Readers Write: MIPS is Here – Don’t Be Afraid

MIPS is Here – Don’t Be Afraid
By Mandy Long

Some feel that the Merit-Based Incentive Payment System, part of the Quality Payment Program intended to improve the healthcare continuum by advancing quality-based care, has created new risk and uncertainty for a main industry pillar – providers. On the one hand, physicians who have been participating for years in the Physician Quality Reporting System and Meaningful Use state they feel ready for MIPS reporting. On the other hand, some have voiced concerns over needing more time to understand the program and prepare their practices due to a lack of resources, including staff and funding.

MIPS presents opportunities and challenges, and practices should stay educated regarding value-based reimbursement. As the chair of the Electronic Health Record Association’s Clinician Experience Workgroup, I’ve spoken with numerous clinicians, stakeholders, and industry experts about the concerns physicians have over the new reporting requirements and potential pitfalls.

While another mandate may seem daunting, many of today’s modern technologies can help address these changes and aid in the clinical, financial, and operational success of physicians. Here are four common MIPS-related concerns I’ve heard and accompanying reasons why the right technology and EHR vendor can help alleviate those stressors:

1) Concern: Practices are concerned about the lack of resources and time needed to help staff understand the new requirements.

Why? Understanding the complex requirements of MIPS can be difficult and overwhelming, especially for practices that feel they have less time and inadequate resources to develop the necessary knowledge.

Resolution: Work with a vendor that doubles as a responsive training and support team. Not only should they supply a modern solution that is intuitive and easy to use, but they should also offer services such as concierge coaching, education, and advisory services for practices that may not have the necessary in-house talent (or time). With limited resources, it is important to have an expert available to keep your staff well-informed as legislation evolves in our industry.

2) Concern: Practices are concerned that their staff doesn’t have the right experience with EHR systems and skills to leverage data needed for participation.

Why? Most physician practices have limited time to devote to additional administrative duties, including collecting and reporting data on quality measures and completing required documentation needed for participation in the new payment models.

Resolution: Select a vendor that has a proven track record in MU attestations and PQRS reporting, and offers an EHR system with structured data that automates the process. The right system should not increase overhead, but rather make your current team more efficient by streamlining data entry and reporting for each patient visit.

3) Concern: Practices that fight joining larger organizations are concerned that they lack the data needed to compare their performance to that of other practices or benchmarks.

Why? Some industry thought leaders have said that MIPS was a Congressional effort to push doctors to join larger organizations, which many consider better equipped to manage and coordinate care across the continuum. It is believed that practices that do so are more likely to participate in quality monitoring or clinical benchmarking than practices that do not share resources.

Resolution: Implement a solution with native analytical capabilities that documents near real-time comparative benchmarking of quality and cost. Your system should not only track individual physician performance and practice performance, but should also show you where you stand when compared to other physicians in your specialty.

4) Concern: Practices are concerned that they lack financial resources needed to make initial investments.

Why? Practices may not have a budget that can absorb the investments and resources necessary to keep up-to-date on and purchase solutions that meet regulatory requirements, especially when it comes to dedicated headcount to focus on quality programs.

Resolution: Avoid headaches by investing intelligently now with a partner offering services and solutions to help you avoid the end-to-end burden yourself. Your vendor should offer a specialty-specific, all-in-one suite of solutions and help develop a roadmap supporting your practice’s evolving needs. Your system should have MIPS success embedded in its technology, and shouldn’t require you to re-enter data already being collected during the clinical visit. It should offer services to educate and train your staff on how to appropriately document to succeed in the new MIPS landscape, and keep you knowledgeable as requirements evolve.

While CMS recognizes some difficulties that practices will face with new legislation, successfully navigating MIPS ultimately falls to the provider in selecting a partner who will best support their long-term goals. If you’re experiencing concerns similar to those listed above, don’t wait and see how these measures will impact your operations and finances. Find a great partner and adopt the right solution to prepare for the volume to value transition.

Mandy Long is VP of product management at Modernizing Medicine in Boca Raton, FL. 

