Healthmonix Advisor

Did you know that CMS has a variety of free resources and organizations dedicated to helping clinicians navigate the Quality Payment Program? In today’s blog, we’ll help you understand your options so that when you have a question, you’ll know where to turn. (This is a good one to bookmark for later!)

Since the latest Physician Fee Schedule and Quality Payment Program final rule was released in November 2018, organizations across the country have scrambled to understand key changes that have been made and adapt to their implications. In today’s blog, I want to focus on one change that may well prove significant to billing and Revenue Cycle Management teams: groups of 16 or more can no longer report via claims.

If your organization invested significant money and time into achieving a high MIPS score in 2017, the final incentive payment you received may have felt… well, disappointing. As easy as it may be to recognize the ideological importance of shifting from fee-for-service to value-based care, many clinicians and organizations feel unable to practically justify such an investment in the absence of a meaningful financial incentive.

But there’s good news: incentives will continue to rise in coming years, and those achieving the highest scores will soon find their efforts rewarded on a much larger scale. Here’s why.

Patients want to be treated with dignity and respect. And when they are, as the American College of Physicians (ACP) points out in a recent position paper on patient engagement, they are more likely to interpret their experience as a quality care encounter. Organizations can improve outcomes and adherence to care plans by helping patients and families feel central to their own care experience, and research even suggests that patient experience is a more important factor in patient loyalty than standard marketing efforts.

Have you checked your 2018 MIPS eligibility status? Since September?

CMS emailed physicians to let them know that their MIPS status for this year may have changed that recently--and some physicians may find that they are no longer eligible to participate. Although CMS conducted an initial review of Medicare Part B claims and Provider Enrollment, Chain, and Ownership System (PECOS) data between September 2016 and August 2017, further updates were made after a second review that took place between September 2017 and August 2018. If you are eligible, your 2018 performance will affect your 2020 Medicare payment adjustment.

Most post offices in the United States stay open late on April 15. The online voter registration portal for voters wishing to weigh in on Brexit crashed due to traffic two hours before the deadline. Our MIPS reporting customer support channels reach their peak traffic between on March 24, a week before the submission deadline. It is clearly human nature to procrastinate, so if you've reached December without a MIPS reporting plan, you're certainly not alone.

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.

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.

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.