Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Value-Based Care News

AMA Pres: Align MIPS Improvement Activities with APM Demands

Providers can “future-proof” value-based care investments by engaging in MIPS Improvement Activities that align with alternative payment model goals, the AMA President stated.

MIPS Improvement Activities and alternative payment models

Source: Thinkstock

By Jacqueline LaPointe

- Providers can ensure their investments in the Merit-Based Incentive Payment System (MIPS) are worth it by engaging in Improvement Activities and other practice transformations that enhance overall Medicare performance and lead them to the alternative payment models, advised AMA President David O. Barbe, MD, MHA.

“Taking purposeful steps to align our current practice-improvement efforts under MIPS with the eventual demands of APMs is a great way to future-proof our investments,” he wrote on the association’s website.

Policymakers and HHS officials designed MACRA to push providers to risk-based alternative payment models beyond MIPS, Barbe pointed out. Implementing quality improvement activities that support risk-based alternative payment models is key to achieving this goal.

Despite HHS goals to move providers to alternative payment models, physicians have been hesitant to make the transition, he recently explained in an interview. Misaligned program requirements and clinical workflows have providers questioning if making the investment in value-based reimbursement is worth it.

“It has come at a pretty substantial cost,” he said. “The investment that physician practices have had to make has been significant for technology and human resources. And it has taken a toll and changed the way a physician’s day goes and how it feels. That has led to incidents of physician frustration or even burnout.”

Providers have particularly shied away from investing in MIPS, he added. CMS excluded about one-third of providers from participating in the program this year and enforced a “Pick Your Own Pace” reporting strategy.

“If a physician has $100,000 in Medicare receipts and gets the maximum incentive on that of 4 percent, that’s $4,000,” he stated. “It costs multiples of $4,000 to ramp up IT and staff in order to do that. Some will simply make the decision on a business case — the investment is not worth the return. We understand that.”

While the business case to delay investing in value-based reimbursement resources is strong, neglecting to or postponing quality improvement and practice transformation projects will not move eligible clinicians to alternative payment models.

Providers should engage in MIPS Improvement Activities that promote care delivery that aligns with alternative payment model goals, Barbe advised in the AMA post.

Under MIPS, eligible clinicians must submit data on four Improvement Activities to qualify for neutral or positive payment adjustments when MACRA is fully implemented. Clinicians can currently choose from 93 activities listed on the CMS Quality Payment Program website.

MIPS Improvement Activities range from relatively simple quality improvement and practice transformation efforts that apply to all provider types to more specialty-specific or advanced efforts. Approved activities such as implementing certified EHR technology and increasing patient access to clinicians are generally applicable, Barbe explained.

But “forward-thinking physicians” are looking to “easily integrated activities that improve the overall quality of care they provide,” rather than just meeting MIPS requirements. These clinicians are engaging in Improvement Activities that:

• Enhance preventative care and chronic disease management

• Increase inclusion of patients, families, and caregivers in treatment plans

• Invest in resources and processes that encourage patient engagement and support timely health data exchange

These Improvement Activities are strategies that “best support the growth and sustainability of our practices and the needs of our patients.”

Providers should use CMS and AMA resources to select the most appropriate practice transformation and quality improvement activities for their organization and calculate the potential financial implications.

AMA manages a MACRA webpage that details Quality Payment Program requirements and offers a 10-minutes assessment for physicians to determine the financial impact the program may have on their practice.

The association also has the STEPS Forward series, which helps providers develop improvement strategies that increase efficiency and advance patient care. The series offers quality improvement best practices and practice transformation processes.

CMS also maintains a Quality Payment Program website that explains program rules and requirements.

The quality improvement and practice transformation initiatives should guide eligible clinicians to alternative payment models, which incentivize providers to increase care quality while reducing spending across all healthcare stakeholders.

MACRA’s Advanced APM pathway offers clinicians an automatic 5 percent incentive payment for those who sufficiently participate in an approved model. Qualifying participants are also exempt from MIPS.

Clinicians who engage in an approved alternative payment model, but do not meet participation thresholds will also earn favorable scores in a special APM standard under MIPS.

Providers should be aware that preparing their organizations for risk-based and value-based reimbursement will take time, he noted in the AMA post.

“While change is a constant, it doesn’t have to happen all at once,” Barbe stated.


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