What Small Medical Groups Need to Know About Virtual Groups - Part 2

By banding together into what CMS has termed “virtual groups,” solo practitioners and small medical groups can take advantage of significant flexibility currently available to help them succeed in the Merit-based Incentive Payment System (MIPS).

In Part 1 of this series, we answered some FAQs about these MIPS virtual groups. In Part 2, we share items to consider before joining a virtual group.

Be Open-Minded

If your goal is to remain independent, give serious thought to participating in a virtual group. CMS is bending over backward to give small medical groups and solo practitioners flexibility—which is likely to decrease over time.

The most successful practices under MIPS will invest in the technology and staff resources to not only track and report the required metrics, but also make clinical changes to optimize their scores. Lone wolves will have a hard time being able to afford, much less manage, those capital resources.

Band Together with Like-Minded Specialists

The virtual group model requires a significant amount of trust since your MIPS composite score will depend on the performance of practitioners who are not part of your practice. That level of trust can be hard for many independent-minded physicians.

We believe that the most successful virtual groups will be those formed of similar specialists who are in the same geographic footprint. For example, a small dermatology group might join with one or two solo dermatologists. Since these physicians likely “run in the same circles,” they are likely to have a level of comfort with one another and the quality of one another’s care.

Determine Best Metrics

Virtual groups will need to identify MIPS metrics that are appropriate and yields the best score for all members of the group.

For physician groups that have some providers who participate in a MIPS Alternative Payment Model (APM) or an Advanced APM, those providers’ scores would be included in the overall group’s MIPS score—although the Qualifying APM Participants (QPs) would receive their payment adjustment through the APM. This is a boon for those clinicians who are not in a position to join an APM since QPs have significant skin in the game and have presumably already made the mindset shift necessary to succeed in risk-based payment models. Therefore, they are in a position to boost the virtual group’s MIPS score.

Don’t Be Afraid to Ask for Help

Don’t try to navigate these waters alone. CMS is offering small physician groups and solo practices a great deal of flexibility and support in this transition period to MIPS. Forming a virtual group can be the key to succeeding in MIPS and moving toward the ultimate goal of joining an Advanced APM and being rewarded for delivering better care at lower costs.

If you have questions about MIPS/APMs and other opportunities created by payment model reform, we can help.

Topics: APMs, MIPS Healthcare, MACRA Summary

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