Category Archives: Quality Payment Program

MACRA is not the Macarena But It Is A Dance You Can Learn

The Medicare Access and CHIP Reauthorization Act of 2015, also known as MACRA, is on the minds of physicians and practice managers from coast to coast. As with any new ruling from CMS, the challenge is to fully understand the changes to the law and what it means for your practice. Change is never easy, but this change has to be met head-on, or the clinic’s bottom line may suffer.

To help address your questions about MACRA, GE Healthcare is hosting a webinar called “MIPS, MACRA and YOU in 2018” on Monday, November 27th from 9:00 a.m. to 10:00 a.m. Pacific Time. The webinar will feature Mark Segal and Donna Maddox from GE Healthcare, and David Swartout from Mountain View Medical in Forest Grove and Hillsboro, Oregon.

While MACRA presents a host of new challenges for clinics, Donna Daniel of IBW Watson Health argues that managing and analyzing patient data is the core function that clinics must learn to master.

Provider performance will be measured against national peer performance to establish goals, incentives, and payment structure. Organizations that perform well against the quality benchmarks while controlling costs will be financially rewarded. Those who miss the mark may see their Medicare reimbursements shrink. This puts a great deal of pressure on providers to immerse themselves in performance metrics.

We all know that practicing medicine has plenty of its own pressures. Know that you can lean on HealthCo and GE Healthcare to help you manage MACRA/MIPS.

Understanding Merit-based Incentive Payment System (MIPS)

MIPS replaced the Physician Quality Reporting System, Value-Based Modifier, and Meaningful Use of electronic health records programs. It also added a fourth component, Improvement Activities, which is intended to give physicians credit for their efforts to reduce disparities in care, engage patients in shared decision-making, and other activities designed to improve care.

Instead of three separate programs, MIPS is designed to be one cohesive program with a single score for each physician or group. The score will be derived from four components: quality, costs, improvement activities, and advancing care information.

Sandy Marks, Assistant Director of Federal Affairs at the American Medical Association, notes that MIPS presents a variety of special challenges for small and rural practices.

When Congress enacted MACRA, it recognized the unique challenges facing physicians in small and rural practices. For example, the law required CMS to set a low-volume threshold so that physicians who do not treat enough Medicare patients to have a chance at getting a positive return from participating in MIPS would be exempt from it. MACRA also called for creating virtual groups so that physicians in small and rural practices can combine their resources to jointly report on MIPS measures.

Get A Firm Grip On 2017 MIPS Reporting

Under MIPS, each clinician will be measured against four categories: quality, cost, improvement activities and advancing care information. Quality is the most important category right now, as it accounts for 60% of the clinician’s overall score. Each clinician under the MIPS program receives a final score (from 1 to 100) and that number determines the amount of payment the clinician is eligible to receive in 2019.

If you’d like to learn more about these four reporting categories, CMS has excellent “explainer” videos on the topic available.

Our dedicated team of Centricity Practice Solution specialists is also available to walk you through any specific MACRA- or MIPS-related questions.

Better Data Leads To Improved Care And Higher Profits

Meeting the various reporting and measurement standards imposed by CMS is no cakewalk. On one hand, clinicians must be adept at change management. On the other, they must be technically proficient and knowledge rich.

There can be no doubt that successfully practicing medicine today requires clinicians to overcome several significant challenges. It’s our job to reduce at least one challenge—and we do, by clearing the path to payment under value-based care.

Shiv Gopalkrishnan, GE Healthcare’s General Manager of Enterprise Financial Management Solutions, addresses one problem head-on when he asks, “How can we deliver solutions faster through the cloud?”

In busy clinics, resources are limited, which puts an extra onus on technology to do more of the heavy lifting. As Centricity migrates to the cloud in 2018 and beyond, physicians and practice managers will begin to benefit from the “no touch, low touch solutions” that help drive automation, which leads to optimized workflows and a notable reduction in workloads around the clinic.

Gopalkrishnan says, “Whether it is clinical outcomes, financial outcomes, or operational outcomes, we know with value-based care, these are all going to be tied together. You’re going to get paid because you demonstrate clear clinical outcomes and quality of clinical outcomes.” He adds, “It’s very important that we deliver a solution suite that helps clinics achieve these net financials.”

In order to deliver the results our partners in clinics count on, GE Healthcare and HealthCo bring a true understanding into provider workflows and reporting requirements. Thanks to our years of experience working in clinics and with clinics, we also understand the pressures involved (in making big changes) and how to relieve them.

Let’s recap. The “Triple Aim” of value-based care can be summarized like so:

    1) Reduce the cost of healthcare
    2) Enhance the patient experience
    3) Improve population health

At HealthCo, we are on board with all of the above. We also come to work each day ready to deliver on these core promises:

    4) Enhance care quality
    5) Improve provider efficiency
    6) Strengthen financial performance

We know the move from fee-for-service to value-based care is a big change, and the entire transition cannot normally be made all at once. It takes time, a solid plan, and reconfiguration of systems to properly record the numerous measures of quality that help determine the overall health of your patient population.

