Overview
One practice area where Merit-Based Incentive Payment System (MIPS) could improve quality of care in my anticipated nephrology NP practice is chronic kidney disease (CKD) management before dialysis initiation, particularly hypertension control, catheter avoidance at the start of hemodialysis, and reducing preventable hospital readmissions. As a nephrology NP, I will manage patients across the CKD trajectory, and these are exactly the areas where a small set of well-designed quality measures can meaningfully change outcomes.
MIPS could benefit this field in two main ways. First, nephrology has often found MIPS challenging because most of the 200+ available measures do not align with the specialty, leading nephrologists to report on primary care measures rather than those focused on nephrology (Tummalapalli et al., 2023). In 2023, the Optimal
Care for Kidney Health MIPS Value Pathway (MVP) was introduced to address this issue by grouping measures specific to CKD and dialysis care, such as ACE inhibitor/ARB use, blood pressure control, catheter use at the start of hemodialysis, acute kidney injury requiring dialysis, and advance care planning (Tummalapalli et al., 2023). This change gives nephrology NPs a smaller, more relevant set of measures to track, reducing administrative burden, and helping them focus on actions that can truly improve patient outcomes. Second, since catheter use at the start of dialysis is closely linked to infection risk, hospital stays, and death, making it a reportable and incentivized measure encourages earlier fistula placement and better planning for vascular access. Nephrology NPs are often well positioned to lead this work during CKD follow-up visits, long before a patient reaches end-stage kidney disease.
Regarding financial viability, the nephrology MVP was designed in part because nephrologists reporting under traditional MIPS were being financially penalized for measures irrelevant to their scope or scored inconsistently relative to other specialties (Tummalapalli et al., 2023). By narrowing the scope of measures to eight quality metrics, thirteen improvement activities, and two cost measures specific to kidney care, the MVP protects nephrology practices from misaligned financial risk while still tying reimbursement to outcomes that matter to patient's hypertension control, avoided hospitalizations, and safer dialysis starts. This dual effect, protecting practice revenue while rewarding better CKD management, is intended to keep financial incentives and patient outcomes aligned rather than working against each other.
Advanced practice nurses can help refine MIPS quality measures by participating in the same structured, professional society-led process used to build the nephrology MVP. The American Society of Nephrology's Quality Committee used an iterative, two-year consensus process, including ranked-choice voting among committee members and public comment from professional organizations, payors, and other stakeholders to select and refine measures before submitting them to CMS through the Measures Under Consideration process (Tummalapalli et al., 2023). Nephrology NPs, who see firsthand which measures reflect real clinical decision-making, versus which ones are just easy to check off, can engage through professional organizations like the American Nephrology Nurses Association to advocate for valid measures, reliably captured in existing workflows, and meaningful to both clients and providers rather than measures chosen simply because they're administratively convenient.