Becker's Hospital Review

13 Executive Briefing Zotec Partners is an industry leader in revenue cycle and practice management services for physicians and health systems, managing in excess of 70 million medical encounters annually. The company is committed to the continual pursuit of excellence, delivering effective solutions through its proprietary technology, personalized service and measurable client results. Currently, Zotec Partners serves more than 8,000 physicians in all 50 states. To avoid the automatic negative payment adjustment, providers only have to submit a minimal amount of data — one quality measure, one Improvement Activity, or report the required measures of the advancing care information category. However, to master the complexities of the program and work to optimize performance scoring, it is in health systems and multispecialty groups' best interest to participate as much as possible during the 2017 transition year. Providers that submit a full year of data have the potential to earn a moderate positive payment adjustment. A practice can also achieve a positive incentive by successfully submitting for 90 consecutive days on each applicable category. However by participating a full year the chances of optimizing the Composite Score should improve. On top of the financial incentives, full MIPS participation could also benefit the U.S. healthcare delivery system as a whole. "Participating as much as possible in the first year is a prudent decision," said Mr. Johnson. "By moving to this model early on a group will become more aware of quality reporting requirements , achieve better utilization of healthcare information technology; more data will be available with a better understanding of the process — it is certainly a move in the right direction." Reporting data under the MIPS payment track Because MIPS is designed to be a budget-neutral program, success under the payment track will be determined by three factors: which measures providers choose to report, how they perform on those measures and how their peers perform in comparison. When deciding which metrics to report on under the MIPS payment track, health systems and multispecialty groups should examine past quality and resource data to determine what areas they excelled in under PQRS and the Value-Based Modifier Program. "The key is not to choose metrics that you perform well at, but to choose metrics where you perform better than others," said Leslie Flake, a medical group CFO. "There may be a metric that is very difficult that very few providers perform well at, but if you perform better than the rest that would give you a bump in your score. That is how providers will be successful financially in the MIPS payment track." Once a provider organization chooses which measures to report on, health systems and multispecialty groups must decide on a reporting methodology. MIPS allows clinicians to report individually or as a group. Although group reporting is less onerous, there are a number of factors to consider in deciding on a reporting method. "Group reporting is probably much better for a multispecialty situation," said Mr. Johnson. However, he noted it may be a good idea to assess individual reporting at multispecialty groups based on factors such as past PQRS performance, number of clinicians exempt from MIPS, etc. Individual reporting may also be a good idea when a group or system includes several specialists. "Unless the MACRA reporting structure is adjusted, each specialty may need to report separately … to be able to report on the quality metrics applicable to their specific specialty," said Ms. Flake. Best practices for MIPS participation It is critical for health systems and multispecialty groups to map out a MIPS strategy that fits into the organization's current trajectory and helps it move toward value-based care. This requires provider organizations to take a coordinated approach across all units when rolling out their MIPS plan. "It's essential for healthcare organizations to align MIPS strategies among divisions such as the health plan, medical group, acute care and ambulatory divisions," said Ms. Flake. "Once all divisions are aligned, MIPS objectives can progress rapidly and quality performance will be realized." It is also vital for health systems and multispecialty groups to have a mechanism in place to continually track the measures on which they choose to report. This will empower them to provide timely and meaningful feedback to clinicians and various departments and revenue centers within the organization, according to Mr. Johnson. He noted the feedback mechanism should also be used to educate clinicians on how to strengthen clinical reporting and contain costs to achieve optimal scores under the program. To provide this valuable feedback, health systems and multispecialty groups must be able to access live clinical performance data within the EMR, according to Ms. Flake. She said it's imperative for provider organizations to build the technology infrastructure necessary to access performance data in real-time. "The biggest challenge with MACRA and any value-based program is accessing live performance quality metrics in the EMR at the provider and patient level," she said. "Historically, health plans have provided data, but it's often at the group level and there's a lag in time. To really be efficient, a provider needs to be able to see specific gaps at the time of service to effectively and efficiently close those gaps." Conclusion Although performance in CMS legacy programs can serve as an indicator of performance under MIPS, there is no sure-fire path to success under this new payment track. With careful planning and strategy, health systems and multispecialty groups can position themselves for success under MIPS. It will be difficult for some organizations to make the changes necessary to come out on top in a MIPS world, but taking steps to achieve the pathway's objectives is a step in the right direction in addressing many of the challenges facing the U.S. healthcare system. "It's not easy. It's one of the more complex changes in healthcare in many years, but we have to start somewhere," said Mr. Johnson. n

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