Healthmonix Advisor

Specialists: The Secret Key to CMS Success

Posted by Mike Lewis on October 18, 2018
Find me on:


  • 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.

The promise of interoperability and usable data was always the light at the end of the tunnel, but that tunnel just seems to get longer and longer every year. Providers are forced to hope that the end goal will outweigh the challenges they are going through now.

Coming out of residency, specialists are eager to see their own patients and use their expertise to provide stellar care. They are problem solvers and healers. Of course, they would answer patient questions on just about any topic, but they desire to stick to their specialty. This way of practicing has all changed with the introduction of value-based care over fee for service.

The CMS programs want specialists to have a greater responsibility in the patient’s overall care. Is this a bad thing? I don’t think so, because the end goal is to have a healthy population, and working together as a healthcare community is a big step to getting there.


A Case Study

I was once in a dermatology practice helping with their EMR implementation and the nurse was asking a middle-aged man about his smoking status. Pretty simple question, you would think. The patient doesn’t see their primary care physician and was only there because he got poison ivy; otherwise, this is a patient that never goes to a doctor. Asking about smoking led to a conversation about his overall health--which is the goal, right? At this point the patient started to open up about a cough he couldn’t kick, restless nights, and dry skin. When the doctor came in, she was prepared to consult the patient and share with them how smoking can cause all of these problems.

The next step was to refer the patient to a primary care provider. This step was made easier by collecting all the data and sending it to the primary’s EMR/EHR.


The Moral of the Story

The link between better healthcare and increased technology is there. It is right in front of us. According to The Office of the National Coordinator for Health IT, even as far back as 2015, 86.9% of office-based physicians are using an EHR. When a specialist can share the data they collect with other specialists and primary care doctors, it catalyzes communication that can only help the patient.

Helping patients is the goal of healthcare; being a provider is not a “check in the box” kind of job. Specialists play an integral part in patients’ overall health. They have always felt like outsiders in the quality reporting circle, but I believe that they can play an integral part in the future. Specialists will drive interoperability, so they can stay on their specialized EMRs. If they are forced to work on hospital systems, it will have a negative impact on their practice.

There may be some of you that disagree with my opinion that specialists will play an integral part in the growth of the CMS programs. I would like to open up the discussion with my healthcare friends on what they believe the next drivers of these programs will be. The easy answers will be the government, hospital systems, or ACO’s, but let’s think outside the box and discuss: who will be next?


Topics: PRO Tips, Small Practice