I recently posted a blog about the upcoming MIPS (Merritt Based Incentive Payment System) program that will be impacting the entire health care industry very soon. I will continue to explore various aspects of this program in future blogs. In today’s discussion, I am going to review the potential impact of your patient panel if this program is not managed correctly within your practice.
We know that this program has the ability to have a significant impact on not only your Medicare Part B payments. The industry is very focused on the payment incentives and penalties associated with the program. This is a very black and white comparison. If you fall under the line, you get a penalty. If you are over the line, you get an incentive. However, there is another element that I feel needs to be discussed as well that isn’t discussed as much as the payment adjustments. The patient is now going to be informed with much more information than they have ever had to select who they get their care from.
Patients Will Begin to Shop for Their Clinicians
The introduction of Affordable Care Act (Obama Care) has given people the ability to have insurance. I won’t discuss the politics of this (that would most likely lead to heated discussions), but what we are seeing currently is that there are more people with insurance but many are moving to plans that maintain a high deductible to keep their monthly costs affordable. This means that while people do have insurance, they are paying a fair amount out of pocket to get that care. The need to spend their money will most likely want them to actively “shop” for the best quality and value for their money. Under the MIPS system, the score of each eligible clinician will be published for patient’s to review on the Physician Compare website. Patients will begin to review this information along with other services offered by the clinician and just like shopping for anything else, the health care system will begin to become more “consumerized”.
What Can You Do Now?
Think of 2016 as a practice run. The MIPS program first reporting period is 2017. As of today, that means that beginning on January 1, 2017 each eligible clinician will begin working on their Composite Performance Score. This is the score that each clinician will be given based on their performance and compared against the national threshold. Quality makes up 50% of this score. That is a really large percentage and will have a direct impact on not only your payments but also your patients.
Select Your Measures Carefully!
In previous reporting years for the PQRS program, many eligible clinicians had very little understanding of what was even happening with the reporting of these measures. Someone in the practice either entered something onto the claim or they hired a registry of some kind to scrub the data from their claims and sometimes clinical systems to report to CMS. That simply cannot be the same process anymore. The entire practice has to be focused on the quality measures that they have selected for their organization. These measures are very important for you to establish not only a baseline but also to be able to actually capture the data and move it forward.
We should be using 2016 as a trial run for these measures. I have listed below a few steps that you can take now that will allow you to be at your best performance starting in 2017.
- Select the quality measures that make the most sense to your practice
- Determine how to incorporate the measure entry into your EHR if it isn’t already captured (see sample below)
- Now is a good time to optimize your system to work for you and present information in a useful way
- Establish clear workflows for who is capturing the data and how it should be managed with the patients
- Develop a reporting mechanism either directly from your system or a 3rd party system
- Evaluate your current quality metrics
- Identify areas of concern and work on a plan to correct issues
Overall, it is very possible to receive a good score in quality. We have time to start this now to allow for the best planning and execution. Your practice could potentially exceed the national average and not only receive an incentive but potentially even more dollars associated with an exceptional performance bonus. Why not take the time NOW to act and become a leader on the board!