MS designed the MIPS program to be a catalyst for change, offering healthcare organizations a low-risk path to gradually transition to value-based payment models. Many organizations reacted negatively, viewing MIPS as another complex federal compliance program, which it certainly is. However, more healthcare leaders are recognizing the opportunity to use MIPS to create a culture of top performers and are employing targeted clinician action plans.
As MIPS has taken root, healthcare leaders are seeing cross-over benefits that are positively impacting performance and helping to lay an operational foundation to participate in higher-risk, quality-based programs.
SA Ignite experiences this progression first hand through our daily engagements with customers. So much so, in fact that we decided to host regional user forums on the topic of making MIPS a change enabler. The goal of these user forums was to bring leaders responsible for managing performance and compliance in the Quality Payment Program (QPP) together to learn best practices from each other and to gain new knowledge that helps effectively drive change in an organization.
Hear about the ‘aha moments’ from our regional forums in this 25-minute Voices in Value-Based Care podcast and read on for more details.
It’s no secret that change is hard, especially in healthcare. So, for each forum (we did three) we brought in a professional coach to facilitate group exercises to find ways to improve day-to-day program management challenges, connect MIPS to the broader organizational mission for value-based care, and communicate in a targeted way to get results.
The level of enthusiasm and engagement was outstanding and led to some key conclusions and actions, including:
- MIPS is a program, not a person. It’s easy to get stuck in the rut of having a single person become the expert in MIPS and rely on them to do everything necessary to comply with the program. This is a dangerous and not particularly effective strategy because MIPS has become much more than a compliance exercise. The program has far reaching impacts on quality improvement initiatives, clinician education and engagement, finance and budgeting, systems and technology (EHR and pop health), public reputation and marketing. MIPS should be viewed as a low-risk training ground for healthcare organizations to lay the foundation for transforming to higher-risk, higher reward value-based payment models.
- Clinician engagement is critical to success. No surprise, however, engaging clinicians effectively is easier said than done. It’s fair to say that clinicians are tired of documenting, especially if there is no perceived value. It’s also fair to say that oftentimes the data and reports clinicians are measured on can be inaccurate or have gaps. This inaccuracy actually de-legitimize the quality manager and puts them in an adversarial position with clinicians, when a partnership is what is desperately needed. A good starting point for quality managers to establish trust and partnership is to collaborate with clinicians to validate data in the reports, and work together to address why gaps or inaccuracies are occurring. The next step is to focus on measures that are relevant to the clinician and set goals that align with their broader performance objectives.
- New internal bridges need to be built. Finance and managed care departments are becoming primary stakeholders in the Quality Payment Program (QPP) because of the increasing financial impact MIPS has on the organization. The maximum financial incentive for MIPS has increased 150% in 2019, which means that a healthcare organization can earn up to a 4.7% positive revenue adjustment on every qualified Medicare Part B service delivered. This could equate to hundreds of thousands of dollars for top performing clinicians and organizations, and significantly contribute to quality improvement initiatives that generate additional incentives from other value-based payment programs.
- Physician compensation must evolve. Everyone recognizes that physician/clinician compensation must evolve to align incentives with organizational and programmatic goals for improving quality and reducing costs. MIPS is a program that can help you generate the quality metrics you need to get started down this path. Today, most organizations are just beginning to explore the potential for physician compensation changes, however payers are heavy into their analysis. UnitedHealth Group examined the correlation between quality performance and cost efficiency within their UnitedHealth Premium Program and found that physicians with high quality marks, had 7.1% better cost efficiency. Armed with this type of data, UnitedHealth Group can create targeted incentive programs, patients can make more informed decisions, physicians can make better referral choices, and employers can reward individuals with tiered healthcare coverage options.
This article was originally published on SA Ignite and is republished here with permission.
About Voices in Value-Based Care
On Voices in Value-Based Care, tune in to hear value-based programs expert Beth Houck and her guests discuss the challenges, opportunities, and best practices for reporting under MACRA’s Quality Payment Program. Whether you’re participating in MIPS or as an APM, Beth and her guests will give keen insights and share real world experiences and use cases to help you be successful in 2018 and beyond. Show rebroadcasts at 5:00am, 1:00pm and 9:00pm ET every weekday.