The Healthmonix Advisor

This One Major Disconnect May Devastate Hopes of MIPS Reporting Success

Posted by Lauren Patrick on December 8, 2017

Considering that the CMS Quality Payment Program can generate payment adjustments of up to 22% of Medicare Part B FFS reimbursements, it’s no wonder that many providers and health systems hope to maximize these incentives. But navigating complex Medicare requirements can be near impossible without the right tools.


Are providers likely to achieve their reimbursement goals in the second year of the QPP program? Unfortunately, as a recent State of QPP Preparedness Industry Report survey found, the answer in many cases may be no. That’s because there is a surprisingly large disconnect between the goals providers have set for themselves and the systems they are choosing to use to reach those goals.


Most providers will use their EHR, but most EHRs are not enough.

While 64% of providers hope to maximize QPP incentives, and while as many as 83% plan to use their EHR as a primary method for managing performance, only 38% are satisfied with their EHR systems’ ability to meet QPP requirements. Almost three out of four respondents reported that their EHR vendor does not offer a MIPS solution, or that they don’t know if it does. Under 5% are very satisfied with their EHR system’s ability to display overall MIPS scores and estimate financial impact.


Respondents were also dissatisfied with the amount of expert guidance offered through EHRs. For overwhelmed staff trying to navigate the often confusing Medicare requirements, expert guidance can mean the difference between successful and unsuccessful reporting. This is especially true because maximizing incentives now means more than just reporting data; providers need feedback on their captured data, and they need to be able to understand that feedback, so that they can respond to it and improve over time.


The fault does not lie with EHRs themselves so much as it does with the apparent misplaced assumption that EHRs are designed with QPP requirements in mind. The survey authors point out that EHR systems “are not intended to manage clinician data and perform the type of program management and detailed analysis required to optimize performance in a value-based program.”

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How to address the disconnect

Researchers recommended that in order to reach their goals, providers should maintain a working knowledge of eligibility changes in the coming years, and should set realistic goals based on system capabilities. Provider organizations, the researchers suggest, should also draw up a multi-year plan which accounts for potential regulatory changes. Practices should “find a purpose-built solution for value-based program management to reduce regulatory complexity and provide clarity about which activities are most meaningful.”


One such solution is the integration of reporting software with an EHR. MIPSPRO works with EHR partners to make reporting as painless and cost effective as possible, and comes with guidance from quality reporting experts who validate data before submission to CMS. The MIPSPRO platform gives users real-time dashboards, MIPS scoring, and performance reports, while our API provides data feeds for a 360 degree view of performance.


If you have questions about QPP reporting requirements, check out our MIPS Resource Library or talk to a member of our quality reporting team today.