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News 1/18/17

Top News

HHS Secretary nominee Rep. Tom Price, MD (R-GA) faces questioning from the Senate HELP Committee around a number of hot topics during his confirmation hearing, including repeal and replacement of the ACA, cuts to Medicare and Medicaid, conflicts of interest related to his investments, and the value of EHRs. Price, a former physician, echoed the sentiment of many MDs with his comments on EHR-related workflow interruptions and diminished face time with patients. He did, however, stress that the technology does have its benefits, including making health data digitally portable, but should be more shareable. He moves on to the next round of his confirmation hearing Tuesday, when the Senate Finance Committee will decide whether or not to forward his nomination on to President-elect Trump.

Webinars

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Jason Burum, chief client officer, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.

February 1 (Wednesday) 1:00 ET. “Get your data ready for MACRA: Leveraging technology to achieve PHM goals.” Sponsored by Medicity. Presenters: Brian Ahier, director of standards and government affairs, Medicity; Eric Crawford, project manager, Medicity; Adam Bell, RN, senior clinical consultant, Medicity. Earning performance incentives under MACRA/MIPS requires a rich, complete data asset. Use the 2017 transition year to identify technology tools that can address gaps in care, transform data into actionable information, and support population health goals and prepare your organization for 2018 reporting requirements.

Acquisitions, Funding, Business, and Stock

Aprima Medical Software acquires reseller Healthcare Data Solutions for an undisclosed sum. Aprima will take over the Coral Gables, FL-based company’s 300 end users from 125 practices across the country. HDS CEO Rodney Barreto expressed interest in selling the company to pursue other interests, a feat that shouldn’t be hard given his interesting work history –  stints at the City of Miami Police Dept., Fish & Wildlife Foundation of Florida, and the South Florida Super Bowl Committee make me think he’ll keep things local.

Oculus Health closes an undisclosed amount of Series A funding led by Excel Venture Management. The Portsmouth, NH-based startup will use the financing to further develop its technology-enabled chronic care management offerings, as well as finish up development of a Comprehensive Primary Care Plus service it hopes to roll out in the coming weeks.

Announcements and Implementations

Anchor offers online HIPAA training targeted to the employees of small and medium-sized organizations.

Kansas Medical Mutual Insurance Company and Kansas Health Information Network subsidiary Kammco Health Solutions develops an analytical tool that pulls together clinical data from all participating HIN providers, giving physicians access to high-risk patient, preventative care, readmissions, and disease registry reports.

Telemedicine

A New Jersey Healthcare Quality Institute survey of 722 adults finds that 84 percent have never received any kind of virtual care, though a third say they would choose telemedicine options if it meant they’d be able to spend more time with their physician, receive care sooner, or save money. State legislators are gearing up to create laws that would define the licensing, privacy, and reimbursement issues surrounding telemedicine.

People

Shantanu Agrawal, MD (CMS) joins National Quality Forum as president and CEO.

Modernizing Medicine Director of Urology Nadeem Dhanani, MD joins the Electronic Health Record Association Executive Committee. MM Senior Product Manager Ida Mantashi becomes chair of the EHRA Quality Measurement Workgroup.

Government and Politics

Acting CMS Administrator Andy Slavitt announces the launch of the Office of Clinician Engagement, which will focus on helping to reduce physician administrative burdens and better engage with them in the field. The office, which Slavitt stresses will not be led from the insular world of DC, will kick off listening sessions this spring led by practicing physicians Ashby Wolfe, MD and Aditi Mallick. Originally announced in October, the new office’s first endeavor will be the launch of an 18-month pilot program to reduce medical review for physicians practicing within certain Advanced Alternative Payment Models.

CMS also makes it known that 359,000 providers are now participating in APMs, which include the Medicare Shared Savings, Next-Generation ACO, Comprehensive End-Stage Renal Disease Care, and Comprehensive Primary Care Plus programs. Nearly 3,000 primary care practices and an associated 13,000 clinicians are taking advantage of the first round of the CPC+ model. A second round of participation will begin next year.

