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Hospital Execs Underestimate QPP Impact

Posted on July 7, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A new survey by Nuance Communications suggests that hospital finance leaders aren’t prepared to meet the demands of MACRA’s Merit-Based Incentive Payment System (MIPS), and may not understand the extent to which MIPS could impact their bottom line. Worse, survey results suggest that many of those who were convinced they knew what was involved in meeting program demands were dead wrong.

The survey found that many hospital finance leaders weren’t aware that if they don’t participate in the MIPS Quality Payment Program (QPP), they could see a 4% reduction in Medicare reimbursements by 2019.

Not only that, those who were aware of the program didn’t have a great grasp of the details. More than 75% respondents that claimed to be somewhat or very confident about their understanding of QPP got the 4% at-risk number wrong. Meanwhile, 60% of respondents either underestimated the percent of revenue at risk or simply did not know what the number was.

In addition, a significant number of respondents weren’t aware of key QPP reporting requirements. For example, just 35% of finance respondents that felt confident they understood QPP requirements actually knew that they had to submit 90 day of quality data to participate. Meanwhile, 50% either underestimated or did not know how many days of data they needed to provide.

On a broader level, as Nuance noted, the issue is that hospitals aren’t ready to meet QPP demands even if they do know what’s at stake. Too many aren’t prepared to capture complete clinical documentation, develop business processes to support this data capture and raise provider awareness of these issues. In other words, not only are finance leaders unaware of some key QPP requirements, they may not have the infrastructure to meet them.

This is a big deal. Not only will their organizations lose money if they don’t meet QPP requirements, but they’ll miss out on a 5% positive Medicare payment adjustment if they play by the rules.

Lest the respondents sound careless, let’s do a reality check here. Without a doubt, the transition into the world of MIPS isn’t a simple one. Hospitals and medical practices will have to meet deadlines and present quality data in new ways. That would be a hassle in any event, but it’s particularly difficult given how many other quality data reporting requirements they must meet.

That being said, I’d argue that even if they’ve gotten a slow start, hospitals have enough time to meet the basic requirements of QPP compliance. For example, turning over 90 days of quality data by March of next year shouldn’t be a gigantic stretch in contrast to, say, submitting a year’s worth of data under advanced Meaningful Use models. Not to mention the Pick Your Pace option of only 1 measure which avoids all penalties.

Clearly, having the right health IT tools will be important to this process. (Not surprisingly, Nuance is picking its own reporting tools as part of the mix.) But I’m struck by the notion that organizations can’t live on technology alone in this case. As with many problems in healthcare, tech solutions aren’t worth much if the business doesn’t have the right processes in place. Let’s see if finance executives know at least that much.

Will How Well You Document Determine Your Quality Ranking?

Posted on March 6, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We all know that the best doctors in the world are determined by how well that doctor documents the visit.
-Said No Doctor Ever!

Seriously, it’s an absurd claim that the quality of a doctor’s documentation would be how we rank the quality of a doctor. I’m sure just reading the headline probably pissed you off. I was upset just typing it. We all know that there are a lot of great doctors who are really awful at documenting. We know there are some awful doctors that’s documentation looks beautiful.

Since we all know this is the case why would I ask the absurd question about a doctor’s documentation determining their quality rating? Because I can see a path where we head this direction.

Yes, it’s scary to consider, but that’s why it’s so important that we consider it. I think this could be the impact of the quality reporting scores that come from MACRA/MIPS/APMs. It seems like it’s only just a matter of time before these scores will hit the Physician Compare website.

Don’t be surprised if they’re also made publicly available so that every health rating site on the internet pulls them down from CMS and uses them as one more factor in how they determine the highest quality doctors. If you don’t believe this will happen, then you haven’t followed what they’ve done with other CMS data.

Remember that these websites don’t have to have actual quality data. They just have to show the perception of quality data. Most consumers aren’t smart enough (or diligent enough) to know the difference. In fact, CMS itself calls it quality data, so they’ll be able to use that word freely. Imagine the doctor who gets ranked lower because their MIPS quality score was lower or non-existent because they have a small Medicare population or because they chose not to participate in the program. This is not a far fetched idea and is a fear I’ve heard from many health systems.

It’s too bad we don’t have a real way to measure quality. Then, we’d all want that data to be shared. However, I’m close to the conclusion that you can’t truly measure clinical quality. At least not in any scalable way. I’m hoping one day we’ll get there, but I don’t see it happening anytime soon. Until then, companies will use whatever perception of quality they can find and many high quality doctors will suffer because of it.

Meaningful Use Has Done Its Job

Posted on September 19, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

While Meaningful Use has been challenging at times, the vast majority of hospitals seem to have stayed on top of things. In its new report on the IPPS negative payment adjustments for fiscal 2017, CMS said that 98% of eligible hospitals and critical access hospitals managed to avoid Medicare payment dialbacks for next year, because they successfully attested to stage 1 or stage 2 Meaningful Use compliance, according to EHR Intelligence.

