Healthmonix Advisor

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.

Note: This article will update as we learn more, and to reflect any changes that may happen before the rule is officially published to the Federal Register on November 23, 2018. To view the entirety of the final rule, view the unpublished pdf version.

In August, the Centers for Medicare and Medicaid Services (CMS) released their proposed rule titled “Pathways to Success,” which outlined significant changes to the Medicare Shared Savings Program (MSSP) that encourage ACOs to move more quickly from one-sided to two-sided risk models. The proposed participation options for the MSSP--the largest ACO model with 561 participants--no longer include an “upside-only” risk model; instead, ACOs would be required to select one of two tracks, both of which ultimately include some downside risk.

EHRs have undoubtedly already changed the way healthcare works in America, and many of these changes have been for the better. Improved workflows and care delivery, enabled through EHR technology, are in many cases key to improving both patient and public health outcomes. But in the face of increasing requirements for providers, and the ever-looming need for health systems to justify their investment, EHRs must recognize that demand is high for a product that continues to improve and keep up with the changing times.

• I’m seeing a patient for dermatitis – Why do I need their BMI?
• I’m seeing a patient for a colorectal screening – How is it going to help me if they got their flu shot?
• I’m a Specialist. Why is it my job to ask these questions?

I encountered these questions all the time as a MIPS consultant within the specialty market. I spent the past 6 years working with providers who just want to provide better care to their patients. They didn’t mind participating in the programs, but they were not convinced there was much value.

In the pursuit of value based care, interoperability is key. But is it achievable in the current healthcare landscape? And if not, what would we have to do to bridge that gap?

Net Health, the leader in software solutions for specialized outpatient care, has partnered with Healthmonix to provide streamlined Merit-Based Incentive Payment System (MIPS) reporting for its WoundExpert customers.  The companies will collaborate to simplify the reporting process, improve patient health outcomes and maximize revenue. 

There’s no doubt that MIPS involves a learning curve. The program’s rules can be complex and can require cumbersome initial investments of time and money, leading many doctors to try to avoid it altogether. But MIPS matters, and the most successful doctors in coming years will be those who invested wholeheartedly in the reporting process. Here’s why.