MIPS replaces the PQRS (Physician Quality Reporting System), the Value-Based Payment Modifier and the Electronic Health Record (EHR) incentive program. Borne from the Medicare and CHIP Reauthorization Act (MACRA) of 2015, MIPS and APM (Alternative Payment Models) are the two available options for quality payment tracks. MIPS is the default track, and its performance categories include Quality (60%), Improvement Activities (25%) and Promoting Interoperability (15%).

In theory, value-based care makes perfect sense. Catalyzing the best outcome at the lowest cost seems straightforward and reasonable by any measure. The Centers for Medicaid and Medicare Services (CMS) couches it as a four-step process: “Collect data, Report data, Feedback available, Payment adjustment.”

Butmoving from theory to practice has presented challenges, sowing frustration in physicians driven by patient care. Physicians and practice administrators envision stacks of paperwork, a quagmire of regulations and processes ad nauseum.

And studies reveal physician’s fears and perceptions are based in reality. Research by Weill Cornell Medical College and the Medical Group Management Association (MGMA) in 2016 showed physicians spent 15.1 hours every week processing quality metrics. Time spent on the intricacies of reporting, tracking metrics and understanding accompanying regulations cuts into patient care.

Success in the value-based framework requires deft planning and patience—which demands the scarcest resource for many physicians: time. As you know, value-based care is not an ephemeral trend; rather, a way of providing care that will catalyze a seismic change in its provision.

To begin planning for 2019:

Review the timeline of implementation.  

1. Review quality measures and compare against current top-performing practice areas.
2. Review your business model. Get acquainted with new reimbursement codes which enable telehealth.
3. Choose a third party telehealth chronic care management provider, such as PharmD Live®, adept in streamlining billing reports and quality measures data and providing care coordination and management.  

Many physicians and hospital clinics have chosen to partner with a third party care management team, such as PharmD Live®, as an element of their MACRA strategy. PharmD Live® serves as a seamless extension of your practice, providing turnkey, pharmacist-led chronic care management services to boost quality metrics, increase revenue and streamline care. To learn more about PharmD Live®’s pharmacist-led care, schedule a consultation.

This article is the first in a series dedicated to helping physicians and hospital clinics prepare for MIPS in 2019.

The post Preparing For MIPS: From Idea To Implementation appeared first on Pharmdlive.

The financial implications—and upside and downside swings—are imminent.

Changes are coming—and proponents and opponents can agree on one thing: a shift of this magnitude requires deft planning.

To experts preparing for value-based care, two things are clear:

1. Choosing the right metrics to report can determine success or failure
2. A successful strategy will preclude added administrative or clinical burden

The Centers for Medicare and Medicaid services (CMS) infused flexibility in Quality Payment Program (QPP) measures, providing more than 250 measures and allowing physicians to choose the yardsticks by which they will be measured.

Choosing measures, however, is no small task.

The sheer volume of measures requires thought and careful scrutiny, but investing time is justified due to its magnitude of effect on reimbursement.

Choosing measures your practice has historically performed well in will set your practice up for MIPS success.

And…choosing measures most closely related to the patients you see in practice will ensure you meet the minimum number of reported cases for that measure.

When reviewing possible measures, keep in mind you will be submitting data for 2019 on at least 60% of your Medicare and non-Medicare patients, on a minimum of 6 quality measures.

Evaluate the data that comprises the measure to ensure the process is in place to capture it.

Determine where—and by who—the data will be captured.

Will it be gathered by the nurse or a front-desk attendant?

What must be entered into the EHR for accurate reporting?

The maximum value of each measure is ten points.

Groups comprised of more than 16 physicians will be evaluated on a seventh ten-point measure for all-cause hospital readmissions.

Data does not need to be reported for the seventh measure, as it is aggregated by the CMS through claims data.

Bonus points can be earned for using Certified Electronic Health Record Technology (CEHRT).

Because many measures are based on patient management that happens between visits, a strategic plan may include outsourcing CCM and TCM (Transitional Care Management) to a third party, such as PharmD Live®, to boost MIPS metrics without increasing physician workload.

PharmD Live®’s turnkey chronic care management services address over 50% of MIPS measures and provide a monthly report to your practice for streamlined billing and reporting.

To learn more about developing your practice’s MIPS strategy, schedule a consultation.

