MIPS is a strategic exercise.
Not a compliance exercise.
MIPS determines up to 9% of your Medicare revenue—positive or negative. But the payment adjustment is only part of the picture. It's CMS's framework for evaluating value-based readiness before mandatory models make that understanding non-optional.
MIPS is not four silos. It's one interconnected system.
Most practices treat Quality, Cost, PI, and IA as separate chores. That's a mistake. Quality and Cost are two sides of the same coin—and understanding that connection is where strategic advantage begins.
- —Guideline-adherent treatment protocols
- —Process measures (med rec, care plans)
- —Patient outcomes and safety metrics
- —Episode-based cost measures
- —Chronic condition management costs
- —Total per capita cost benchmarks
Traditional MIPS reporting checks boxes. Strategic MIPS management builds a sustainable practice.
The performance gap is measured in dollars.
The difference between “avoiding the penalty” and “maximizing the bonus” isn't just points—it's real revenue impact, compounding year over year.
| MIPS Score | Adjustment | Impact ($2M Revenue) | Status |
|---|---|---|---|
| 0–18.75 | −9% | −$180,000 | Maximum Penalty |
| 75 | 0% | $0 | Neutral |
| 89+ | ~2–3%* | +$40,000–$60,000 | Exceptional Performance |
*While the statutory maximum is 9%, the bonus pool is budget-neutral. In recent years, exceptional performers have received ~2–3% positive adjustments.
The full impact isn't just avoiding the penalty or earning the bonus—it's the swing between the two. A practice moving from penalty territory to exceptional performance sees a combined 11–12% shift in Medicare reimbursement.
The asymmetry is the point: penalties are fixed, bonuses are earned.
A poor score costs you a guaranteed 9%. A strong score earns you a modest bonus—but more importantly, it positions you for mandatory models where the stakes are higher. We identify the “easy wins” in your existing clinical data—the points you're leaving on the table through suboptimal measure selection, incomplete documentation, or missing attestations.
Why “standard reporting” is a financial risk.
Most registries simply transmit what you give them. If your data is incomplete, they transmit a low score. VBCA acts as a pre-submission filter.
Standard Registry
Transmits whatever data you submit. If documentation is incomplete, your score suffers. No analysis, no optimization, no warning.
VBCA Approach
We analyze your performance before it goes to CMS, identifying where simple workflow adjustments can lead to double-digit increases in your final MIPS score.
The strategic advantage by category
| Category | The Compliance Burden | The VBCA Strategic Advantage |
|---|---|---|
| Quality | Submitting 6 measures and hoping for decent benchmarks | Selecting the 6 measures that maximize your specific decile scoring based on your patient population |
| Cost | A “black box” surprise when the score arrives | Interpreting historical QPP data to predict and prevent future high-cost episodes |
| Promoting Interoperability | Technical EHR hurdles and attestation confusion | Ensuring your documentation flow meets the high-weight “high priority” requirements |
| Improvement Activities | Checking a box for 90 days | Selecting activities that actually improve your bottom line, like Chronic Care Management |
Is your practice ready for the sunset of Traditional MIPS?
CMS is moving toward MIPS Value Pathways (MVPs) and mandatory models like ASM. MVPs are specialty-specific and require much tighter alignment between your Quality measures and your Cost data.
We use your current QPP data to “dry run” your performance in upcoming MVP frameworks—so there are no surprises when the mandate hits.
The practices preparing now—understanding their cost position, aligning measures to clinical reality—will transition smoothly. The rest will scramble.
ASM mandatory participation starts January 2027
Cardiology, pain management, anesthesiology, orthopedics, neurosurgery, and PM&R in designated geographic areas will be required to participate—using the same cost methodology already in MIPS.
Learn about ASM preparation →See where the points—and the dollars—actually come from.
The Platform brings together score modeling, cost analysis, and measure optimization. Model scenarios before you commit.
Go deeper
MIPS Cost Category
At 30% weight and rising, Cost is no longer ignorable. Understand the episode methodology before it defines your ASM score.
Learn about Cost →MIPS Value Pathways
MVPs bundle Quality, Cost, and IA around clinical themes. See what the specialty-specific transition means.
Learn about MVPs →Ambulatory Specialty Model
Mandatory in 2027 for six specialties. The cost methodology you're measured on in MIPS is the same one ASM will use.
Learn about ASM →