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

Value-Based Care News

Using EHR Systems, Supports to Aid MIPS Reporting, Boost Scores

Clinicians at Premier Dermatology expect to earn incentive payments under MACRA with the help of MIPS reporting support in their EHR system.

MIPS reporting and EHR systems

Source: Thinkstock

By Jacqueline Belliveau

- Delivering high-quality care is already a complicated process for healthcare providers. Understanding, as well as reporting, to MACRA’s Merit-Based Incentive Payment System (MIPS) has made the task even more complex, explained Brad J. Abrams, DO, FAAD, a dermatologist and Mohs surgeon.

CMS designed MIPS to accelerate the value-based reimbursement transition. But many providers, especially specialists, have yet to catch up with how the value-based reimbursement program works.

About one-half of providers recently told the American Medical Association (AMA) and KPMG that they were somewhat knowledgeable of MACRA and affiliated programs, while another 41 percent admitted that they had heard of MIPS and other MACRA models, but were not knowledgeable.

While provider understanding of MACRA was lacking, specialists were particularly uncertain of their MIPS knowledge. All 800 specialty physicians surveyed in June 2017 stated that they have yet to fully understand MACRA and MIPS.

Of the surveyed specialists, 41 percent also reported that they are still working to comprehend MIPS despite the program launching at the start of 2017.

READ MORE: MIPS Quality Reporting Flexibilities Trouble Providers, EHR Vendors

From the original 2,400-page MACRA implementation rule and subsequent rules to a new MIPS quality reporting system, providers are finding that their jobs are getting harder.

“There are so many things that we have to worry about during the course of a day,” Abrams of Premier Dermatology in Sarasota, Florida recently told RevCycleIntelligence.com. “It seems like it’s getting to the point where taking care of patients is the easiest thing I do.”

Comprehending government rules on MACRA and MIPS and learning how to report information to avoid penalties added to Abram’s already full plate.

“It seemed like a laborious chore that we had to do a certain amount of reporting,” he added. “For example, we now had to report on melanoma, our security risk and analysis, and who got vaccinated and who didn’t get vaccinated for the flu. The government just puts on these restrictions that further complicate an already complicated situation.”

To shoulder the burden of participating in MIPS, Abrams turned to the health IT world for a solution specific to the new MACRA program. He hoped a software or system would prevent his practice from receiving a four percent negative Medicare payment adjustment under MIPS in 2017.

READ MORE: What We Know About Value-Based Care Under MACRA, MIPS, APMs

“I, as well as all the other physicians, were pretty concerned about getting a really good method and software that was able to address MIPS,” he said. “It would decrease our anxiety. We were worried about getting dinged as far as the government would give us a penalty. There were also the rewards that we didn’t want to miss out on as well.”

Abrams and his colleagues researched third-party solutions and different health IT vendors. But the answer to MIPS reporting support was through Premier Dermatology’s own EHR vendor, Modernizing Medicine. The company offered a MIPS composite score reporting component built into its EMA EHR system.

“There were a lot of options out there,” he elaborated. “One option was to go with another company that just does MIPS, but we all decided that it doesn’t make sense to go with an outside company, rather than going with a company that’s fully integrated. So, we took third-party companies out of the equation.”

Through the practice’s existing EHR system, providers at Premier Dermatology could access reports that generated the clinician’s MIPS composite scores.

CMS plans to determine a MIPS composite score for each eligible clinician in the program using three performance categories in 2017: Quality, Advancing Care Information, and Improvement Activities.

READ MORE: MIPS Reporting Success Depends on Choosing Suitable Measures

The composite score will determine MIPS payment adjustments. Scores above the performance threshold will earn clinicians an incentive payment, whereas scores below the benchmark will bring penalties. At full MACRA implementation, the threshold will be the mean or median performance score.

Rather than gathering and analyzing data from across the organization and trying to understand complex CMS methodologies for calculating performance, Abrams can view his potential MIPS composite score with a click of a button.

The ability to regularly view his MIPS reporting and performance scores encouraged the practice to fully participate in MIPS despite 2017 serving as a transition year.

Eligible clinicians have the option of not participating in MIPS this year and receiving an automatic 4 percent penalty, submitting partial data and earning a neutral or modest positive adjustment, or fully participating and receiving a higher positive MIPS payment adjustment.

“We’re fully participating and, as a matter of fact, I just looked up on my software and now it’s like 98.7 percent as far as MIPS is concerned,” Abrams stated. “So, I don’t have any anxiety. I sleep fine at night because I’m not concerned at all about MIPS.”

Implementing a MIPS or EHR system that could integrate quality measures and present them to providers in the exam room was also key for MIPS support.

“When my medical assistants go into the room, they go into the MIPS program and there’s a bunch of questions that they answer,” he explained. “Has the patient been vaccinated for the flu? Any history of melanoma? Was it reported? They just check off all the boxes.”

The EHR system also records when providers check off quality measure boxes to improve efficiency and provider productivity at the next appointment.

“What’s really great about it is the next visit they have, they don’t have to ask the same questions again. It carries on to the next visit,” he said. “For example, if the patient had a vaccination and my nurse checked off vaccinations, if I see the patient back in four weeks, we’re not going to ask them if they had another vaccination because it was already checked off. It saves us time.”

In addition to MIPS reporting support, Abrams found that his EHR vendor offered personalized coaching on MACRA. The company connected Premier Dermatology with an industry expert, who specifically monitored and advised the practice’s providers on MIPS.

“We just send her an email or place a phone call,” he stated. “We also have quarterly calls to review our data. If she sees that we’re falling low in one area, she’ll give us a call and say, ‘You know, you guys are falling below in this aspect. This is what needs to be done in order to catch up.’”

The MIPS coach also takes health policy and law interpretation off provider plates. Abrams stated that he no longer attempts to interpret every MACRA implementation rule or regulation coming from the government because his MIPS coach advises him on the key points he needs to know.

“I don’t have to go on to ten or fifteen websites to figure out, ‘Okay, what’s the newest thing that they decided to put into MIPS?’ Our experts are already on top of it,” he said.

Without that responsibility, providers at Premier Dermatology could now focus on delivering high-quality care that also lives up to MIPS performance standards.

The personalized MIPS support in conjunction with regular score reports should boost the practice’s MIPS composite score, Abram predicted. And those high scores should translate to greater MIPS payment adjustments as the first performance year draws to a close.

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