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Surviving and succeeding in MIPS as a private practice


One physician offers advice to peers to make value-based care work at private practices, and perhaps even see financial gains.

Year one of the Medicare Quality Payment Program’s Merit-based Incentive Payment System (MIPS) is in the books. As physicians anxiously await reimbursement implications for 2019, they cannot let up on year two initiatives.

While CMS enacted a “pick your pace” approach in 2017, allowing physicians to essentially dip their toes into the value-based pool, this year requires more data, a larger reporting period and therefore, more focus on how their practices are promoting quality care.

“In our first year, we focused on maximizing participation,” said David Nilasena, MD, MSPH, chief medical officer for CMS Region VI, based in Dallas, Texas. “We emphasized that and had some success there last year.”

Nilasena, who spoke at this year’s American College of Physicians annual conference in New Orleans, added that CMS continues to find ways to make the program “continually easier” for physicians to participate in.

But for many private practices, tracking and collecting data on their patient panel and simply understanding the program is the main obstacle. Others remain hopeful that the Trump administration will simply repeal the program, so they are hesitant to participate past the minimum requirements for fear of spending time and energy on a temporary effort.

In 2018, under MIPS, physicians must no longer simply score three points to avoid a decrease in payment, but instead score at least a 15 on the program’s four categories: quality (comprising 50 percent their score); cost (10 percent); clinical improvement activities (15 percent); and advancing care information (25 percent).

Ryan Mire, MD, FACP, of Nashville-based multi-specialty practice Heritage Medical Associates, said this is an important number for all physicians participating in the Medicare program.

“QPP is a program we need to understand to get paid,” he said. “The bottom line is that we all want to make more money, but we definitely do not want to lose money. So you want to make sure to at least get the minimum score of 15 to at least keep our current payment rate from CMS. The better you do, the more incentive.”

Mire, who was involved with the QPP at his 140-physician private practice, told Medical Economics that physicians “have to take this seriously” as the value-based environment is here and looks to be around for a while.

The key for his practice, Mire said, was changing the culture in team-based care, requiring buy-in from everyone from the primary care and specialty physicians to medical assistants, nurses, and other non-physician providers.

Traditionally, we’ve worked in silos as the physician and the head of the team, taking care of the patient,” he said. “But now we are in a more team-based environment, with physician extenders that can do a lot of this work, such as contact patients after discharge, do their medication reconciliation, which once again, minimizes cost because it decreases [hospitalization]. So physicians need to get to a point of team-based culture.”

During the session, Mire detailed several best practices for private practices to survive and potentially even thrive under MIPS, including:

Become recognized as a patient-centered medical home. “A lot of the same concepts for PCMH translate into results in MIPS from quality improvement and using an EHR to just clinical improvements,” he said. Under MIPS, such recognition gives practices full credit for the clinical improvement activities category, “and that’s one less pillar [in MIPS] to worry about,” he told Medical Economics.

Incorporate HEDIS measures. Utilizing the Healthcare Effectiveness Data and Information Set (HEDIS) at a practice to measure performance on care standards can go a long way, he said. It can also assist-or translate-in the success of commercial value-based programs, which often take their lead from Medicare. Several HEDIS measures align with MIPS criteria.

Utilize available tools. Getting educated on the QPP is critical, he said. This includes utilizing tools from the ACP, CMS, and other professional organizations that are geared toward helping small practices with finding the best measures for them to report on.

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