Reflections on the 2017 Quality Payment Performance Year

By Matthew Fusan, Director, Customer Experience, SA Ignite
Twitter: @saignite

With the first year of the Quality Payment Program (QPP) having officially concluded, our team has spent time reflecting on 2017, including what we have learned and the impact the QPP has had on the healthcare community. Here are our top 3 reflections on 2017.

1. Clinicians lack the QPP knowledge needed to be successful
CMS has done more to promote and educate the healthcare community about the QPP and MIPS more than any other program in the past. CMS created a user friendly QPP only website, which is continually updated with fresh content, has conducted many webinars focusing on the many components of the QPP and specifically MIPS, and has developed specific user guides, among other things.

But, despite these efforts, numerous surveys conducted throughout 2017 show that the majority of clinicians are not confident they have the knowledge about the QPP and MIPS to be successful in the program. The QPP is complex, requiring both time and robust data analysis in order to maximize successful participation. Surveys showed that most employed physicians expect their employer to provide solutions and strategies for QPP success. Building a successful organizational strategy requires strong participation and leadership across the executive group, physician leadership, and an action-oriented communications plan. The communications should include why the strategy is being executed and what is expected, not only of the clinicians, but of the entire care team. We discuss How a Multi-year QPP Strategy Will Help You Excel in a recent ABCs of the QPP webinar.

2. MIPS and the QPP have prompted organizational change toward value-based care
The start of the QPP, even with the limited implementation of MIPS, has been a wakeup call to organizations. The tipping point seems to have arrived where organizations are realizing that success in value-based care programs, whether they are from CMS or other payers, requires a change in mindset, and new operational processes that support performance monitoring and improvement. These changes require new tools, as the days of adding ‘one more thing’ to the plate of employee and clinician’s existing workloads, and expecting success is over. Operational and clinical redesign will be required to successfully compete in the future.

For value-based care programs, organizations are finding they need more robust technology that can handle the complexities of the programs, including continuous performance monitoring and analysis. A recent survey found, that from a tools perspective, 83% of respondents are using their EHR solutions as their primary method of managing QPP performance, yet 72% reported that their EHR vendor either doesn’t offer a specific MIPS solution, or they don’t know if the vendor offers a solution. For those participating in alternative payment models (APMs), it was even worse, where 94% stated that their EHR vendor does not offer a solution today. Population health management (PHM) systems faired about the same, with 91% reporting no current MIPS solution and 79% reporting no current APM solution.

3. Messaging from Health and Human Services (HHS) has been confusing
In recent communications, CMS Administrator, Seema Verma, has voiced her commitment to move from fee-for-service to value-based care. But, at the same time, CMS has canceled two mandatory bundled payment models and removed the mandatory requirement from a third. The CMMI RFI creates some uncertainty regarding the future role that the CMMI will play, making it clear that all existing programs will be analyzed. This initiative will likely result in a reduction of CMMI programs overall, but will lead to an emphasis on Advanced Alternative Payment Models, which are also a key part of the QPP. Adding to the uncertainty was the short tenure of former HHS Secretary Tom Price, who seemed to have a different opinion and approach to how CMS should move toward value-based care than his predecessor Secretary Burwell and his likely replacement, Alex Azar.

Despite the conflicting signs, overall 2017 has shown us that CMS is continuously looking at how to improve value-based care programs, leaning toward consolidation around the key tenets of the of the QPP. Throughout 2017, CMS reiterated time and again that they are committed to these programs and the transition to a value-based healthcare system. In the past few weeks, the new HHS Secretary nominee, Alex Azar, has clearly communicated his dedication to moving CMS toward value-based care. “One of the great legacies of [former HHS Secretary Sylvia] Burwell’s tenure was launching so many of the alternative payment models we have out there, and I would like to keep driving that forward,” Azar said during his Senate confirmation hearing.

The QPP is a competitive program, and each year the stakes will increase making it more difficult for organizations to maximize their positive payment adjustments. 2018 will be a year where providers will need to closely monitor and improve performance, while keeping an eye on how cost and quality tie together. With 2019 fast approaching, and cost becoming a driving factor of the QPP, clinicians and healthcare organizations need to develop and implement multi-year strategies with tools that will manage through the chaos, and lead to success in MIPS and other value-based care programs.

This article was originally published on SA Ignite and is republished here with permission.