Every independent practice has about twelve weeks left to move its 2026 quality numbers. Payer attribution lists are fixed, the MIPS performance year ends December 31, and every open care gap is a patient who still needs care — and a measure not yet met.
The 4th Quarter Review is not a year-end report. Done well, it answers two questions: which strategies we started in January actually worked, and what we should pilot next year while keeping what works.
PRACTICE SPOTLIGHT: A primary care practice entered Q4 trailing its largest Medicare Advantage contract targets for breast cancer screening and diabetic A1C control. an assigned care team pulled each payer’s attribution list, sorted open gaps by patient, partnered with provider schedules, and booked gap-closure visits into annual well or well visit slots. In 10 weeks they closed 212 gaps and met three of four quality targets — keeping a shared-savings payment they expected to miss. (partial Illustrative example)
WHY IT MATTERS IN 2026: CMS kept the MIPS performance threshold at 75 points for 2026–2028. Scoring below it triggers a negative payment adjustment — and every care gap closed before December 31 counts this year.
FIVE QUESTIONS YOUR 4TH QUARTER REVIEW MUST ANSWER
•WHERE ARE OUR OPEN CARE GAPS — BY PAYER? Compare each payer’s attribution list to your EHR gap report. Measure gaps per contract; a practice-wide report hides the patients who count.
•IS CHRONIC CONDITION MANAGEMENT WORKING? Review A1C, blood pressure control, and medication adherence. Then check what matters most: did ER visits and hospital admissions go down?
•ARE OUR TOOLS EFFECTIVE IN BOTH CHANNELS? Evaluate in-person and telehealth workflows. Is the data accurate? Are reminders and portal messages opened and acted on?
•DO WE HAVE THE RIGHT TEAM IN PLACE? Who owns outreach? Who owns gap reports? If the answer is ‘everyone,’ it is really ‘no one.’
•WHAT ARE THE ROOT CAUSES OF THE GAPS THAT REMAIN? Transportation, cost, fear of results, language, or no reminder? Each barrier needs a different fix. Know your patient population before choosing the next tactic.
WHAT THE RESEARCH TELLS US
•CMS held the MIPS performance threshold at 75 points through 2028. (CMS CY 2026 PFS Final Rule)
CALL TO ACTION
This week, block 90 minutes for your 4th Quarter Review. Bring three reports: open care gaps by payer, chronic condition control rates, and ER/admission trends. Assign one or two care team owners and one deadline per payer.
#TuesdayTips #TheInsights #TRAYNE51 #QualityMeasures #CareGaps #MIPS #PracticeManagement #PhysicianPractice #ValueBasedCare
