The MACRA program has been placed to give clinical providers the time to consider their options. However, since its implementation, the large number of changes has disconcerted majority of the industry and several of them remain confused as to what is required of them and what choices they should make to comply. And mostly, many are concerned about the readiness of their colleagues to make these choices.
The deadline to start collecting performance data for the QPP (Quality Payment Program) Merit-based Incentive Payment System (MIPS) was Monday, the 2nd of October. These clinicians opting to submit only ninety days of quality data must hand it over to the CMS by the 31st of March, 2018.
Fewer than one in four practitioners feel up to the task of meeting QPP requirements, according to the American Medical Association. Over a span of five years, the CMS has committed over a hundred million dollars to assist small practices in meeting the requirements of the MACRA program; however, many are still struggling to understand it, and some wonder if the money put in has been sufficient.
The importance of choosing metrics
Choosing metrics has boomed in importance because it has become the determining factor in what questions providers will ask and the ultimate changes in clinical behavior. However, it is a daunting task because there are more than three hundred options available; and for multi-specialty practices, there are an exponential number of options.
As for improving clinical service, there are over ninety options, and many are specialty specific. According to officials, the goal is not just attaining a bare minimum, but getting a running start to the future years.
The long-term impacts
Many clinicians are not concerned about the long-term effects and merely wish to elude a penalty for this year. It is advisable to have a long-term strategy to manage MIPS.
By this decree, clinicians that score above the MIPS performance threshold are rewarded with escalating incentives; and those that are below it are penalized. A logical approach to maintaining and optimizing your score on a regular basis would be beneficial.
The MIPS score, however, is not just about reimbursement; it is a permanent mark on clinician’s record. There seems to be a general disregard, or maybe ignorance, about how deep this program runs and the lasting long-term effects. Since it is not something that will disappear every year, as the widespread misconception seems to be, trying to craft an effective strategy would be rational.
Modern digital solutions
For now, major healthcare organizations seem to be relying on tools that have been provided by the government to analyze, calculate MIPS scores and do their best to optimize. While many have not looked outside of what EHR vendors and the state have provided, there are several other MACRA solutions available. All major EHR vendors provide solutions for MACRA, and you only need look in the right place.
Some vendors began providing guidance to their customers on the best way to leverage solutions to meet the QPP requirements from the middle of 2016.
Such tools allow physicians to verify their eligibility and calculate their performance score by computing, data measured from the EHR, the quality categories of MIPS, etc. The tools allow them to further input their improvement techniques and activities. The reporting capabilities of these systems are by far greater than expected. They support the program requirements wherever necessary.
This is one such example of a good EHR. With the increase of such vendors, the health industry has seen an increase in analytics and thereby an increase in productivity and performance.
However, healthcare providers are fixated on finding better tools that capture data more efficiently without losing sight of patient records and health history.
Many clinicians prepare themselves for the submission and anticipate great scores. They wonder how CMS applies the algorithm to score them – the score that is displayed on the dashboard and scorecards.
Some healthcare IT companies provide a combination of tools that help users decide which measures will increase their score and how to adopt improvement methods that will help them reach their goals.
The market requires tools that not only validate the current year’s data, but also compare it with the previous year’s statistics to give an optimal report. With this comparison, the reports can provide insight on the steps to take moving forward and improving the quality of healthcare.
Caution to the providers – Be aware of outlier clinicians as their activities have to be accentuated to provide optimal scores.
Challenges still remain
However, with all the effort and development the IT industry has put in, there are still many challenges that clinicians have to overcome in order to prepare for MIPS and MACRA.
The hurdles are not too high; however, the complexity of the program to not be undervalued. The potential it has to provide better healthcare for lower costs is greatly advocated by the government.
Since the government has taken the initiative to get the system implemented, many physicians and clinicians tend to get overstressed. The link between CMS based programs and clinicians’ burnout is predicted to increase. However, it is not a cause for concern as the scores might be low only because they didn’t have access to CMS cost and quality data.
Keeping providers concerns in mind, the 2018 QPP proposed rule has allowed for exemptions. It is predicted that with all the exemptions in place, only a meager 36% of healthcare providers will be eligible for MIPS.
Health care providers should take note that this system is going to be full-blown implemented and it is better not to reach out to these exemptions as local competitors with higher scores can affect their business.
If the work has to be done anyway, why not start now. Start preparing for the MIPS validation and align practice improvement goals, keeping the score in mind. This system is a blessing for both the providers and the healthcare seekers. It reduces the cost for the health care seekers and improves the quality of the service provided by the healthcare providers opening them up to more business.
If you enjoyed this article, you are recommended to read about the 2018 proposed MACRA rule here.
Saqib Khan
Saqib Ayaz is the co-founder of Workflow Management & Optimization https://www.workflowoptimization.us, a technology, software and back-office services company, that provides every conceivable solution for your business and practices. I'm an expert in managed enterprise HR, technology outsourcing and practice management solutions.