Remember, you need to demonstrate improvement to get paid today.

According to RevCycle Intelligence:

Value-based reimbursements are calculated by using numerous measures of quality in determining the overall health of populations. Unlike the traditional model, value-based care is driven by data because providers must report to payers on specific metrics and demonstrate improvement. Providers may have to track and report on hospital readmissions, adverse events, population health, patient engagement, and more.

We are happy to help you refine your tracking procedures and update your workflows to meet the need of value-based care. Measuring the full set of outcomes that matter most to patients is indispensable to better meeting patients’ needs. It is also one of the most powerful vehicles for lowering health care costs. Let’s work on it together. Better care at a lower cost is a promise for the future that is within reach today.

Clinics Trust GE Healthcare for Good Reason

Trust between physician and patient is sacred. Trust between clinic and EHR provider is as well. That’s why news that top executives at EHR software provider, eClinicalWorks, willfully manipulated their software to achieve federal certification has rightfully sent shockwaves across the industry.

Clinic admins and physicians are now all asking the tough questions:

  • Are quality incentive payments at risk for my clinic?
  • Has my EHR vendor done something similar?
  • Should I consider moving to another platform?

Let’s admit that we sometimes compete with eClinicalWorks. Let’s also admit that we’re nothing like them. HealthCo is a value-added reseller for GE Healthcare’s Centricity Practice Solution. GE Healthcare is not a startup, nor the kind of firm that risks its reputation. GE Healthcare is a multi-billion dollar division of GE and a globally respected brand with way too much to lose to play fast and loose with the truth or federal regulation.

The False Claims Act lawsuit brought by the Department of Justice alleges that eClinicalWorks hardcoded drug codes into its EHR software to comply with certification testing; did not adequately manage imaging orders or drug interactions; and failed to meet data portability requirements. In addition to a $155 million fine, the company has entered into a five-year Corporate Integrity Agreement (CIA).

Making matters worse, the company also settled a case that stated eClinicalWorks paid customers in exchange for recommendations of its software to potential customers, a violation of the Anti-Kickback Statute.

“Electronic health records have the potential to improve the care provided to Medicare and Medicaid beneficiaries, but only if the information is accurate and accessible,” said Special Agent in Charge Phillip Coyne of HHS-OIG. “Those who engage in fraud that undermines the goals of EHR or put patients at risk can expect a thorough investigation and strong remedial measures such as those in the novel and innovative Corporate Integrity Agreement in this case.”

The CIA requires eClinicalWorks to give customers the option to transfer their data to another EHR software provider without penalties or service charges. While current eClinicalWorks customers don’t necessarily need an added incentive to make the move, this savings is helpful to take the first step.

When trust is violated in this manner, it can cast a shadow on the entire industry. We welcome any and all questions that you might have about the case, and how the overall quality and safety of your clinic’s medical records are assured through HealthCo’s hands-on consulting and GE Healthcare’s superior technology and corporate integrity.

How To Meet the Needs of CMS’ New Quality Payment Program

If your clinic participates in Medicare Part B, you are part of the dedicated team of clinicians who serve more than 55 million of the country’s most vulnerable Americans.

The new Quality Payment Program (QPP) from Centers for Medicare and Medicaid (first announced as “MACRA” in January 2015) provides new tools and resources to help you give your patients the best possible care. The Quality Payment Program achieves the following:

  • Repeals the Sustainable Growth (SGR) Formula
  • Streamlines multiple quality reporting programs into the new Merit-based Incentive Payment System (MIPS)
  • Provides incentive payments for participation in Advanced Alternative Payment Models (APMs)

What does this mean for your practice? It means adopting new policies and practices to help you monitor and care for patients at a group level. Like any change, QPP requires both business and clinical leadership to state the goals and achieve them.

Don’t let this new program sneak up and surprise you. In these first weeks of 2017, HealthCo team members have been speaking with our partners in clinics that are now starting to see their first penalties associated with abstaining from Meaningful Use programs, and some are shocked at the adjustments. Thankfully, the HealthCo team is ready to answer your questions and help you adjust workflows, as needed. There are also great resources to help you navigate QPP, including this New White Paper from GE Healthcare.

5-Answers-To-Your-Most-Important-MACRA-Questions-White-Paper-01192017-JB4608845_pdf

In lieu of a future deep dive into the topic, we have a few quick tips to get you started:

  • Determine which providers are eligible: Research the rules to make certain you understand which of your providers meet the criteria to participate in QPP.
  • Assess how quickly you want to move: CMS has given you several options for participation from submitting nothing to submitting partial or full-year data.
  • Assess group or individual participation: When reporting as a group there are additional methods for reporting on Quality and Advancing Care measures, so make sure you are clear on your clinic’s reporting status.

Wading through white papers on legislative changes can be time-consuming and dense reading. Remember, we are just a phone call away. Our team of rock star trainers can walk you through the all the various QPP steps and get you heading in the right direction.