This article is the second in a series dedicated to helping physicians and hospital clinics prepare for changes to MIPS in 2019.

The post Choosing MIPS Measures: Catalyzing Success appeared first on Pharmdlive.

But as 2018 draws to a close, business plans for 2019 are demanding attention, especially for practices who treat a high volume of Medicare patients. Magnitudinous changes to reimbursement models are imminent, but there is still time to accelerate your MIPS plan and ensure it is aligned with 2019 practice objectives.

Of the myriad of concerns I have heard from stakeholders during past months, reducing physician burden tops the list. Studies show 28% of physician’s time is spent on non-clinical paperwork, translating to lost revenue for practices and increased physician dissatisfaction. It trends as a hashtag on Twitter for good reason—the role of the physician has expanded to include serving as a steward of the healthcare economy—no small task. And, success in the new healthcare model relies on between-visit care, which adds exponential demands on physician time.

If diving into the 2019 QPP requirements on CMS.gov feels daunting, read on. Caveat—consider this a conversation starter rather than an exhaustive list.

Quick Tips to get MIPS ready:

1. Check your eligibility status. CMS requirements change from year to year, so this may vary over time. Remember, you can participate as an individual clinician or as part of a group. According to CMS.gov, “to be excluded from MIPS, clinicians or groups would need to meet one of the following three criterion: have ≤ $90K in Part B allowed charges for covered professional services, provide care to ≤ 200 beneficiaries, or provide ≤ 200 covered professional services under the Physician Fee Schedule (PFS).
2. Choose your track: MIPS or APMs.
3. Select six measures based on your patient population; focus on quality measures, as they will have the greatest impact on your final MIPS score. Improving patient care means quality measures will become increasingly stringent over time. Cost measures are weighted at 30% for the 2019 performance year and will increase over time—a cost-reduction strategy is a crucial element of a successful long-term plan.
4. Innovate. In the context of the profound paradigm shift, physicians open to innovating their care models are most likely to thrive. CMS’ approval of several codes for chronic care management services via telehealth is a nod to the critical nature of innovation. Explore partnering with a third party CCM provider, such as PharmD Live®, to shoulder between-visit care, adding value for patients and serving as a seamless extension of your practice.   
5. Earn. In 2018, physicians could earn up to 5 extra points for caring for complex patients. CPT codes 99487 and 99489 allow reimbursement for CCM for complex patients, which can be outsourced to a third party vendor, such as PharmD Live®, to optimize clinical and financial outcomes.

As January 1 approaches, explore evidence-based solutions, such as implementing pharmacist-led CCM services to meet and track quality measures. Clinical pharmacists are equipped to manage complex medical pictures, and make high-level clinical decisions to support your care plan.  

Ready or not, change is coming.

The post MIPS Tips: Procrastinator’s Edition appeared first on Pharmdlive.

A national survey, The Physician Task Load and the Risk of Burnout Among US Physicians (The Joint Commission Journal on Quality and Patient Safety 2021; 47:76–85), describes the look and feel of an albatross around the necks of struggling providers. The metaphor is supported by the direct relationship between physician task load and burnout. Overburdened with tasks, providers struggle to reconcile workload and patient care, often sacrificing necessary social relationships and support. To guide improvement efforts, the study highlights two key areas for meaningful improvements: staffing and technology.

Until now, most solutions suggest an either/or scenario. Bring in more staff, on contract if necessary (which the study shows can degrade team spirit), or add technology. This is less than helpful. While technology is not going away, incorporating it well and in a hurry may be more trouble than it’s worth in a moment of crisis.

MIPS performance year 2022 (with payment year in 2024) offers fewer performance guard rails and exceptions–we’ve entered real-time quality improvement and performance measurement. It’s time to shake off the giant bird and figure out how to restore the feelings of camaraderie in the office to improve morale. Make a move to increase patient satisfaction and overall quality scores.

Capture the best of Q3-4 2022 MIPS, CCM, and RPM 

Countless technology firms have pitched ways to code the work that captures maximum Part B reimbursement, but they often cost money up front resulting in a gamble because these alternative coding and billing schemas are unproven and risky. Meanwhile, the staff is exhausted. Some have left for greener pastures and others find their time monopolized with non billable activities for chronic care patients. To increase revenue, you need to land on the far right side of the curve and improve quality, reimbursement, staff and patient satisfaction. Something has to give. 