CMS began making Medicare payment adjustments on October 1, 2014 for eligible hospitals, of which there are more than 4,800 in the United States. The current adjustment will fall into place on October 1, 2016, as a reduction in the percentage increase to the Inpatient Perspective Payment System.

The negative payment adjustments to the IPPS now stand at 75%, up from 25% for the 2013 reporting period. Eligible hospitals had a chance to apply for hardship exceptions to the payment adjustments, though if they haven’t done so already it’s too late, as the window for seeking those exceptions for 2017 closed in April of this year. But as noted, few hospitals will be affected.

At this point, it’s worth taking time to stop and admire how this took place. Even when you consider that the feds handed lot a lot of money in incentives, this has all happened relatively quickly as IT investments go. Everyone likes to talk about how successful the banking industry was at rolling out interoperability with ATMs, but I doubt the backroom negotiations went any faster than the cascade of Meaningful Use attestations. In other words, Meaningful Use did its job.

After all, very few programs achieve close to 100% compliance under any circumstances. Even if providers face large government fines, no initiative is going to get 100% of the industry on board. So bringing 98% of eligible hospitals on board within a few scant years is an impressive achievement, particularly considering the healthcare industry’s record of foot dragging when it comes to new technologies.

Of course, the industry has clearly gone well beyond the need for Meaningful Use’s rather mechanical reporting requirements, valuable though they may have been as a training ground. So if we assume that Meaningful Use isn’t that, well, meaningful anymore, what’s next?

The answer is….drumroll…quality. Most hospitals will be focusing on the larger and more complex quality measurement demands imposed by the next generation of incentive payments proposed by CMS.

As many readers know, the Medicare Meaningful Use program for ambulatory is being rolled into the Merit-Based Incentive Payment System (MIPS), along with the Physician Quality Reporting System and Value-Based Modifier programs. beginning with the 2017 performance year.

Meaningful Use now has a new name in ambulatory care, Advancing Care Information, and strong performance on this measure can contribute up to 25% of the MIPS score a provider receives – or in other words, smart health IT deployment still counts. But that’s dwarfed by the 50% of the score contributed by strong quality performance.

This shift away from IT-specific performance measures is necessary and valuable. But as federal authorities lay out their new incentive programs, it’s worth giving good ol’ Meaningful Use a send-off. A job needed to be done, and however unsubtly, MU did it. We’ll see how quickly the MIPS program rolls over to replace MU in hospitals.

An Acronym Look at MACRA QPP

Posted on April 28, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The proposed rule for the MACRA program has been announced. Here’s an acronym laden summary of what MACRA did (Worth noting that CHIP is the C in MACRA for those keeping track of acronyms at home).

MACRA creates a QPP.

MACRA ends SGR

MACRA creates two paths: MIPS and APMs.

MIPS and APMs timeline from 2015 through 2021.

MIPS combines PQRS, VM (or VBPM if you prefer), and Medicare EHR (MU and Certified EHR) into 1 program.

APMs include ACOs, PCMH, and bundled payments.

MU is now ACI.

If you’re not sure about some of the acronyms above, you can find their longer names here. Good thing they simplified and streamlined the various programs!

We’ll be becoming friends with the acronyms MIPS and APMs. Here’s a good summary PDF of MACRA as well. More details to come.

UPDATE: In a bit or irony, Andy Slavitt posted this acronym free video about MACRA:

New Merit Based Incentive Payment System (MIPS) Whitepaper

Posted on July 20, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’m not sure why MIPS (Merit-based Incentive Payment System) doesn’t seem to have gotten more attention, but for those not familiar with MIPS, it’s the law that was put in place as apart of the replacement to SGR. What does that mean? MIPS is going to be the framework that’s used to switch from a fee for service based reimbursement environment to a value based care model. Short Story: MIPS is going to be very important to the future of healthcare!

Jim Tate just put out a whitepaper he recently created that covers the details of the MIPS program. If you’re not familiar with what was signed into law, Jim’s whitepaper will be a good place for you to start. Here’s a small section of the whitepaper which will give you a feel for the MIPS program:

Under MIPS, high-performing providers will be rewarded and low-performing providers will be penalized. It is designed to strengthen, incorporate, as well as consolidate the financial impacts of the MU of CEHRT, PQRS, and VBM programs. The current incentive programs will be combined and a composite threshold performance score (scale 0-100) will be established aimed at informing providers of the levels of reimbursement based on four key performance measures: resource use, MU, quality, and clinical practice improvement activities.

There are four performance categories for deriving a provider’s potential annual score (0-100 points) for MIPS: 25 points for the MU of CHERT, 15 points for clinical practice improvement, up to 30 points for VBM-measured quality and 30 points for the VBM-measured resource use. The details for the MIPS program will be determined by CMS. 2017 will be the first MIPS performance year and those scores will lead to potential payment adjustments in 2019.

Check out Jim’s whitepaper for a lot more details. You can be sure we’ll be talking a lot more about MIPS in the future. Understanding MIPS is going to be extremely important for every healthcare organization. Get ready to put together whole teams of people to make sure you understand MIPS and are able to comply.