Research and Innovation

Researchers take data protection to an entirely new level with the development of an EHR password based on a patient’s heartbeat. “The ECG signal is one of the most important and common physiological parameters collected and analyzed to understand a patient’s’ health,” says lead researcher Zhanpeng Jin, who has done similar work using a person’s “brainprint.” "While ECG signals are collected for clinical diagnosis and transmitted through networks to electronic health records,” he explains, “we strategically reused the ECG signals for the data encryption. Through this strategy, the security and privacy can be enhanced while minimum cost will be added.”

Other

Say it ain’t so: A study of 10 million passwords from 2016 data breaches reveals that the most common password is still 123456. The study’s authors point some fingers at users, but lay the biggest amount of blame on website operators who “who fail to enforce the most basic password complexity policies.”

Sponsor Updates

• EClinicalWorks will exhibit at the NHMI Annual Orthopaedic Winter Meeting January 20-21 in Stowe, VT.

Blog Posts

• How AdvancedMD is Changing Independent Practices Like Yours (AdvancedMD)
• A Eureka Moment – Insights from a Consultant (Culbert Healthcare Solutions)

Contacts

Jenn, Mr. H, Lorre

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News 1/17/16

Top News

Formativ Health will open a 65,000 square-foot office next month in Jacksonville, FL – home to the Baptist Health system, Mayo Clinic, and Blue Cross Blue Shield. The practice and revenue cycle management company – an offshoot of Northwell Health (NY) that formally launched just a few weeks ago – will begin training 500 employees at the new patient contact center, which will begin partial operations in April. Full build-out of the space is expected to wrap up by the middle of next year. Chief Patient Access Officer June Scarlett will oversee operations. City officials apparently rolled out the red carpet to close the deal, which was brought to a satisfying conclusion during the Notre Dame/Naval Academy football game at EverBank Field (home of the Jacksonville Jaguars).

In other Formativ news, the company acquires EHR/PM/RCM vendor Etransmedia. CEO Vikram Agrawal calls the sale to Formativ “a great outcome for all our major stakeholders – shareholders, employees and customers.” Etransmedia backer Praesidian Capital walked away with $20.4 million.

Webinars

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Jason Burum, chief client officer, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.

February 1 (Wednesday) 1:00 ET. “Get your data ready for MACRA: Leveraging technology to achieve PHM goals.” Sponsored by Medicity. Presenters: Brian Ahier, director of standards and government affairs, Medicity; Eric Crawford, project manager, Medicity; Adam Bell, RN, senior clinical consultant, Medicity. Earning performance incentives under MACRA/MIPS requires a rich, complete data asset. Use the 2017 transition year to identify technology tools that can address gaps in care, transform data into actionable information, and support population health goals and prepare your organization for 2018 reporting requirements.

Announcements and Implementations

Miami Lakes, FL-based DashboardMD develops a population health and clinical analytics module to help physicians monitor and manage quality and outcomes.

Essex County Mental Health Services selects TenEleven Group’s EHR for its outpatient mental health clinic in upstate New York.

Tysons Corner, VA-based United Medical Laboratories enlists the help of Halfpenny Technologies to help connect its LIS to the EHRs of its physician customers.

Telemedicine

An MGMA poll of 1,325 respondents finds that the majority – 36 percent – do not plan to offer any form of virtual consult this year, though 21 percent are planning to at some point and 20 percent are unsure. The stats line up with the plans of several physicians I’ve talked to in recent months. They are interested in adding some kind of telemedicine service, which they see as a way to differentiate themselves from the competition, and increase patient satisfaction and loyalty. And yet they are taking their time in signing on the dotted line with any one particular vendor. A practice manager told me just this morning that his big qualifications are the legal hurdles he’ll have to overcome in the state the practice operates in, price, and service quality. Given that independent practices are already stretched thin, it’s no surprise that vetting telemedicine vendors is a priority that most are putting off.

