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

Value-Based Care News

Quality Payment Program, MIPS Top 2017 Regulatory Burden List

The Quality Payment Program topped the list of most burdensome regulations in 2017, with providers especially concerned about the clinical relevance of MIPS.

Providers cited the Quality Payment Program and MIPS as their top regulatory burden in 2017

Source: Thinkstock

By Jacqueline LaPointe

- Medicare’s new value-based reimbursement program has topped the list of most burdensome regulations for healthcare providers, according to a new MGMA survey. About 82 percent of leaders from 750 group practices viewed MACRA’s Quality Payment Program as “very” or “extremely” burdensome.

While the survey showed that 84 percent of providers and practice leaders plan are participating in the program via the Merit-Based Incentive Payment System (MIPS) in 2017, the providers expressed concerns about the relevancy of MIPS. Approximately 80 percent of respondents stated that clinical relevance was a key concern with the value-based reimbursement program.

Another 73 percent of respondents stated that they viewed MIPS as “a government program that does not support their practice’s clinical quality priorities.”

Other top issues that providers ranked as “very” or “extremely” challenging with their practice’s ability to successfully participate in MIPS included:

• 78 percent said relevance to specialty care

• 71 percent reported overall implementation costs

• 69 percent stated unclear program guidance

• 67 percent cited timely feedback

• 59 percent said conflicting program requirements

• 56 percent stated unattainable program requirements

Less than one-half of providers and practice leaders found inadequate preparation time and vendor readiness as key MIPS issues.

MGMA also uncovered that providers and practice leaders view the MIPS performance scoring methodology as complex. About 38 percent of participants rated the scoring system as very complex and another 35 percent considered it extremely complex.

Only 6 percent of providers and practice leaders thought the value-based reimbursement program’s scoring methodology was slightly or not complex.

Despite providers voicing several issues they have with participating and succeeding in MIPS, most of the survey respondents plan to report the full set of MIPS data during the transition period in 2017.

Roughly 41 percent said they anticipate submitting complete MIPS data to earn a positive payment adjustment as well as an exceptional performance bonus in 2019.

The next most common MIPS participation track in 2017 was reporting some data to qualify for a modest payment adjustment with 31 percent of participants, followed by reporting the minimum MIPS data to avoid a penalty with 20 percent of respondents.

Just 8 percent of providers and practice leaders are unsure of their MIPS reporting pace in 2017.

In terms of the other Quality Payment Program track, about 40 percent of practice leaders stated that they are uncertain about participating in an Advanced Alternative Payment Model in 2017.

Although 13 percent said they are planning to join the Comprehensive Primary Care Plus (CPC+) program, 6 percent said they are in a qualifying Medicare Shared Saving Program accountable care organization (ACO), 4 percent are in a Next Generation ACO, and 2 percent expect to join the End-Stage Renal Disease model.

No participants expect to participate in the Oncology Care Model or collaborate with a hospital in the Comprehensive Care for Joint Replacement model. Another 36 percent also reported “other” when asked if they plan to join an Advanced Alternative Payment Model.

Additionally, the survey showed that providers and practice leaders are facing a number of other regulatory burdens. The other top troublesome regulations besides the Quality Payment Program and MIPS that respondents labeled “very” or “extremely” burdensome were:

• Lack of electronic attachments for claims and prior authorizations with 74 percent

• Payer audits and appeals with 69 percent

• Lack of EHR interoperability with 68 percent

• Payer use of virtual credit cards with 59 percent

• Accessing data through Medicare web portals with 53 percent

• Translation and interpretation services with 53 percent

To comply with federal regulations, practice leaders are spending a significant amount of money. Nearly one-half reported spending over $40,000 per full-time equivalent physician a year to meet regulatory requirements.

“The magnitude of regulatory demands on physicians forces medical group practices to needlessly focus precious time and resources on administrative tasks instead of patient care,” stated Halee Fischer-Wright, MD, MMM, FAAP, CMPE, MGMA President and CEO. “MGMA calls for national effort to relieve physician practices from excessive government regulation and looks forward to working with both the Administration and Congress to find meaningful solutions.”


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