Becker's Hospital Review

89 FINANCE CMO / CARE DELIVERY Is MIPS Dead? 5 Questions, Answered By Emily Rappleye T he Medicare Payment Advisory Com- mittee, a federal group tasked to advise Congress on Medicare, voted in January to eliminate the Merit-based Incentive Payment System and replace it with an alternative pro- gram. MedPAC characterized the clinician pay- ment program as "burdensome and complex." What does this change mean for providers? Becker's tapped Tim Gronniger, senior vice pres- ident of strategy and development at Caravan Health, to answer this question. Mr. Gronniger served as the CMS deputy chief of staff under the Obama administration and helped write MIPS. Here we answer five top questions about the short-term future of the MIPS program. 1. What's wrong with MIPS? at MIPS is flawed is no secret among clinicians. "ere's no question that they don't like MIPS," Mr. Gronniger says. "ere's an attitude that this is a lot of work with no benefit." e program is seen as confusing and particularly burden- some for independent physicians. To be fair, MIPS has baggage. It's a mashup of past programs, like the value-based payment modifier program and meaningful use, and as such, it has been dogged with complaints that once haunted those initiatives. For example, MedPAC has pointed to studies that show the value-based patient modifier worsened care disparities and resulted in payment adjustments for a concentrated group of physicians. Many clinicians also feel the incentives are misaligned, pushing them to report on measures that are easiest to improve, rather than working on true practice or outcome improvements. "No one wants to practice that way," Mr. Gronniger says. 2. What does MedPAC want to replace it with? MedPAC's solution is the voluntary value program, which — like MIPS — still has an overarching goal to push physicians toward participation in Advanced Alterna- tive Payment Models, the more "elite" track of the Quality Payment Program. However, the VVP would automatically withhold 2 percent of a physician's fee schedule payments, which could be earned back by participating in an AAPM or by opting into a voluntary group for a performance assessment. e assessment would use population-based, claims-calculat- ed measures and evaluate groups on clinical quality, patient experience and value. 3. How does the VVP compare? e VVP has its own flaws. "Claims-collected measures, as applied to physicians right now, haven't been working very well either, which is one reason I'm skeptical of this proposed replacement," Mr. Gronniger says. "e reason most clini- cians and Congress don't like it is it starts with a 2 percent withhold, and then your best up- side case is clawing back that 2 percent." 4. How likely is Congress to act on Med- PAC's recommendation? e short answer? Not likely. ough MedPAC plays an import- ant role in what Medicare legislation Con- gress considers, MIPS is an unlikely target at the moment. "Congress has made it pret- ty clear they don't want to comprehensively revisit the MIPS program right now," Mr. Gronniger says. Much of the discussion is tied up by funding legislation, and there's no easy fix. "ere's not a silver bullet," he says. "ere is a lot of attachment to the structure of MIPS, and I think the major thing to do is to figure out another way to reward partici- pation in AAPMs and focus on a discrete set of activities that are known to improve care, not attempt to measure each physician in the country individually." 5. Will MIPS change at all this year? Some small changes are likely, according to Mr. Gronniger. Specialty societies, in particular, are pushing CMS to keep delaying full imple- mentation of MIPS. is could happen, Mr. Gronniger says, but it's unlikely delays will continue forever. Another change to the pro- gram physicians may see this year is taking Part B drugs out of the payment adjustment, he says. Unless Congress takes up MedPAC's rec- ommendation, Mr. Gronniger advises phy- sicians to get involved in other value-based programs like ACOs, which can provide a framework to proactively address many MIPS requirements. "[It's] better, from our perspective, to have physicians and hospi- tals working together to improve quality and cost on predefined dimensions. e ACO program has a set of 30-plus quality mea- sures that are tracked. When you sign up for the ACO program, that's what you're signing up to work on, and there's a very well-un- derstood cost benchmarking process that you are judged on as part of an ACO," Mr. Gronniger says. n Why First Impressions of Providers Matter More for New Patients: 4 Insights By Megan Knowles P atients who felt their medical providers and staff were competent during a first visit were more likely to continue to visit the practice, according to a report by athenaInsight. Here are four insights from the report. 1. Researchers from athenahealth analyzed data from more than 200,000 pa- tient surveys issued by MedStatix. The report revealed the longer patients had to wait before meeting their provider during a first appointment, the less likely they were to recommend the practice to friends. 2. Eighty-two percent of patients who waited 0-5 minutes before meeting their provider during a first appointment were likely to recommend the practice, compared to 47 percent of patients who waited 45 or more minutes. 3. "Patients want to know what's going to happen to them and when and why, and they want people to be kind and have an appreciation for the fact that this is a person going through a difficult circumstance," said Barbara Sarnoff Lee, senior director of social work and patient and family engagement at Bos- ton-based Beth Israel Deaconess Medical Center. 4. To ensure a practice has loyal patients, Ms. Sarnoff Lee also recommends prac- tices pair technology tools with face-to-face efforts to improve engagement, such as smiles and knowing names. "[Tech] should enhance the experience and give people access to information," she said. "But at the end of the day, when you're sick and scared, nothing can help you the way humans can." n

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