Research and Innovation

A HealthMine survey of 750 insured consumers reveals that 73 percent believe their payers don’t understand their health needs very well, while nearly 40 percent say their plans give them “personalized incentives and recommendations that are specific” to their health. While seemingly at odds, the stats reinforce the notion that, though more consumers are insured than ever before, many don’t understand the sponsored health plans they’ve signed up for. It seems like there’s definitely room for improvement around communication on the payer’s part, though I’m not sure how much incentive there is for that to happen quickly. 

A Kareo survey of 170 medical practices finds just 4 percent understand what will be required of them under MACRA, while 41 percent say they aren’t sure and a similar number admit to being clueless. That’s not surprising given the feedback CMS received and the flexibility options it offered as a result. The majority were in accord in their belief that associated reporting requirements will definitely increase.

Government and Politics

Current policy advisor and former Rep. Phillip Gingrey, MD (R-GA) shares his enthusiasm for the appointment of colleague and fellow Georgian Tom Price, MD as HHS secretary. The two became acquainted 25 years ago while practicing in Atlanta, and went on to serve together in the Georgia State Senate. “While some may disagree with his specific approach to solving the nation’s challenges of providing affordable coverage and access to care,” Gingrey writes, “one cannot disagree that he is a health policy leader who puts pen to paper and does not shy away from the details and complexities of healthcare reform. The secretary of HHS needs to be someone thoughtful, knowledgeable, respected, trusted and able to solve problems. Price exceeds these job requirements.”

Other

American Society of Clinical Oncology CMO Richard Schlisky, MD looks to light a fire under patients when it comes to demanding interoperability between providers: “We encourage patients to ask their doctors about the type of EHR system they use, and whether you are able to access your health information through a patient portal. Ask about the challenges your physicians face in sharing records with hospitals and specialists. If you are not satisfied, make your concerns known to your physician and others charged with ensuring that EHR information can be safely and securely shared. And keep hard copies of key medical reports just in case! Technology has presented us with an unprecedented opportunity to improve patient care. If we squander it because our EHR systems can’t communicate with each other, everyone loses.” His zeal is admirable, and I’m sure there are many tech-savvy patients who will take him up on the challenge. I fear, however, that there is a far bigger chunk who just aren’t aware of the benefits until they’re in the thick of an interstate medical crisis.

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Jenn, Mr. H, Lorre

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Readers Write: Inspiring IT Action to Improve Flu Season Outcomes

Inspiring IT Action to Improve Flu-Season Outcomes
By Sara Johnston

The busy cold and flu season can be a challenging time for physicians inundated by patients with coughs, colds, and fevers – not to mention the calls, questions, and scheduling demands associated with them. The added interactions can cause delays to the appointment schedule and result in unhappy patients left waiting for appointments longer than necessary all the while increasing the chances of potential exposure to  viruses lurking in the waiting room. To help alleviate this burden, physician practices should consider using a point-of-care education strategy to deliver flu vaccine information. In so doing, they can reduce the headaches and burdens associated with flu season and inspire healthy actions to improve outcomes, while at the same time improving the patient experience, enhancing patient loyalty, and increasing practice profitability.

Point-of-Care Education

POC education leverages the moment that healthcare is top-of-mind with patients – as they are waiting to see their provider – to deliver health-related messaging. Messaging can be delivered via print or digital channels; in the waiting room or exam room; and typically takes the form of video loops on a television monitor, tablet-based interactive modules, print brochures, or wall panels. Individual practices typically tailor the offering with messages specific to their practice.

For physicians, there are many benefits to educating their patients on the flu vaccine. Having higher rates of vaccination among their patient base means that patients are less likely to get sick with the flu. The vaccine also can be an important preventive tool for patients with other chronic health conditions, and can help reduce hospitalizations. At the same time, by increasing the number of vaccinated patients, physicians are less likely to experience interrupted workflows and additional winter scheduling pressures, since fewer patients will require emergency sick appointments for unexpected flu visits. Practice productivity can increase, as the burden of remembering to remind patients about flu vaccines and other practice announcements can be incorporated into the POC offering.

