Adapting to MIPS 2025: Key Reporting Changes and Impacts for Dermatology Practices

Since the inception of Merit-Based Incentive Payment System (MIPS) in 2017, CMS has implemented several healthcare quality improvement programs, and each iteration has brought in more providers and more specialties to become required to report under MIPS. While Medicare does not cover some dermatological services, many dermatologists, dermatopathologists, and Mohs surgeons are now required to report due to the medical necessity of dermatology services our seniors face. 

CMS has estimated that the annual treatment cost of melanoma is $3.3 billion annually with over 196,000 new cases being diagnosed each year. Considering the cost of melanoma treatment and other additional factors, CMS has placed dermatology’s quality of care and cost of services for such conditions under a microscope. This has resulted in increase in the number of requirements for the dermatology specialty in terms of MIPS healthcare reporting.

There are four MIPS performance categories: Quality, Promoting Interoperability, Improvement Activities, and Cost. There is a big push by CMS to engage with patients to achieve better health outcomes at a lower cost. Specialties, including dermatologists, will be pushed to document quality information and strive for positive treatment outcomes. For example, two new measures introduced by CMS are the Psoriasis-Improvement in Patient-Reported Itch Severity and Dermatitis-Improvement in Patient-Reported Itch Severity. Both new measures require documentation of a patient’s itch symptoms improving over the course of their treatment in a performance year. CMS is increasingly putting emphasis on outcome-based measures as they ramp up reporting requirements in efforts to improve quality of care for patients under the Quality Payment Program (QPP).

Some dermatology-specific Quality measures available to report include, but are not limited to, Melanoma Recall System, Psoriasis: Clinical Response to Systemic Medications, TB Screening for Psoriasis Patients Prior to Starting a Systemic Medication, Psoriasis-Improvement in Patient-Reported Itch Severity, and Dermatitis-Improvement in Patient-Reported Itch Severity. Unfortunately, CMS has proposed to remove the Melanoma Recall System measure for the MIPS 2025 reporting year and has proposed to replace it with the Melanoma: Tracking and Evaluation of Recurrence, which is an Outcome measure. It has become harder to find many Quality measures within the dermatology scope to report, let alone achieve perfection. 

Providers must be ready to track and document Quality measures beginning January 1, 2025 to not fall behind. They should also be aware of changes made in the MIPS reporting program from year to year. Healthcare staff and MIPS eligible clinicians should also be aware of the measure specifications, as patient age minimums, diagnosis, procedure codes, and the number of times to be documented may be different from measure to measure.

Moreover, since 2022, CMS has begun to apply the Cost category practices again after taking a brief break due to the COVID pandemic. Based on the codes that are billed and the patients seen, dermatologists could potentially be scored on the Cost category. Cost is directly calculated and scored by CMS based on Medicare Part fee-for-service (FFS) claims they receive for services performed during the performance year. If you pass the volume threshold for a specific measure, the practice or provider will receive a MIPS score. 

The cost score may also be affected by patient risk scores, regional adjustments, patient comorbidities, etc., which will be considered by CMS when scoring this category. CMS calculates cost measures such as Total per Capita Cost (TPCC) and Melanoma Resection frequently for dermatology. It is important that practices are aware of the measures that can potentially be applied and use the CMS feedback to make purposeful workflow changes in their practice that may help to improve both cost and quality of care, which represent 60% of your total MIPS final score.

CMS may approve the proposed Dermatology MVP for 2025 MIPS Reporting. The MIPS Value Pathway (MVP), is a MIPS reporting track that aims to make it easier for specialists to report. If the Dermatology MVP is approved, dermatologists under this track will be required to report four Quality measures rather than the six required under Traditional MIPS reporting. Under the MVP, a practice or provider will also be required to select a Population Health measure as part of their Quality category, which CMS will score based on claims data they receive. As CMS moves to improve specialty reporting, we can expect them to place additional emphasis on cost and quality of care under the alternative payment model (APM) or merit-based incentive payment system.

TriumpHealth MIPS Consulting Services for Dermatology Practices

MIPS 2025 is designed to reward high-quality, cost-efficient care, making it essential for clinicians to stay informed about updates, select the right reporting measures, and use resources to enhance their performance. Successfully participating in MIPS can result in positive payment adjustments, which benefit practices by improving care delivery while maintaining financial health. 

At TriumpHealth, we offer customized MIPS compliance consulting services specifically for dermatology practices. Our expert team helps you optimize your MIPS score, navigate reporting requirements, and ensure consistent performance across the MIPS performance categories. With innovative tools and expert guidance, we take the stress out of MIPS compliance, helping your practice secure the positive payment adjustments you deserve.

Ready to elevate your MIPS performance? Contact us today at (888) 747-3836 x0 or sales@triumphealth.com and let’s begin your journey to MIPS success!