How to prepare for MIPS 2026 changes in orthopedics

How orthopedic practices can prepare for 2026 MIPS changes

Merit-based Incentive Payment System (MIPS) reporting has always been a balancing act for orthopedic practices. They must juggle high-volume procedural work, track patient-reported outcome measures (PROMs), and stay ahead of evolving quality benchmarks. But as CMS doubles down on its MIPS Value Pathways (MVPs) for 2026, the stakes are getting higher and the reporting requirements more complex.¹

The good news: Orthopedic practices that understand what's changing can act now to reduce administrative burden, avoid penalties, and position themselves for long-term success in value-based care.

A brief MIPS refresher

MIPS is CMS's quality payment program that adjusts Medicare reimbursement based on performance across four categories: Quality, Cost, Improvement Activities, and Promoting Interoperability.² Practices that perform well can earn positive payment adjustments; those that fall short may face penalties.

Since 2021, CMS has been rolling out MVPs, which are streamlined reporting frameworks that connect quality measures, cost measures, improvement activities, and interoperability requirements around specific specialties or conditions.³ Instead of selecting measures from a broad menu, practices reporting through MVPs follow a curated set that's designed to reflect meaningful, episode-based care.

For orthopedic practices, this shift is particularly significant because MVPs align naturally with how musculoskeletal care is already delivered and measured.

The American Academy of Orthopaedic Surgeons (AAOS) defines value in musculoskeletal care as "the relationship of a patient-centered health outcome to the total cost required to reach that outcome" — a framework that MVPs are designed to operationalize through episode-based measurement.⁴

And starting in 2026, CMS is positioning MVPs as the future of MIPS.

Quick reference: 2026 MVP for orthopedic surgery

MVP Name: Improving Care for Lower Extremity Joint Repair⁵

Applicable Specialties: Orthopedic Surgery

Key Measure Categories:

• Quality: Functional status assessment (PROMs)
• Cost: Episode costs for total hip arthroplasty (THA) and total knee arthroplasty (TKA)
• Improvement Activities: Care coordination and patient engagement
• Promoting Interoperability: EHR data exchange

Reporting Options: Individual clinician, group practice, or through a third-party intermediary

Why It Matters: Ties MIPS performance directly to high-volume, high-cost orthopedic procedures

What this means in practice: If your group performs 50 total knee replacements in a year, for example, CMS will evaluate your MIPS performance based on how well you collect PROMs, manage episode costs, coordinate post-acute care, and exchange data electronically. Weak performance in these areas can affect a practice’s MIPS final score and, depending overall performance, its future Medicare Part B payment adjustment.

Why CMS is pushing MVPs and why it matters to orthopedics

CMS views MVPs as the future of MIPS.⁶ The agency believes that by focusing on specialty-specific, coordinated care measures, it can generate more comparable performance data and better align incentives with patient outcomes and cost efficiency.

For orthopedic practices, this shift is particularly significant because orthopedic care naturally aligns with the MVP model. ⁷ And that alignment brings both opportunity and scrutiny.

Here's why MIPS changes hit orthopedics differently:

1. Orthopedics has its own MVP, and practices may want to evaluate it now

   According to the 2026 Finalized MVPs Guide, CMS offers an MVP specifically designed for orthopedic surgery: "Improving Care for Lower Extremity Joint Repair." This pathway includes cost measures tied directly to elective primary hip and knee arthroplasty — two of the highest-volume, highest-cost procedures in orthopedics.

    

   The MVP specifically lists orthopedic surgery as a specialty that may report, with performance measured across the full episode of care, from pre-operative assessment through post-acute recovery.

    

2. Orthopedic care is naturally episode-based

   Joint replacements, fracture care, and musculoskeletal rehabilitation have clear beginnings and endings — episodes with measurable starts, interventions, outcomes, and costs. That's what MVPs are designed to capture.

    

   As the AAOS notes in its Value-Based Care Guide, joint replacement bundles like the Comprehensive Joint Replacement (CJR) and Bundled Payments for Care Improvement Advanced (BPCI-A) models have already introduced orthopedic practices to episode-based accountability. MVPs build on this foundation by incorporating functional outcomes and cost performance into MIPS scoring.⁸

    

   If your practice is already navigating value-based contracts, MVPs aren’t a new direction — they're an extension of the same accountability framework.

    

3. Cost performance is front and center

   Under traditional MIPS, CMS calculates cost measures from claims data. Under MVPs, CMS scores practices only on the cost measures included in their selected MVP, and only when they meet case minimums.

    

   For orthopedics, that means your cost score could be directly tied to high-cost procedures like hip and knee arthroplasty. If your practice lacks real-time tracking tools — dashboards that show episode costs, readmission trends, and post-acute utilization patterns — you likely won't know you're underperforming until it's too late to course-correct.

    

   CMS won't penalize you any less because your EHR couldn't surface the data. The expectations are the same whether you have robust cost analytics or you're relying on retrospective claims reports that arrive months after the episode ends.

    

   This is why technology infrastructure matters. Practices that can track episode-level performance in real time can intervene early — adjusting care pathways, coordinating post-acute referrals, and reducing unnecessary utilization before it impacts their MIPS score.

