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Docs risk reputation damage by reporting minimal MIPS data


This year, physicians can avoid a payment penalty in the Medicare Quality Payment Program by simply submitting a minimal amount of data. But that small amount of data could cause a bigger problem in 2019.

This year, physicians can avoid a payment penalty in the Medicare Quality Payment Program by simply submitting a minimal amount of data. But that small amount of data could cause a bigger problem in 2019.

In the first year of the program, under the Medicare Access and CHIP Reauthorization Act (MACRA), physicians can ease their way into the program requirements. Under MACRA’s Merit-based Incentive Payment System (MIPS), physicians can submit as little as one quality measure improvement activity for any time period in 2017 and avoid a financial penalty. The more data they submit, the more potential to earn a payment incentive.


Further reading: How to succeed under MIPS


Data entered for 2017 for quality (60% of a physician’s overall score), advancing care information (25%) and clinical improvement activities (15%) will affect 2019 reimbursement under the program.  Not submitting any data will result in a 4% payment penalty two years from now.

So while easing into this new realm of value-based care and quality metrics may seem attractive to physicians still figuring things out, Tom Lee, PhD, MBA, chief executive officer and founder of software solution provider SA Ignite warns physicians to maximize their efforts.

Speaking at the American College of Physicians (ACP) conference in San Diego, Lee said this is because part of the Medicare Quality Payment Program lets the Centers for Medicare & Medicaid Services (CMS) publish each physician’s annual score (as well as scores for all participating physicians) on its Physician Compare website. Furthermore, it will also share that data with other third-party ratings sites including HealthGrades, Yelp and Google.

“Don’t lose track of this,” Lee warned. “That score will be in the public domain even if you are just simply trying to avoid a payment penalty [in 2019 by testing out the program’s data requirements].”

That means patients and others will see physicians’ scores  online, likely without the context included.  So a low score, either due to poor performance or just simply doing the bare minimum to meet quality metric requirements will essentially look the same.

And, Lee noted, the score follows physicians who switch organizations--becoming, in essence, a part of that physician’s permanent file. That reputational damage alone could affect mergers and acquisitions, contracting and other evaluations of the physician.


Related: Top MACRA apps physicians need to download


“[MACRA] is a competitive program,” said Lee. “All the scores, out of 100, for you and other physicians will be published on Physician Compare for everyone to see.”

Next: Making MIPS work for physicians


Making MIPS work for physicians

Both Lee and his co-presenter, Priya Radhakrishnan, MD, FACP, a practicing internist in Arizona and a member of the ACP’s medical informatics committee, gave attendees several tips to go beyond just participating and work to achieve the best quality score possible.

Because the quality and advancing care information categories comprise 85% of a MIPS score, Lee noted that electronic health records (EHRs) can be a strong asset in collecting and submitting data.  From working with vendor to ensure they are prepared for MIPS’ measures and can properly report the data, to simply ensuring that all the information for daily work is entered, EHRs can be a true asset, he said.


Related: Top tips for physicians to deal with uncertainty


“Make sure you are getting credit for what you do,” Lee said. “MIPS is where every single point equals dollars.”

Under the clinical improvement activities section of a physician’s scores, they are rewarded for care focused on care coordination, patient engagement and safety. But selecting which of the 92 measures to report on can be daunting for physicians, noted Radhakrishnan.

Her advice to physicians is to make the data work for them by selecting for measurement the activities they already do and want for their patients. So from increasing rates of diabetes screening to implanting fall screening and assessment programs, focus on what the practice already does.

“Look at what you want from the data,” she said. “For us, as physicians [it’s about] understanding the [MIPS] process versus getting lost in the forest of numbers and saying ‘I can’t do this.’”

Both Lee and Radhakrishnan noted how important education regarding the Medicare Quality Payment Program overall and MIPS specifically is as an initial step, from physicians to all staff at a practice.

The next step, said Lee, is to estimate your MIPS scores so you know exactly what you’ll get in 2017 – and is reported two years from now on Physician Compare – as well as where you want to be in the future. Setting that goal early on and understanding what it will take to get there will go a long way.

“Try to predict your score now,” Lee said. “It is critical to your continuous improvement and success.” 

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