Healthmonix Advisor

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!

Malvern PA, August 7 2019 – Healthmonix, an industry leader in healthcare performance analytics, has been approved as a certified quasi-Qualified Entity (quasi-QE) by the Centers for Medicare & Medicaid Services (CMS). This status allows Healthmonix to use QCDR clinical data, combined with CMS Medicare data, to publicly report provider performance across the US.

Healthmonix is also launching the CostPRO^TM platform, integrated with the industry-leading (as published by KLAS) MIPSPRO platform. CostPRO is an unprecedented solution for Cost performance tracking and optimization that supports the Cost component of MIPS reporting, allowing providers and their staff to be proactive in analyzing the cost of care for their patients, and to determine how to control spending and provide better value throughout their ongoing care.

Since 2017, the Centers for Medicaid and Medicare Services (CMS) Merit-Based Incentive Payment System (MIPS) has provided eligible clinicians a score of zero -100 annually based on the clinician’s efforts and data collection in four program categories: Quality, Improvement Activities, Promoting Interoperability, and Cost. A clinician’s final score for each year’s MIPS performance ultimately dictates a payment adjustment that is applied to his or her Medicare Part B reimbursement rate two years later. In practical terms, this means that a clinician’s 2017 performance impacts all of his or her Medicare claims that are filed in the 2019 calendar year.

In last week’s blog I laid out the case for opting into MIPS, an option that allows clinicians and groups to still receive a MIPS payment adjustment if they exceed 1 or 2, but not all, elements of the low-volume threshold. Although this option can be beneficial for a wide range of clinician types depending on their situation, today I want to focus on psychologists in particular. Because in my experience, they provide some of the most striking examples of this “MIPS hack” in action.

Today, CMS posted CY 2020 Updates to the Quality Payment Program to the Federal Register. Many clinicians are still trying to wrap their heads around how to report MIPS in 2019, but the release of the 2020 proposed rule is advantageous in deciding what to conquer both this year and in the future. As the title suggests, this document also covers other Quality Payment Program tracks, like Advanced APMs; however, for now we will just focus on the MIPS component of the proposed rule.