our business, we can improve our operations and bottom line. We need to be able to identify our individual key performance indicators as well as those of our practice, plus determine where we stand compared with other ophthalmology practices. Knowing the information in real time will enable us to quickly make changes to improve a situation that may need some TLC.


MIPS is coming, and it is going to directly affect your practice. Having a MIPS-ready EHR system that provides structured data will help prepare you for when the time comes.

1. CMS. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html. Accessed August 12, 2016.

2. Black Book Market Research. https://blackbookmarketresearch.newswire.com/news/physicians-wary-of-macras-potential-to-hasten-the-demise-of-11896567. Accessed August 12, 2016.

David A. Goldman, MD | Section Editor
David A. Goldman, MD | Section Editor
  • Private practice, Goldman Eye in Palm Beach Gardens, Florida
  • david@goldmaneye.com; (561) 630-7120
  • Financial disclosure: Consultant (Modernizing Medicine)