10 Tips To Prepare for MIPS – Merit-Based-Incentive Program System

PeggyLosey-200By Peggy Losey, Manager of Ambulatory Incentive Programs, ehealthcare Consulting Inc.
Twitter: @ehealthcareorg

Since first hearing of the new Pay-for-Performance reimbursement model MIPS, created through the MACRA legislation, I have noticed a strong similarity to the auto industry. Detroit roots, here!

Comparisons are made in both industries to the continual introduction of new models, incentives to get you to “buy”, new technology and a focus on top performance! All driven by behind the scenes mandates of federal regulation toward safety, advanced technology, affordability and the best customer experience.

Alluring advertisements from vendors flood our ignorance with claims of the latest and greatest. With an eye on meeting regulations, capturing investment for their new technology and competing for best-of-class accolades, the manufacturer lures the vulnerable consumer. The naive customer, skeptical of any truth in advertising, must “buy” to stay in the race.

What isn’t transparent, are the facts that we need to prepare to drive these new models. How do we optimize for best performance once we’ve made the purchase? This applies to both the vehicle and the laws that dictate the structure of the product components.

This comes to you below in an easy-to-read users-manual!

As you prepare to enter the “showroom”, we offer these MIPS best practice tips. They will allow you to test drive our industry’s newest model, pay-for-performance reimbursement, and determine the best make and model to fit your “family”. Rules of the road toward successful long haul performance.

  1. Understand that Meaningful Use and PQRS are NOT going away. Elements of those programs will, in fact, along with their cousin, Value Based Modifier, compose up to 85% of your future composite performance score, and resultantly, reimbursement. Master your efforts in these programs NOW. MIPS performance year begins on January 1, 2017!
  2. Become familiar with the depth of the details of clinical quality measures in these current programs and identify the potentially highest performing clinical quality measures appropriate to your scope of practice. Nail those!
  3. Check measures against crosswalks of other quality program initiatives from which you may also benefit. This is the best way to maximize efficiency and performance levels.
  4. Assure that your certified electronic health records technology can collect quality data appropriate to you, so that you can collect data and report on those measures. Not all products are certified to collect data on all measures. Is it time to look browse the “showroom” in search of a model that with more miles to the gallon?
  5. Research and select the best PQRS reporting vehicle to match the measures identified. Not all measures can be reported via all reporting mechanisms, ie: claims-based reporting, registry reporting, EHR-Direct reporting have different measures available to select from.
  6. Monitor quality report card dashboards early and often to identify deficiencies, remediate and advance to the next performance level.
  7. Expand your community-of-care network for optimal patient care and reimbursement.
  8. Become familiar with the Alternative Payment Models concept and investigate participation in one of them. (ACO, Medicare Shared Savings Program, PCMH etc.) The most lucrative performance opportunities will exist for the highest achieving providers in these organizations.
  9. Embrace the pit stops. This transition is not a once-and-done project. It will require routine “maintenance tune ups” along the way to avoid costly “repair bills” in the future.
  10. Check out Physician Compare! Clinical quality statistics are now publically reported via this consumer-facing provider evaluation tool. It is currently available for anyone’s review, online. Attaining your highest quality scores now, allows this to reflect both the physician effort as well as the customer opinion. Check out your profile today! YOU are in the driver’s seat now!

Create a strong relationship with a trusted advisor. eHealthcare Consulting has years of successful attestation, submission and compliance experience, advising clients in all incentive programs. Get in touch with us today to see how we can help you can take control. You can drive your own success! Start TODAY!