MIPS 2025: What Small Practices Need to Know

MIPS compliance doesn't have to consume your practice. Here's a focused guide to maximizing your score without losing your mind, or your revenue.

The 2025 Landscape

What's Changed

Performance threshold: 75 points (up from 73)
Quality weight: 30%
Cost weight: 30%
Promoting Interoperability: 25%
Improvement Activities: 15%

The Stakes

Positive payment adjustment up to +9%
Negative adjustment down to -9%
Revenue at risk for typical primary care: $5K-20K per physician

Category-by-Category Strategy

Quality (30%)

Small Practice Advantage: You need fewer measures

Choose 6 measures wisely:

Pick measures you're already doing well
Include at least one outcome measure
Avoid measures with small denominators
Consider high-priority measures for bonus points

Pro tip: Run a mock performance report in Q1 to identify problem measures early

Cost (30%)

Good news: You don't control the measures chosen

Bad news: You still impact the results

Focus on:

Appropriate referrals
Care coordination
Avoiding unnecessary services
Efficient care delivery

Promoting Interoperability (25%)

Just hit the threshold. Don't over-invest.

Required measures:

e-Prescribing
Health information exchange
Provider-to-provider exchange
Security risk analysis

Common pitfalls:

Forgetting the security risk analysis
Not hitting denominator thresholds
Excluding too many patients

Improvement Activities (15%)

Easiest category to max out

Choose 2-4 high-weighted activities:

PCMH recognition (automatic high weight)
Anticoagulation management
Care coordination agreements
Patient safety initiatives

Small Practice Tips

1. Consider a MIPS APM

Alternative payment models can simplify requirements:

ACOs for primary care
BPCI for proceduralists
CPC+ if still available

2. Use Your EHR Reports

Most EHR systems have MIPS dashboards. Use them monthly.

3. Don't Aim for Perfect

You need 75 points to avoid penalty. Getting 90 vs 80 barely changes your payment adjustment. Focus efficiency.

4. Document for Credit

Many practices do activities that could count for Improvement Activities but don't document them. Fix this.

Timeline for Success

Submit prior year if not done
Select measures for current year
Run baseline reports
Address any Promoting Interoperability gaps

Q2-Q3

Monthly performance monitoring
Mid-course corrections
Staff education on weak measures

Final push on measures close to thresholds
Ensure attestations complete
Plan for following year

Common Mistakes to Avoid

Waiting until Q4 Many measures need full year of data
Choosing measures based on vendors Choose based on your practice
Ignoring denominators Small denominators = volatile scores
Not using exclusions properly Legitimate exclusions help
Forgetting about cost Just because you don't choose it doesn't mean it doesn't count

Resources

CMS QPP website: qpp.cms.gov
Small practice exemption (if eligible): Fewer than 15 clinicians
Virtual groups: Collaborate with other small practices

Measure selection drives most of the score, and most of the administrative burden. Schedule a discovery call to review your current measure set.

MIPS 2025: What Small Practices Need to Know