Healthmonix Advisor

If your organization invested significant money and time into achieving a high MIPS score in 2017, the final incentive payment you received may have felt… well, disappointing. As easy as it may be to recognize the ideological importance of shifting from fee-for-service to value-based care, many clinicians and organizations feel unable to practically justify such an investment in the absence of a meaningful financial incentive.

But there’s good news: incentives will continue to rise in coming years, and those achieving the highest scores will soon find their efforts rewarded on a much larger scale. Here’s why.

As laid out in the 2019 MACRA final rule*, one of the ways CMS hopes to expand participation options in the program’s third year is by offering certain facility-based clinicians, if they participate as a group, the option to use facility-based Quality and Cost performance measures. CMS expects to release a facility-based scoring preview for this option, which does not require any data submission, in Q1 of 2019. In today’s blog, we’ll take an in-depth look at the details of facility-based scoring and how it will be applied.

With the new year comes a renewed focus on data analytics and interoperability.

Patients want to be treated with dignity and respect. And when they are, as the American College of Physicians (ACP) points out in a recent position paper on patient engagement, they are more likely to interpret their experience as a quality care encounter. Organizations can improve outcomes and adherence to care plans by helping patients and families feel central to their own care experience, and research even suggests that patient experience is a more important factor in patient loyalty than standard marketing efforts.

Have you checked your 2018 MIPS eligibility status? Since September?

CMS emailed physicians to let them know that their MIPS status for this year may have changed that recently--and some physicians may find that they are no longer eligible to participate. Although CMS conducted an initial review of Medicare Part B claims and Provider Enrollment, Chain, and Ownership System (PECOS) data between September 2016 and August 2017, further updates were made after a second review that took place between September 2017 and August 2018. If you are eligible, your 2018 performance will affect your 2020 Medicare payment adjustment.

Most post offices in the United States stay open late on April 15. The online voter registration portal for voters wishing to weigh in on Brexit crashed due to traffic two hours before the deadline. Our MIPS reporting customer support channels reach their peak traffic between on March 24, a week before the submission deadline. It is clearly human nature to procrastinate, so if you've reached December without a MIPS reporting plan, you're certainly not alone.

“The early bird gets the worm.” 

I'm not sure when I heard this for the first time, but it became the guiding principle to my work ethic. Always show up first to any event whether personal or professional - that's the code.  This time it paid off!

Value-based care seems like such a good idea. Who doesn’t want better health, and better care, at a lower cost? It is one of the premises of the MACRA legislation: “Change the way that Medicare rewards clinicians for value over volume.” We all think, in theory, preventive care is better than fixing problems after they occur. That’s why we take our cars in for regular maintenance, we have our furnace checked each year before winter, we get our teeth cleaned and checked every six months.

Yet, the current evolution to value-based care is adding burden and distracting from care in many ways, rather than focusing on the intended goals. I attended the Patient-Centered Oncology Care (PCOC) 2018, the annual meeting presented by The American Journal of Managed Care, last week and listened to some of our most highly-trained and most needed oncologists talk about how the current payment models have affected their practices. Oncology practices have been asked to take on risk for the cost of care and manage that cost. These practices are now responsible for costs that are not within their control, and that they don’t even know about until long after decisions have been made.

Bundled payments are on the rise. Last Thursday, Health and Human Services Secretary Alex Azar announced in a keynote speech at the Patient-Centered Primary Care Collaborative Conference that CMS will be revisiting mandatory bundled payment models, changing the way bundled payment programs have been treated by this administration under his predecessor, Tom Price.

CMS reports that for 2017, just over 90% of eligible clinicians participated in the Quality Payment Program (QPP). That number is impressive, but what about the nearly 10% who declined to participate? Many adopted a “wait-and-see” approach, or were concerned that the required investment of time, money, and effort wasn’t worth the reward. But the QPP is here to stay, and some physicians may only now be wondering where to start, or even whether they can succeed at all after avoiding it for so long.

If you find yourself among that number, don’t worry, because it’s not too late! This week we’re laying out the first things you should know, and the first steps to take.