Healthmonix Advisor

For years, healthcare providers have navigated the complexities of the Merit-based Incentive Payment System (MIPS). They often find it to be a burdensome, one-size-fits-all compliance requirement that feels more like an administrative chore than a true measure of quality.  

But the landscape of quality reporting is undergoing its most significant evolution yet. The Centers for Medicare & Medicaid Services (CMS) is shifting away from the broad traditional MIPS framework toward a focused, specialty-specific model: MIPS Value Pathways (MVPs). 

CMS recently released updated MIPS quality measure benchmarks that affect how your performance translates into points for 2024 (https://qpp.cms.gov/api/frontend/benchmarks-csv/quality/2024). Below, we summarize what's new and provide complete lists of newly benchmarked measures, categorized by decile completeness. 

On Jan. 1, 2026, CMS will launch the Transforming Episode Accountability Model (TEAM), a mandatory 5-year program designed to hold hospitals accountable for both the cost and quality of care delivered around major surgical episodes. TEAM covers 5 high-volume, high-cost procedures, creates two-sided risk, and ties financial performance to outcomes like readmissions, safety, and patient-reported results. 

Are you feeling overwhelmed by MIPS reporting requirements? You’re not alone. With the 2025 performance threshold holding steady at 75 points and hundreds of measures to sort through, many providers are turning to MIPS Value Pathways (MVPs) for a more streamlined — and smarter — approach. 

The frantic pace, high-stakes decisions, and unpredictable patient flow of the emergency department make it a unique and challenging environment in healthcare. For years, the Merit-based Incentive Payment System (MIPS) program has presented a formidable obstacle for emergency physicians, and now the Cost category will have a measure just for emergency medicine in your 2024 feedback. This part of MIPS, which assesses the total cost of care for patients, can feel disconnected from the realities of emergency medicine, where the primary goal is rapid stabilization and appropriate disposition, not cost control. 

On July 10, 2025, CMS released the CY 2026 Medicare Physician Fee Schedule (PFS) Proposed Rule. While CMS characterized 2026 as a “stabilization year,” the Proposed Rule brings several notable updates to the Merit-Based Incentive Payment System (MIPS), particularly around MIPS Value Pathways (MVPs), the Cost performance category, and registry participation.  

These changes are crucial for providers aiming to protect their reimbursement, streamline reporting, and improve performance. 

As CMS continues to evolve value-based care, the Ambulatory Specialty Model (ASM) in the 2026 Physician Fee Schedule (PFS) Proposed Rule represents a landmark opportunity for specialists who have historically been excluded from broader accountable care models like MSSP and ACO REACH. 

In 2025, Medicare introduced three new Advanced Primary Care Management (APCM) codes —G0556, G0557, and G0558 — to support streamlined, comprehensive care for patients with chronic conditions. These codes not only simplify billing but are also tied to performance reporting under the Merit-based Incentive Payment System (MIPS). This post breaks down what providers need to know. 

One theme emerged loud and clear at the NAACOS Spring 2025 Conference: transformation isn’t just about systems. It’s about people, collaboration, and actionable workflows. 

Healthcare organizations nationwide are navigating the complexities of value-based care (VBC). VBC success is measured in procedures performed and outcomes achieved. It requires coordination between technology, teams, and providers. 

Many organizations are struggling to close the gaps.

Last week, I had the opportunity to join healthcare executives, clinical leaders, and innovators from across the country at the Becker’s Hospital Review 15th Annual Meeting. Every year, this event captures the current temperature of healthcare transformation — but this year felt different. There was a sharpened urgency in the air and a deeper willingness to challenge long-standing norms. 

Across sessions, one question echoed consistently: How do we design a healthcare system that truly delivers value — to patients, providers, employers, and communities?