Understanding MIPS reporting for retina practices
By Besse Medical
What is the difference between traditional MIPS and MIPS value pathways (MVPs)?
Traditional MIPs is the most common way to participate in MIPS. There are four categories:
- Quality: Select and submit on six Quality measures, with at least one being an outcome measure or high priority. There are four claims-based measures, which are unlikely to impact retina practices, and overall, there are almost 200 measures to select from, plus QCDR measures.
- Promoting Interoperability: There is a set of measures to report for all practices, unless the exemption applies. Reporting on this category requires a certified EHR.
- Improvement Activities: Activity weightings were removed in 2025, and small practices just have to report on one activity to achieve a full score, while large practices report on two.
- Cost: This category can be one of the most difficult for practices because it’s not just looking at your cost. It’s looking at everything that the patient had done as it is applicable to a measure and is calculated on claims data after the year is over. There are 35 cost measures, though most of them are unlikely to impact retina.
MVPs are very similar to traditional MIPS. While still optional, MVPs continue to include the same four performance categories, but the requirements differ. Most importantly, practices must register by November 30, 2026, to participate.
One of the biggest differences is the Quality category. Under MVPs, the measure set is more streamlined and specialty-specific. Practices need to report on four measures, including at least one outcome or high-priority measure. MVPs also reduce the Improvement Activities requirement to one activity, even for large practices. Promoting Interoperability requirements remain the same unless a practice qualifies for an exemption, such as the small practice exemption.
Every MVP includes two foundational layers: population health and Promoting Interoperability. These apply across all MVPs unless a Promoting Interoperability exemption is met.
Deciding whether to participate in an MVP or remain in traditional MIPS depends on how well the MVP structure aligns with a retina practice’s workflows, case mix, and scoring opportunities. For most retina practices, the Complete Ophthalmologic Care MVP is the only viable option. Its sole Cost measure is Cataract Removal with Intraocular Lens (IOL) Implantation. Retina practices that do not routinely perform cataract surgery – or do not meet the 10-case minimum – will not be scored on this measure.
If a practice does not meet the case minimum and therefore does not receive a Cost score, it does not count against them. Instead, the Cost category is reweighted across the remaining categories.
Partnering with Cencora
At Cencora, our team of MIPS experts is deeply invested in the success of the practices we support. Using your retina practice’s data, workflows, and reporting history, we can help determine whether traditional MIPS or MVPs are the best fit – and guide you on how to maximize your score and potential upward payment adjustments.
Our consultants work across 30+ EMR platforms and support 21 specialties, giving us a broad perspective on what drives strong performance and where practices often face challenges. By partnering with Cencora, your clinicians gain a dedicated team to manage reporting requirements, optimize measure selection, and oversee the full data submission process.
Watch the full webinar to learn more about MIPS reporting for retina practices, Cencora’s MIPS consulting services, and how our team can support your success.
