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March 9, 2017 Guest articles No Comments

5 Tips for HIPs to Help Jumpstart MIPS Readiness
By Chris Gluhak

Despite rumblings among the new administration and some members of Congress about dismantling the ACA, one thing remains certain: The move toward a performance- and outcome-based healthcare economy is critical to ensuring affordable access to quality care. MACRA is designed to do just that by establishing baseline performance requirements aimed at improving both the quality and cost effectiveness of care to benefit patients, providers, and payers.

As part of MACRA compliance, the MIPS Quality Payment Program kicks off this year, requiring healthcare providers to start collecting and reporting on quality metrics to CMS. With the first clinician scores set to be published in 2019, the stakes are high for providers in demonstrating that they meet performance and outcome expectations.

Not only is MIPS required for successful population health management and adequate reimbursement under CMS guidelines, but the trend toward healthcare consumerism will also force providers to compete for market share on the basis of their performance. Consumers care about ease of access, transparency of care and costs, affordability, and outcomes. These factors are driving patients to select providers more carefully. With these kinds of metrics soon to be publicly available, clinicians are under increasing scrutiny to maximize their performance scores to maintain market share.

As a result, Health Information Professionals (HIPs) are in a powerful position to help providers implement accurate, efficient data collection and reporting processes to meet these new standards for reimbursement and market satisfaction. Here’s where your expertise is needed most:

1) Determining performance measures. Clinicians can choose what types of data they will submit to CMS in order to measure performance. Several scoring criteria relate directly to the work of HIPs including the use of end-to-end electronic reporting through certified EHR technology; heavily weighted activities like member outreach and engagement, care coordination and population management; and IT-related requirements, such as establishing reporting structures for measures on individual and group levels, and planning for including Part D cost data into cost reporting. Choosing the right scoring criteria can make a substantial difference in the reportable success of the practice, and HIPs can help practitioners understand which metrics make the most sense for their practice.

2) Implementing MIPS systems. One of the most critical aspects of MACRA will be implementing the necessary infrastructure to support timely and accurate submissions. That means IT systems must provide for efficiency and accuracy in collection, documentation, reporting, tracking, and submission of clinical metrics. One of the biggest obstacles in this process is often the inability to use unstructured data in clinical charts. Manual analysis is exceptionally expensive and time-consuming, and frequently prone to error. To resolve that problem, HIPs should investigate and lobby for a MIPS solution that uses an advanced natural language processing engine to automate the extraction of all data from clinical charts.

3) Integrating data across reimbursement processes. In addition to required MIPS reporting systems, practices may also find that integrating data collection and analysis across all of their reimbursement processes, including clinical data collection, analysis, and tracking, will provide for additional efficiencies, as well as reveal insights into practice management. Again, implementing the right technology can enable this integration. Solutions that provide a versatile data acquisition and integration suite that supports a wide range of interfaces, with the ability to ingest and integrate data from even the most complex and disparate sources are ideal. HIPs can assist in this process by collaborating with payers and other partners to ensure congruency across data fields, ensuring all data fields and patient records are complete and accurate, and monitoring data entry processes for data cleanliness and efficiency.

4) Educating providers. Providers must be made aware that the performance scores for all participating clinicians (or groups of clinicians) will be made public by CMS in 2019. It’s imperative that they understand the implications of this publication, in terms of both reimbursement and competitive positioning. As stewards of the information, HIPs can play a primary role in articulating the importance of positive performance metrics in maintaining a strong CMS relationship, and a successful practice overall.

5) Continuous evaluation. Along with emphasizing the importance of the initial score publication, HIPs can also play a critical role in establishing internal monitoring mechanisms that keep clinicians informed of their performance status relative to others in the organization, and relative to themselves on an ongoing basis. This type of continuous evaluation not only provides benchmarking data to improve practice performance and care quality overall, but also to help maintain a strong position in the marketplace as consumers begin to gravitate toward practices that demonstrate top-notch performance.

With the initial MACRA/MIPS reporting period already underway, HIPs must act quickly to ensure their practices are in compliance both operationally and technologically. In order to earn the maximum benefit through CMS, clinicians must submit a full year of data by March 31, 2018. Implementing the most effective IT systems and processes now will ensure accurate data collection throughout the year, for the most thorough and efficient reporting now and into the future.

Chris Gluhak is director of risk adjustment – solutions consultant at Health Fidelity in San Mateo, CA.


Jenn, Mr. H, Lorre

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