Achieving Clinical Success in Quality Payment Programs

justin-headphones1-200By Justin Barnes, Partner, iHealth Innovations
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Twitter: @RevenueSherpa
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In the inaugural reporting year of MACRA’s new Quality Payment Program, quality measures and clinical practice improvement activities will collectively account for 85 percent of MIPS composite scores used to determine Medicare reimbursement penalties and incentives for healthcare providers. As clinicians prepare to embark upon MIPS reporting, knowledgeability on clinical performance metrics and standing heading into and throughout QPP participation will be essential to meeting reporting and care delivery objectives under the new value-based payment model.

Providers have a unique opportunity under relaxed first-year reporting requirements to layer new clinical analytics practices in with financial, technical and administrative best-practices incrementally. The clinical insight providers are poised to glean from data gathered through the new quality payment model will increasingly drive both reimbursement and evidenced-based care protocol moving forward.

Clinical Quality: Know Where You Stand
When building a game plan for clinical reporting under MIPS, cognizance of the clinical areas where a practice has traditionally experienced success can inform quality metric selection heading into participation. By opting for quality measures that sync with identified high-performing areas, providers can put their best foot forward in the push to avoid penalties, achieve positive payment adjustments and potentially earn bonus incentives.

It is also important that participating entities be well-versed in the broad array of reporting measure options available under MIPS. Appoint QPP subject-matter experts, either internally or through a trusted external partner, to help the healthcare organization identify best-fit reporting metrics, including any that may align to specific practice specialties. (Twenty-two of the more than 270 quality measures, for example, relate specifically to radiology.) Take advantage of measures that appear across multiple categories to reduce reporting burdens.

Garnering the clinical data and analytics needed to execute on MIPS reporting and track outcome trending over time may require new resources and/or roles within the organization.

Clinical Improvement: Action via Analytics
Effective population health management and care coordination are at the crux of value-based care targets the QPP aims to meet (better outcomes, higher patient satisfaction, and lower costs). Many of the MIPS improvement activity measures center on collecting and sharing patient information with care teams, referred providers, and the patient themselves. The objective is to optimize patient outcomes by partnering with facilities across the continuum of care.

Practices should focus on expanding communication with beneficiaries and patient care teams, as well as specialists, to meet clinical improvement activity goals. Identify new, cost-effective opportunities for patient engagement, communication, education, and empowerment in the clinical process to satisfy both MIPS measure requirements and evolving healthcare consumer demands.

The clinical data capture and analytics practices ushered in by MACRA will bring never before seen transparency to healthcare that providers can use to begin understanding and addressing utilization, cost and care patterns. The clinical process monitoring and analytics infrastructure that providers establish today will increasingly serve value-based care programs and population health management objectives in the years to come.

The first blog in this series touched on ways to cement revenue cycle best practices heading into MACRA. The next blog in this series will touch on best practices for technical success.