Healthmonix Advisor

 The 2018 winter Olympics wrapped up this weekend in PyeongChang, leaving us at Healthmonix contemplating the many analogous connections between the Olympian athletes and providers of value-based care. So in honor of this year’s champions, we’re laying out why you should follow their example and go for the gold:

1. If you want to place, strive for peak performance.

Apply to help CMS in its new study, running from April 2018 through March 2019, and make your voice heard.

CMS is looking for groups and individuals that are eligilbe for MIPS to help study the burden that the MIPS program, particularly the Quality component, place on eligible clinicians. In return, successful participants will receive full credit for the Improvement Activity component of MIPS this year (2018).

In year two of MIPS and beyond, CMS is including an Improvement score for Quality and Cost measures. This week we take a deep dive into what this score entails, as well as what you need to know to keep yours ahead of the curve.

Living squarely in Eagles territory with the big game less than a week away, I've noticed several correlations between the journey to becoming a winning football team and the implementation of a winning value-based care strategy.  A successful transition to VBC requires time, deliberation, and dedication to improving quality outcomes.  Sharing a vision isn't enough. There must be a greater commitment by the whole team to do what is necessary to achieve greatness.  Nothing good ever comes easily, so the key to winning is to keep your eye on the prize.  Here are just a few pro-tips for paving your way to victory:

Hospital readmissions can be bad news for patients, but they can also be bad news for a hospital’s bottom line. Readmissions cost $41.3 billion overall, a majority of which—about $26 billion annually—is paid by Medicare. Moreover, as much as $17 billion of Medicare-paid readmissions are considered to be avoidable.

But why would they care? If a clinician moves to a new practice, wouldn’t they receive the score, and adjustment, for that new practice? Unfortunately for clinicians looking to start fresh, the answer is no.

In late October, CMS launched a new initiative, Patients Over Paperwork, targeted to reduce unproductive regulatory burdens on health care providers and increase efficiency. CMS Administrator Seema Verma announced the initiative during a stakeholder meeting with more than 30 industry groups.

The initiative is potentially wide reaching, affecting a broad range of regulations surrounding practices such as prior authorizations, documentation of evaluation and management codes, OIG audits, and EHR requirements.

According to Verma, this has already touched the QPP final rule for 2018. As an outcome of this initiative, the QPP final rule includes policies that exclude individual MIPS eligible clinicians with less than or equal to $90,000 in Part B allowed charges or less than or equal to 200 Part B beneficiaries.

Depending on your performance and your desire to maximize your reimbursement in 2019 (who doesn’t want more revenue?), there are a number of options available in final submission of your MIPS data to CMS. All of these choices can seem overwhelming, but Healthmonix is here to help! Read on to find out what choices you'll face and how to make the best ones for your practice.

On October 30, CMS Administrator Seema Verma announced the Meaningful Measures initiative, which is intended to streamline quality reporting. This initiative is meant to address common criticisms of today’s performance measures, including their excessive focus on evaluating processes and the lack of alignment between programs. According to Verma, “Meaningful Measures will involve only assessing those core issues that are the most vital to providing high-quality care and improving patient outcomes.”