Healthmonix Advisor

The shift from volume to value-based care can be frustrating, especially when the reasons behind such a significant change aren’t clear. But with an estimated 250,000 American deaths per year caused by medical errors, minimizing these errors is a noble and vital effort. Additionally, CMS is now raising the bar for healthcare providers with the assessment of quality metrics against benchmarks and peers. With that in mind, let’s break down the meaning of, and intentions behind, Quality Measures.

When we asked MIPS eligible clinicians about their experiences transitioning from PQRS this year, one of the biggest takeaways was that quality matters even more under MIPS than it did under PQRS. Clinicians who want to maximize their reimbursement would consequently be very smart to start reporting as early as possible, and to adjust performance to maximize quality, rather than waiting until the end of the year. If you’re not sure whether or not you are a MIPS-eligible clinician, take advantage of one of the following resources for determining your MIPS participation status as soon as possible so that you don’t get left behind.

On Monday night this week, in the wake of news that there might not be enough votes to pass the updated Senate version of the AHCA, Senate Majority Leader Mitch McConnell (R-KY) announced a plan to vote for legislation that would repeal most of Obamacare without immediately putting an alternative in place. The alternative plan would instead be developed over the course of the next two years.

Transparency is a vital aspect of the transition to quality care because it allows patients to make more informed healthcare choices. To this end, CMS has increased accessibility of physician information with the Physician Compare website, which publicly reports provider data including some quality measures. If you are a provider and want to assess or even optimize how you appear compared to your peers, you may have questions about how the Physician Compare website works and how to make sure it represents you accurately.

The American Health Care Act (AHCA), also known as Trumpcare, was narrowly passed through the House of Representatives on Thursday May 4th. On Thursday June 22nd, after a secretive seven-week revision process led by Majority Leader Mitch McConnell, a draft of the Senate version of the bill has been released. Following is a comparison of some of the important changes between the ACA (Obamacare) and both versions of the AHCA.

Maybe you’ve reported PQRS in the past and are already preparing to make the transition to MIPS this year. Or, maybe this year is the first time your practice plans to report. Either way, your method of reporting can help determine whether or not you achieve your quality and revenue goals, and the benefits and drawbacks of different methods must be weighed in relation to the unique needs of your practice. To give you a place to start, this post compares and contrasts some considerations related to two common submission mechanisms: EHR and Qualified MIPS Registry reporting.

HIMSS is the seminal event in healthcare technology each year.  This year it grew to 45,000 attendees and literally a mile of exhibit hall.  We logged miles of walking in one day just to cover the exhibit floor, and still did not see it all.  At this pivotal time in healthcare information technology, there were many important themes that were covered.

Early on the morning of February 10th, the Senate approved the nomination of now-former Rep. Tom Price to be the Secretary of Health and Human Services.  While some say his chief priority is “dismantling of the Affordable Care Act”  (Sen. Maria Cantwell of Washington), the tasks that will be put in front of him also include five major health IT initiatives:  appointments to ONC and other agencies, the future of MACRA and Meaningful Use, the enforcement of interoperability, telemedicine, and cybersecurity. 

The MIPS Quality Performance Category is replacing PQRS reporting in 2017, folding it into the Merit-Based Incentive Payment System. The Quality portion will comprise 60% of an eligible clinician's MIPS Composite Performance Score for 2017.  To calculate that score, there is significant math involved.  This article will walk you though the calculations and logic used to determine your Quality score, but it is important to note that many data submission vendors will automatically give you a predictive calculation.

In December we posted about a CMS announcement related to ICD-10 diagnosis and procedure code changes, and how this might affect payment adjustments in 2018. At the time CMS had not yet issued their addendum detailing specific code updates for measures being used in the Merit-Based Incentive Payment System (MIPS), but now that they have, here’s an update:

CMS and the National Library of Medicine (NLM) have published the addendum to the 2016 eCQM specifications which affects ICD-10 Clinical Modification (CM) and Procedure Coding System (PCS) value sets for 2017. Health Quality Measure Format (HQMF) specifications, value set object identifiers (OIDs), and measure version numbers for 2017 were not changed. The eCQM value set addendum for 2017 is published to the eCQM Library and the eCQI Resource Center. The NLM’s Value Set Authority Center also provides a complete list of revisions to the eCQM value sets.