Winning the later rounds: Keep getting stronger
Physicians next need to fully commit to value-based care. The penalties for not doing so will come not only from MIPS, but possibly from private payers.
The noncompliance penalty for MIPS increases to 9% by 2023—a substantial hit to any practice’s Medicare revenue. Private payers are likely to create their own incentives and bonuses, if they haven’t already, that may be based on the same quality measures, so a practice’s revenue might be reduced by penalties from them, says Robert Dean Jr., DO, a critical care physician and senior vice president for performance management at Vizient, a Dallas-based healthcare performance improvement company. “You really have to look at how much you might be sacrificing by not making this investment in value-based care,” Dean adds.
Investment can come in many forms, from having an EHR that’s certified to 2015 standards to population health tools or care coordinators who can help manage complex patients.
“Not only do they need to look at the chronic diseases, but some of the social determinants of health, which are really important in value-based care,” says Joseph. Social determinants are factors like access to safe housing, education and healthy foods, which can all have an effect on whether a patient adheres to treatment.
“Once you put the registries together, ID your complex patients, you’ll find all sorts of reasons why they aren’t keeping up, such as they don’t have transport or can’t afford their meds,” says Schlecht. “Then you can match them up with programs that are in place to get them to participate and help take care of themselves.” The result is better care for the patient and high quality numbers for the doctor.
Schlecht has seen his practice’s diabetes treatment rankings go from the bottom quartile to the top—and knows that patients are better cared for as a result. “The goal is better quality and costs, and we achieved that compared to where we were at the very beginning of the effort,” he says.
CMS’ stated goal is eventually to move all practices into APMs, but for most small practices, the only realistic path now is to start in MIPS and see what additional APMs are offered in the future, says Buchnowski. APMs are shared-risk models, and most small practices are not ready for that. Because many of the quality measures in APMs are the same as those in MIPS, moving forward with MIPS gets a practice ready for a future transition to an APM, he adds.
Gilberg says doctors that want to stay independent need to not only educate themselves about MIPS and APMs, but understand the capabilities of their EHR and practice management systems and how they can help capture the data for quality reporting that drives performance.
“Familiarize yourself with MIPS and have conversations with your vendors now on how they can help,” says Gilberg. “Take the basic steps to protect yourself and your practice while at the same time looking at the ways you can get some positive payment opportunities for things you may already be doing.”
Dean says that as doctors adopt value-based care protocols, the results will be positive for both them and their patients. “When they adopt some of these things, we see many clinicians feel like they are taking better care of their patients. We are seeing an increase in the improvement of burnout and more joy in their work. I think we need to get through this transition, but they are all things that will make patient care and the practice of medicine better.”