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Quality Improvement Fundamentals and MIPS

Stethoscope and money

Connecting basic quality improvement (QI) work to new government programs can be a bit of work. A case in point is the Merit-based Incentive Payment System (MIPS), one of two payment tracks for Medicare Part B clinicians under the Quality Payment Program.

If your practice takes part in an Advanced Alternative Payment Model (AAPM), you don’t necessarily need to participate in MIPS unless your AAPM requires it. Most AAPMs do require participation in the same requirements of the MIPS program. So, in most cases you’ll need to participate in MIPS (or prescribed components of it for your AAPM) in 2018 to avoid a negative payment adjustment. And starting in 2020, the cost of care you provide will affect the way you get paid for Medicare services, based on your MIPS performance in 2018.

The four variables of MIPS―Costs, Quality Reporting, Advancing Care Information and Improvement Activities―will all count toward a performance score that can swing your payment as much as 5 percent downward or upward, depending on your performance. Costs will account for only 10 percent of your overall performance score in 2018 (for 2020 implementation), but will increase to 30 percent of your score in 2019 (for 2021 implementation), as it affects your payment fee schedule from Medicare.

What should you be looking at to work on costs? For starters, look at your Quality Resource and Use Report (QRUR) from Medicare, which reports two very important variables: Medicare Spending Per Beneficiary and Total Per Capita Costs. If your QRUR shows poor quality in some areas (which could be due to insufficient documentation) and your costs are high, you need to start doing something about it.

Identify specific areas of low quality and high cost to work on. Chronic illnesses such as hypertension and diabetes are good places to start for primary care providers. Specialists can work on other areas, such as hip and knee replacements or other conditions relevant to their specialty, using a quality clinical data registry.

Measure data on quality monthly if possible, quarterly at a minimum, to provide feedback for staff to improve quality. Publish quality data by provider if possible and share with internal staff. This is not popular in all clinics, but some clinics find it helps them identify outlying processes where comparison is possible. If you’re solo, find your cost and quality benchmarks and compare them against your peers.

Some clinics struggle with monthly and quarterly QI measurement reports, which do take time and money. Clinics that have already started on the quality path are benefiting from payment increases.

Big hint: Your electronic health record (EHR) can help you do this―your clinicians don’t have to do all the work―but you will need to manage it. You don’t necessarily need to upgrade your EHR yet; providers can use 2014 certified products for 2018 MIPS performance reporting, though they will most likely have to upgrade in 2019 to a 2015 certified version. For more details on which version you need, please contact me.

If you’re starting late, better now than never. You’ll benefit from the lessons your peers have learned and you may achieve quicker success.

For some hard facts on why you should be participating in programs like MIPS and focusing on quality and costs, I recommend that you read this post by Dan Memmott, HealthInsight’s chief financial and administrative officer.

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