Healthmonix Advisor

Over the last month, there’s been a lot of discussion around the 2020 Medicare Final Rule updates for the QPP and MIPS here at Healthmonix and with our partners and clients. While the last three years of the program were about getting healthcare providers up-to-speed with the program, now the focus is on challenging providers to adhere to tougher rules.  High performers will reap significant rewards, others will see increasing downside.

(Malvern, Pennsylvania) - Healthmonix, the country’s largest provider of quality and MIPS reporting and healthcare data analytics, has announced a national distribution partnership with ChartSpan, the market-leading vendor in chronic care management (CCM) services.

When I was in graduate school, I was the only woman in the department of Computer and Electrical Engineering. At my first job, at an engineering company, out of perhaps 300 engineers, there were 3 women. We became close and were recruited to the company volleyball team because it needed to be co-ed in order to compete in the league. I can go on about the myriad of times I was the only woman in a meeting, group, or department.

The 2020 final rule dropped yesterday and at first glance, there are some interesting highlights.  

It felt as if the Medical Group Management Association (MGMA) Annual Conference, which we have attended for years, was smaller this year. The hall was down 10 percent, and the foot traffic was slower. Regardless, we left with plenty of insights into the state of the industry. Here are some of the highlights of what we learned:

The Merit-based Incentive Payment System (MIPS) can be rewarding for those who optimize their scores, and devastating for those who fall behind. 2019 is no longer considered a transition year, which means that the program is doing away with much of the leniency that made reporting easier in the past. The financial risk is now as high as 7%, while the performance threshold has increased to 30 points.

As the stakes continue to rise, it’s more important now than ever before that organizations strategize about their MIPS reporting process for 2019 and beyond. And in the course of that effort, one major decision they will need to weigh carefully is whether to report as individuals (at the NPI level) or as a group (at the TIN level).

For many years now, Healthmonix has supported clients who engage with the Merit-based Incentive Payment System (MIPS) on a variety of levels, in terms of the maturity of their process. At the lowest level—let’s call it Level 0—we have clients that come to us because they just want to report and avoid a penalty. Just beyond that, at Level 1, are those clients that seek an incentive.

Now, as we continue to settle into the brave new world of value based payments, we have noticed that our clients at Level 1 are starting to get comfortable. Clearly they are investing time and effort into the process, but with incentives still relatively small, MIPS can unfortunately seem more like an annoyance than an opportunity, and it can be hard to see beyond the immediate requirements.

But we’re thinking bigger, and we want you to do the same.

There's a lot to learn about Merit-Based Incentive Payment System compliance in 2019. Luckily, we've produced many resources over the past few months that break down the essentials in a way that is more quickly understood than reading hundreds of pages of federal policy. We've rounded them up for you this week in one convenient list!