Physician practices that accept Medicare are already enrolled in the Merit-Based Incentive Payment System (MIPS). Whether or not they have submitted data in the past, practices must prepare for the realities of performance-based payment now, not 2 years down the road. With the first quarter of Performance Year 2022 in the books, being inattentive for the balance of 2022 will have steep financial consequences in 2024 when payments are disbursed.

Practices need an effective, easy solution NOW

To grow revenue AND alleviate the issues of burnout, ideally you can work with a service that provides the staff resources to follow chronically ill patients and Medicare patients with two or more chronic conditions. They should provide technology to code and keep medical records for prompt reporting to CMS without introducing the stress of a steep technology learning curve. 

PharmD Live® offers patient-centered, chronic care management services that can alleviate the workload burden and assist with relevant coding and billing, improving practice morale and revenue in one simple step. 

With an algorithm to identify at-risk patients, clinical pharmacists working on behalf of your practice use PharmD Live® technology to capture relevant data. 

Medicare programs for Chronic Care Management (CCM) and Remote Physiologic (Patient) Monitoring (RPM) are structured to provide billable time for the patients who will benefit from closer supervision between regular office visits. Patients achieve improved outcomes, and the practice is compensated for time spent on these activities. The benefits of having a PharmD monitoring medications and health indicators include elevating the remote care provided to identify and prevent adverse drug events and flag potential health issues.

“Pharmacists’ innovations touch our daily lives and, most importantly, pharmacists complete the care cycle for patients. PharmD Live®’s pharmacist leaders are rooted in rigorous education and the highest standards of professionalism,” says PharmD Live® CEO Cynthia Nwaubani, PharmD, BCGP, CMTM. Founded and managed by clinical pharmacists, PharmD Live® offers disease and medication management solutions to identify and address disease care gaps and medication-related problems.

Choose the method and technology to stay ahead of the curve

The value of the PharmD Live® approach to solving post-acute care was recognized by trend scouting and analysis firm StartUs Insights. In examining 762 global HealthTech startups and scaleups in 2021, they noted, “Staying ahead of the technology curve means strengthening your competitive advantage.” PharmD Live® ranked in the top five.

The StartUs Insights recognition looked at post-acute care. PharmD Live® is better known for its chronic care management services. Dr. Nwaubani explained the benefits of PharmD Live®, “Medication misuse, underuse, and overuse is detrimental to patients and accounts for $300 billion in healthcare costs, which are both unsustainable and preventable.” 

PharmD Live® model is attractive for medical practices

MIPS tracking improves patient health and other targets. A potential financial gain is possible  when paired with the CMS’ chronic care management and remote patient (physiologic) monitoring programs. 

CMS reviews and adjusts various performance categories annually, at a minimum. PharmD Live®’s practices are continuously updated to ensure your data collection and reporting reflect the rules. 

PharmD Live® provides chronic care management services to capture data for CCM and RPM reimbursement reports the primary care physician can submit for the 2022 performance year:

• Performance threshold: Establishes a performance threshold of 75 points, up 15 points from last year
• Performance category weights 2022 performance year/2024 payment year: 
  • 30% quality
  • 30% cost
    • Cost performance category: five episode cost measures were added to the cost category
  • 15% improvement activities
  • 25% promoting interoperability–reporting requirements have changed 

Enroll in CCM and RPM programs with PharmD Live® and pay nothing for implementation, no subscription fee, and benefit from additional quality measures identified by PharmD Live®. Revenue is generated for both parties through the CMS reimbursement process the doctor’s office submits monthly to Medicare. 

Links

www.startus-insights.com

www.startus-insights.com/innovators-guide/discover-5-top-post-acute-care-solutions-impacting-healthcare

www.pharmdlive.com

References

Webinar slides: Integrating Organizational Actions Toward Patient Safety and Clinical Wellbeing

Michael R Privitera MD MS Medical Director, University of Rochester Medical Center;  Kate MacNamee MS Director of Design Research at Ximedica Senior Human Factors Engineer; July 15, 2021 https://www.ama-assn.org/system/files/organizational-actions-toward-patient-safety-webinar-slides.pdf

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