Action Leads to Positive Outcomes

When patients are engaged at the point of care, they are more likely to be inquisitive about their health and to discuss treatments with their physicians. In partnership with 15 practices running flu education campaigns, AccentHealth recently conducted interviews with a research firm to assess patient behavior in response to POC messaging. The study showed that patients who were exposed to flu-specific POC messaging were 68 percent more likely to discuss the vaccine with their doctor that day, and patients who typically do not vaccinate were 8.6 times more likely, compared to those who were not exposed to the messaging.

What’s more, recall rates were quite high and patients appreciated receiving the information while in the waiting room. A large majority of patients found the flu information helpful, relevant and effective. Not only did the POC messaging lead to more interest and discussion with their healthcare providers, patients exposed to messaging were ready to take action. The discussions that day led to significantly more doctor recommendations for the vaccine compared to patients not exposed to the flu-specific POC messaging; a number of patients received the vaccine that day or planned to shortly thereafter.

Satisfied Patients

When patients recalled the flu messaging at the point of care, they were more likely to feel cared for by their physician, with 80 percent noting that the messaging reflected positively on the doctor’s office. The degree to which patients valued the information is reflected in the fact that not only did they initiate conversations with doctors, but they were also 87 percent more likely to recommend the flu vaccine to their friends compared to those who did not see the messaging.

The survey confirmed that patients view the physician’s office as their top source of information for flu and flu vaccines – more so than Internet-based information, print media, advertising, family, and friends. This includes not only conversations with their healthcare provider but also the information available in the doctor’s waiting room.

Increasing Practice Profitability

Providing flu education at the point of care can add to a practice’s profitability. Research shows that patients influenced to take action typically do not plan to receive the flu vaccine at another location. Flu vaccines administered at the practice can augment practice income, sometimes providing a significant portion of the overall revenue.

In short, POC flu education can be an effective tool for physicians looking to improve patient outcomes, create office efficiencies, and generate additional revenue for the practice. By educating on flu vaccines, physician practices can improve the patient experience, create greater loyalties, and help patients feel greater care.

Sara Johnston is senior manager, Insights and Analytics, at AccentHealth in New York City.

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Jenn, Mr. H, Lorre

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News 1/16/17

Top News

MDlive dives deeper into the employer market with the launch of MDlive prime, a collection of virtual health and wellness benefits for small businesses. The plan – offered as either a stand-alone product to small businesses that don’t offer traditional insurance or an add-on to employers that do – gives employees unlimited virtual consults (including behavioral health counseling), pharmacy benefits, and a soon-to-be released cost comparison tool.

Webinars

January 18 (Wednesday) 1:00 ET. “Modernizing Quality Improvement Through Clinical Process Measurement.” Sponsored by LogicStream Health. Presenters: Peter Chang, MD, CMIO, Tampa General Hospital; Brita Hansen, MD, CHIO, Hennepin County Medical Center. The presenters will describe how they implemented successful quality governance programs, engaged with their health system stakeholders, and delivered actionable information to clinical leadership and front-line clinicians. Q&A will follow.

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Jason Burum, chief client officer, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.

February 1 (Wednesday) 1:00 ET. “Get your data ready for MACRA: Leveraging technology to achieve PHM goals.” Sponsored by Medicity. Presenters: Brian Ahier, director of standards and government affairs, Medicity; Eric Crawford, project manager, Medicity; Adam Bell, RN, senior clinical consultant, Medicity. Earning performance incentives under MACRA/MIPS requires a rich, complete data asset. Use the 2017 transition year to identify technology tools that can address gaps in care, transform data into actionable information, and support population health goals and prepare your organization for 2018 reporting requirements.

Acquisitions, Funding, Business, and Stock

McLean, VA-based Cognosante, a government programs-focused health IT consulting firm, moves into the Louisiana Business & Technology Center in Baton Rouge. The incubator offers office space and access to business counselors and the expertise of MBA graduate students. 

