How did you do in the first year of reporting under the Quality Payment Program? Are you expecting a negative payment adjustment under the Merit-based Incentive Payment System (MIPS)? Or did you only submit the minimum data necessary in 2017 to avoid this adjustment? The good news is that you can get on track to report critical MIPS measures in 2018 that will safeguard and perhaps even enhance your revenue in 2020 and beyond.
In fact, your electronic health record (EHR) technology may already include various features that can help increase your MIPS score, says Marina Verdara, senior training specialist at Kareo. All you need to do is take advantage of them. Verdara discusses five ways in which medical practices should be able to capitalize on their EHR to improve performance under MIPS.
- Use an EHR Certified With the 2015 Criteria
Technology certified using the 2015 criteria supports interoperability across the care continuum, and it also enables physicians to earn additional revenue under MIPS, says Verdara. According to the Medicare Access and CHIP Reauthorization Act final rule, physicians earn a one-time bonus of 10 percentage points under the advancing care information (ACI) performance category of MIPS when they report objectives and measures using only 2015 edition certified electronic health record technology during calendar year 2018. In 2018, 25% of a physician’s MIPS score is tied to ACI.
“The federal rule indicates the clinician will earn a 10% bonus to their ACI score if they report using only a 2015 CEHRT, but they will determine this based on the measures submitted,” Verdara explains. “Therefore, a clinician can switch anytime during 2018 as long as they can report at least 90 days for the ACI category.”
In addition to this bonus, clinicians are eligible to receive a bonus of 10 percentage points applied to the ACI category if they report Stage 3 objectives and measures, says Verdara. They can do this if their certified EMR can document and track these measures. Refer to Table 7 in the MACRA final rule for more information about these measures.
- Choose Applicable Quality Measures
In 2018, 50% of your MIPS score is based on the quality measures you submit. Your 2015 Certified EHR should support your quality measure selection. “For instance, our physicians have an easy-to-use tool within our EHR that prompts them to narrow down measures that are most applicable for their specialty,” says Verdara. Customers can contact them directly for more information about each measure, its specifications, and what CMS is looking for when calculating numerators and denominators.
When using your EHR to choose measures, Verdara suggests running a report for all of the quality measures your vendor supports, including those you may not plan to submit for attestation. That’s because the data could reveal one or more measures you hadn’t anticipated as advantageous for your practice that could ultimately boost your score, she adds.
Examine the entire report, and identify your top 10 measures (i.e., those on which you’ve performed most effectively). Now dig into the data. Are each of these measures applicable for your specialty? If so, focus on data capture for those 10 measures. If some of your top 10 measures are in other specialties, eliminate those from your workflow and choose ones that are relevant. “Make sure you understand how to document and improve the score for that measure,” says Verdara.
Ultimately, submit all 10 measures to CMS even though only six are required, says Verdara. During the submission process, the CMS attestation website automatically scores each measure based on available benchmarks, and physicians have an opportunity to remove the measures on which they’ve performed most poorly prior to final submission.
- Don’t Overlook Reporting Opportunities
Your EHR should be looking out for reporting opportunities so that you can focus on patient care. Verdara provides the example of smoking cessation counseling. Physicians commonly perform this type of counseling but may not receive credit under MIPS because they don’t check the box indicating the work was done. “We have built-in guides to help physicians understand why they might be missing out on a particular quality metric,” says Verdara, adding that physicians should be able to look to their EHR to prompt and guide them to understand where missed opportunities may lie.
- Use Clinical Decision Support to Enhance MIPS Performance
Your EHR should also provide prompts to remind physicians about age- and condition-specific preventive screenings and care that, when provided to patients, can help improve MIPS scores. Physicians using Kareo, for example, can improve performance on MIPS measures related to influenza and age-specific immunizations as well as screening for clinical depression, high blood pressure, and more, all of which directly translate to higher scores, says Verdara. “It helps the physician provide better care,” she adds. “It’s a win-win for the clinician and the patient.”
- Run Clinical Reports to Pinpoint Opportunities for Care Improvement
MIPS reports not only allow for attestation, but they also help practices understand what they do well—and what needs improvement, says Verdara. For example, practices tracking patients whose hemoglobin A1C is greater than 9% during the performance period can use this report for MIPS attestation and to improve outcomes. More specifically, they can reach out to patients with a poor A1C to provide additional counseling and guidance. “This is a good one to track because diabetes is an epidemic,” says Verdara. “It helps practices target patients who are non-compliant.” The same is true for measures related to controlling high blood pressure and asthma.
To learn more about MACRA, visit https://qpp.cms.gov/.
About Lisa Eramo
Lisa Eramo is a regular contributor to Kareo’s Go Practice Blog, as well as other healthcare publications, websites and blogs, including the AHIMA Journal. Her focus areas are medical coding, clinical documentation improvement and healthcare quality/efficiency. Kareo is a proud sponsor of Healthcare Scene.