The Role of Advanced Practice Providers (APPs) in MIPS Success for Dermatology Practices
In today's evolving healthcare landscape, Advanced Practice Providers (APPs) have become vital players in helping Dermatology practices thrive in value-based care programs. Specifically, they are critical to succeeding in the Merit-Based Incentive Payment System (MIPS), a Centers for Medicare & Medicaid Services (CMS) initiative designed to reward providers for delivering high-quality, cost-effective care.
Understanding MIPS Eligibility for APPs
CMS determines eligibility for MIPS using several key thresholds:
Annual billings of $90,000 or more in Medicare Part B allowed charges
Providing over 200 covered professional services
Caring for more than 200 Medicare Part B patients within a performance year
APPs, including Nurse Practitioners (NPs), Physician Assistants (PAs), and Clinical Nurse Specialists, are evaluated as individuals unless reporting as part of a group under a Tax Identification Number (TIN). This dual path provides opportunities for dermatology practices to strategically manage reporting and performance to optimize MIPS results.
How APPs Positively Impact MIPS Performance Categories
1. Quality Performance
APPs frequently manage routine skin care, chronic skin conditions, and follow-ups—activities that directly impact MIPS quality metrics. In dermatology practices, this includes:
Psoriasis improvement measures (e.g., Itch Severity and Symptom Reduction)
Biopsy follow-up care and pathology result management
Preventive counseling (e.g., sun protection education, skin cancer prevention)
Their close patient relationships and regular touchpoints help close care gaps and improve reported outcomes, especially in chronic dermatological conditions.
2. Cost Category
Often underutilized, APPs play a significant role in reducing the overall cost of dermatological care:
Managing follow-up care for chronic skin conditions to avoid unnecessary specialty referrals
Educating patients to prevent flare-ups that lead to higher-cost interventions
Coordinating post-procedure care to reduce complications and unnecessary visits
According to industry data, dermatology practices that leverage APPs in routine and follow-up care see reductions in unnecessary utilization and costs.
3. Improvement Activities
CMS incentivizes practices for adopting activities that enhance care delivery. APPs naturally lead many of these initiatives in dermatology:
Coordinated care planning for chronic conditions like psoriasis and eczema
Advance care documentation and accurate coding for biopsies and procedures
Patient education programs for acne, melanoma prevention, and sensitive skin management
Their accessibility makes APPs ideal leaders for patient engagement and quality improvement programs.
4. Promoting Interoperability
While APPs may not head IT efforts, their EHR usage directly supports MIPS success:
Entering structured dermatology-specific data accurately (e.g., lesion tracking)
Utilizing electronic prescribing for dermatological medications
Promoting patient portal adoption for biopsy results and treatment adherence
Properly trained APPs can ensure complete and compliant use of certified EHR technology, positively impacting this category.
Elevating APPs as MIPS Performance Drivers
To excel in MIPS and value-based care, dermatology practices should view APPs not just as clinical support, but as performance drivers. Their role in managing patient relationships, ensuring accurate documentation, and supporting cost-efficient care directly contributes to higher MIPS scores.
Recommendations for Practices:
Provide targeted MIPS training to dermatology APPs
Appoint APPs as leaders in chronic skin condition management and care coordination
Include APP-specific metrics in internal quality dashboards
By recognizing and optimizing APP contributions, dermatology practices can maximize reimbursement, reduce penalties, and gain a competitive advantage in the evolving healthcare economy.
For tailored guidance on aligning your dermatology team with MIPS performance goals, KRK Value Based Care Consultants is ready to help.
Book a performance strategy session: www.krkvbc.com
