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 physicianCategory-by-Category Strategy
Quality (30%)
Small Practice Advantage: You need fewer measures
Choose 6 measures wisely:
Pick measures you're already doing wellInclude at least one outcome measureAvoid measures with small denominatorsConsider high-priority measures for bonus pointsPro 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 referralsCare coordinationAvoiding unnecessary servicesEfficient care deliveryPromoting Interoperability (25%)
Just hit the threshold. Don't over-invest.
Required measures:
e-PrescribingHealth information exchangeProvider-to-provider exchangeSecurity risk analysisCommon pitfalls:
Forgetting the security risk analysisNot hitting denominator thresholdsExcluding too many patientsImprovement Activities (15%)
Easiest category to max out
Choose 2-4 high-weighted activities:
PCMH recognition (automatic high weight)Anticoagulation managementCare coordination agreementsPatient safety initiativesSmall Practice Tips
1. Consider a MIPS APM
Alternative payment models can simplify requirements:
ACOs for primary careBPCI for proceduralistsCPC+ if still available2. 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
Q1
Submit prior year if not doneSelect measures for current yearRun baseline reportsAddress any Promoting Interoperability gapsQ2-Q3
Monthly performance monitoringMid-course correctionsStaff education on weak measuresQ4
Final push on measures close to thresholdsEnsure attestations completePlan for following yearCommon Mistakes to Avoid
Waiting until Q4 Many measures need full year of dataChoosing measures based on vendors Choose based on your practiceIgnoring denominators Small denominators = volatile scoresNot using exclusions properly Legitimate exclusions helpForgetting about cost Just because you don't choose it doesn't mean it doesn't countResources
CMS QPP website: qpp.cms.govSmall practice exemption (if eligible): Fewer than 15 cliniciansVirtual groups: Collaborate with other small practicesNeed help optimizing your MIPS strategy or considering APM participation? We can help you maximize payment adjustments with minimal administrative burden.