People

Ronald Keurbitz (Fresenius Medical Care North America) joins fledgling physician practice management company Agilon Health as CEO.

Former CMS COO Mandy Cohen, MD joins the State of North Carolina as HHS secretary.

Telemedicine

Oakland, CA-based Dictum Health receives government clearance to offer its hardware and cloud-based software telemedicine services to providers in Saudi Arabia, the United Arab Emirates, and Thailand.

The local news highlights the growing role telemedicine plays when winter storms hit, helping patients receive diagnoses and treatment while safely staying put at home. Kaiser Permanente Northwest Physical Therapist Kirsten Pauken corresponded with a colleague via the technology during one house call made by skis to check on a patient suffering from a skin infection. “It’s been such a hard winter with so many icy days,” she says. “At least I have the option to ski. It was not too bad. The snow was a little heavy. There was not as much slide as normal.” KPN has been training its providers on telemedicine visits over the last year.

Agricultural health plan UnitedAg expands its services agreement with Teladoc to include behavioral health, dermatology, and smoking cessation for its 35,000 members, many who farm in rural areas with a lack of mental health services. The payer partnered with Elite Medical to open a member health clinic in Visalia, CA late last year.

Government and Politics

The Council of Accountable Physician Practices joins other trade associations in offering unsolicited advice to repeal-and-replace lawmakers. Chairman Robert Peal, MD who also serves as CEO of The Permanente Medical Group and the Mid-Atlantic Permanente Medical Group, recommends that legislators focus on speeding up the move to value-based payments, more widespread and efficient coordination of care via healthcare technology, and simplified and standardized quality measurement and reporting for easier benchmarking. “In the debate over healthcare reform, we must not ignore the importance of improving how healthcare services are organized and delivered,” he explains. “If we do not continue to emphasize the need for care initiatives that promote physician-led, value-based, patient-centered, technologically-enabled care, we will lose ground in quality, innovation, and outcomes that lower the cost of healthcare, while making it more available and convenient to patients. The consequences of inaction for our patients, their communities, and the nation are significant.”

CNN offers up several physician opinions of the ACA. Some blame it for increased administrative burdens while others tout its benefits for safety net populations. Atlanta-based urologist Brian Hill, MD who sold his practice to Northside Hospital several years ago, believes that “[W]e, as physicians, have dropped the ball. We’ve given up our role. Our role should be the caretakers of healthcare, and instead we gave that to the insurance companies. We got other people to step in. We’ve got to look at a way to allow physicians to innovate, to change, to bring forward a better product than what’s out there right now. There are people out here that love healthcare, that love providing care for their patients, and believe that there’s a better way. And I think that’s where this is going to come from. I think the solutions are going to come from us.” Like many, Hill is thinking about entering the telemedicine space.

The Federation of State Medical Boards encourages the incoming administration to support state efforts to join the Interstate Medical Licensure Compact, which looks to expedite physician licensing across state lines and thus increase access to telemedicine services. (Eighteen states have enacted the compact thus far.) It also prioritizes working with federal agencies to combat the opioid crisis, and accelerating access to telemedicine services for active-duty military and veterans.

Other

She puts my Goodreads account to shame: Four year-old Gainesville, GA native Daliyah Marie Arana acts as “Librarian for a Day” at the Library of Congress in Washington, DC. The bookworm achieved the honor after completing the Georgia Public Library literacy program called 1,000 Books B4 Kindergarten. I may have mentioned this before, but my first job was a library assistant at my local public library. It was a dream job given my love of reading and the perk of getting my hands on best-sellers before they were made available to patrons.

Sponsor Updates

• Rock Health awards Medicity’s Brian Ahier with the Digital Health Evangelist of 2017 award. Snowed in and unable to accept the award in person, Ahier posts his acceptance speech from his blanketed driveway.
• Nordic Consulting releases a new podcast, “What the best health IT consultants do at the end of their contracts.”

Blog Posts

• RTLS: A Hot Healthcare Technology to Watch in 2017 (Versus Technology)

Contacts

Jenn, Mr. H, Lorre

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