    

4. Functional outcomes are becoming more important

   The 2026 Musculoskeletal Care MVP includes functional status measures for knee, hip, low back, shoulder, neck, ankle/foot, elbow/wrist/hand, and other impairments. Many orthopedic practices are already tracking these outcomes, but some may still rely on manual workflows or inconsistent PROM collection.

    

   The AAOS has advocated for the integration of more PROMs into CMS quality programs, emphasizing the need for condition-specific tools and minimizing administrative burden.

    

   If your practice isn't systematically capturing pre- and post-procedure functional status, you're leaving points and reimbursement on the table.

    

5. The AAOS-CMS tension: Flexibility vs. standardization

   Here's where it gets tricky. While CMS is pushing broader MVP adoption to create standardized, comparable metrics across practices, the AAOS has opposed mandatory MVP participation, citing gaps in applicability for specialists and subspecialists. ⁹ The AAOS has advocated for maintaining the traditional MIPS framework, allowing clinicians to select measures, improvement activities, and strategies most relevant to their specific practices.

    

   CMS, however, hasn't wavered. The agency has reiterated its intention to move to full MVP adoption, though it hasn’t set a future date. The goal: standardized metrics that allow CMS to compare how practices perform against each other and identify which ones deliver better outcomes at lower costs.

    

   This means orthopedic practices need to be adaptable. This requires a connected, network-enabled EHR and practice management platform that can flex with regulatory changes — not one that requires manual workarounds every reporting cycle.

This is why technology infrastructure matters. Practices that can track episode-level performance in real time can intervene early — adjusting care pathways, coordinating post-acute referrals, and reducing unnecessary utilization before it impacts their MIPS score.

What orthopedic practices should do now

The 2026 performance year is already underway. Here's how to prepare:

1. Evaluate your current MIPS tracking capabilities

   Can you pull real-time reports on quality measure performance? Do you have automated alerts when a measure is at risk of falling below benchmarks? If you're relying on end-of-year retrospective reporting, you're already behind.

    

   Action step: Audit your current MIPS workflow. Identify gaps in automation, data collection, and performance visibility.

    

2. Assess whether an MVP aligns with your practice

   If you perform lower extremity joint repairs or treat musculoskeletal conditions, review the “Improving Care for Lower Extremity Joint Repair” MVP and “Musculoskeletal Care” MVP. Compare the required measures to what you're already tracking.

    

   Action step: Map your current quality measures to the relevant MVP. Identify any gaps in data collection (especially PROMs and functional status measures).

    

3. Streamline PROM collection

   PROMs are central to orthopedic MVPs, but they can also create administrative headaches (collecting data before and after surgery, tracking patient compliance, ensuring EHR integration).

    

   Action step: Implement digital PROM collection tools that integrate directly with your EHR. Automate reminders for pre- and post-procedure surveys to improve response rates.

    

4. Build cost and episode awareness

   Cost measures aren't optional under MVPs. CMS tracks every dollar of Medicare spending tied to your joint replacements — not just the surgery itself, but also the skilled nursing facility stays, readmissions, home health visits, and physical therapy that follow. If you don't know your episode costs, readmission rates, or post-acute care patterns, you can't manage them.

    

   Action step: Work with your EHR vendor or analytics partner to build episode-level cost dashboards. Track trends in readmissions, complications, and post-acute utilization.

    

5. Leverage technology that adapts with you

   MIPS requirements will continue to evolve. The practices that thrive are the ones using technology that updates automatically, surfaces actionable insights in real time, and reduces administrative lift.

How athenahealth supports orthopedic MIPS success

athenahealth helps orthopedic practices manage MIPS reporting through automated quality measure tracking, real-time performance visibility, and streamlined reporting workflows that are all built into the athenaOne® platform.

Based on PY2023 MIPS results, here’s what practices using athenahealth achieved:

• 72.09% of eligible athenaOne orthopedic clinicians reporting Traditional MIPS achieved positive payment in Performance Year 2023, with an average MIPS score of 85.93 — compared to the national rate of 58.53% and a national average score of 74.63.^10*
• 73.46% of eligible athenaOne orthopedic clinicians achieved positive payment in PY2023, with an average MIPS score of 80.08 — compared to the national rate of 66.60% and a national average score of 78.41.^11*

For orthopedic practices navigating the shift to MVPs, athenaOne offers:

• Automated measure tracking that surfaces performance gaps before the end of the reporting period
• Integrated PROM collection that reduces administrative burden and improves data completeness
• Real-time dashboards that give you visibility into quality, cost, and improvement activity performance
• Automatic regulatory updates that help ensure you stay informed of key CMS changes

The bottom line

MIPS isn't getting simpler, but it is becoming more focused. For orthopedic practices, the shift toward MVPs represents both a challenge and an opportunity. Practices that invest in the adaptable technology, streamline their workflows, and build episode-level awareness may be better positioned to reduce penalty risk succeed  in the broader value-based care landscape.

Learn more about preparing your practice for MVPs with automated MIPS tracking, integrated PROM workflows, real-time cost dashboards, and regulatory updates with athenahealth's orthopedic solutions.