2.02% Reward for Perfect 2017 MIPS Score

Lynn Scheps

Lynn Scheps

VP, Government Affairs & Consulting Services at SRS Health
Lynn Scheps is a leading resource on MACRA, MIPS, and Meaningful Use. She is the SRS liaison with government policy makers. Representing the voice of specialists and other high-performance physicians, she develops strategies to respond effectively to government initiatives.
Lynn Scheps

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final-score-100The results are in! We now know how providers will be rewarded for their 2017 MIPS efforts. You may be disappointed to see that with a perfect score of 100, the 2019 payment adjustment will max out at just slightly above 2%. And, unless a provider exceeded the exceptional performance threshold, thereby qualifying for a share of the $500 million bonus pool, the reward for successful MIPS performance is no more than an approximately 0.3% positive payment adjustment.

A survey of a few SRS Health customers revealed the following correlations between scores and payment adjustments:

2019-positive-payment-adjustments-v3

To summarize, MIPS Medicare payment adjustments fall into the following categories:

chart3

So what happened to the 4% positive payment adjustment “carrot” that the MACRA legislation appeared to offer (even before the bonus)? It vanished when CMS eased the requirements and reduced the threshold for penalty avoidance. Under the mandate of budget neutrality, with fewer providers receiving negative payment adjustments, there will be less money to share among the many providers who merit positive payment adjustments.

This was not unexpected, and a similar result should be anticipated for the next few years. The 2020 payment year (2018 performance year), offers a carrot of 5%, which will be similarly elusive. And the challenge of how to sufficiently motivate and reward providers will continue over the next few years, now that Congress has extended the transition period and relaxed the previously aggressive timetable for increasing the performance threshold.

 


 

Note:  To find out your individual or group’s 2017 final score and precise payment adjustment, log in to the QPP portal and follow the “QPP Performance” prompt. Your final score will likely be what you expected based on your attestation and/or other submission(s). If there is a difference, it could be due to new information reflected in the Quality component of your score, for example:

  • If, based on sufficient volume, you were subject to the All Cause Hospital Readmission measure, that data would be included in both the numerator and denominator of your Quality score.
  • If one of your CQMs was CAHPS for MIPS, that score will now be reflected.
  • If you reported a CQM for which no historical benchmark had been available at the time of submission, a benchmark may have been created subsequently, based on 2017 performance data.

If you believe that there is an error in CMS’ calculation of your final score—and therefore your payment adjustment—you can request a “Targeted Review” by September 30, 2018.

Are You Preparing for Appropriate Use Criteria Compliance?

Barbara Mullarky

Barbara Mullarky

Director, Product Management at SRS Health
Barbara has had a successful career in the healthcare industry, working for both vendors and healthcare provider organizations. She has held roles in sales, marketing, product management and professional services, working with EMR and department-focused solutions for the laboratory and imaging.

Prior to becoming the Director of Product Management at SRS, Barbara was with GE Healthcare (now GE Digital), where she held the positions of Senior Product Marketing Manager for Centricity imaging products, Product Marketing Manager and Customer Collaboration Leader for what is now Caradigm, and Upstream Marketing Manager for Centricity Laboratory. Barbara also worked at the University of Arizona Medical Center, where she managed a team that was responsible for implementing and maintaining 27 departmental IT solutions, the ambulatory EMR and the patient safety initiatives.

Originally from New Jersey, Barbara now lives with her husband in Tucson, AZ. She is a graduate of the West Virginia University College of Medicine and is a registered Medical Technologist. When not at work, she loves traveling, taking photographs, watching football and spending time with her two Brittanys.
Barbara Mullarky

auc-blogAppropriate Use Criteria (AUC) is a lesser-known government law that will affect everyone who orders advanced imaging procedures—a staple of orthopaedic practices. AUC is part of the Medicare Physician Fee Schedule regulations.

The law will impact the ordering, performing, and payment for advanced imaging procedures beginning January 1, 2020. The initial year (2020) will be an educational and testing year that will not affect payment.

Included in the advanced imaging procedure category are MRI, CT, PET, and nuclear studies. While certain specialties may not order many PET or nuclear studies, MRI and CT are staples in the diagnostic pathway and help determine care.

How does the law work?

The government is mandating that before any advanced imaging procedure is ordered, the ordering provider must consult an approved Clinical Decision Support Mechanism (CDSM). The CDSM will consider multiple factors on the patient and provide a recommendation as to whether or not the ordered procedure is appropriate or whether an alternative would be better.

At this point, providers have the choice to continue with the original order or to follow the CDSM recommendations. Information provided in the CDSM recommendation must be provided to the furnishing provider (imaging facility). The imaging facility must then include this information on the claim to the payer, and data on the choices made by the ordering provider will be stored in the CDSM for future auditing purposes.

Those who do their own in-house imaging will be impacted on the ordering and furnishing side. Your EHR, Radiology Information System (RIS), and claims management system will all need to be updated with new software to manage this.

We encourage you to speak with your EHR vendor to make the process of remaining compliant and meeting the requirements as seamless and minimally invasive as possible.

Spring at SRS Brings New Growth

Khal Rai

Khal Rai

CEO at SRS Health
Khal Rai brings over 20 years of leadership experience to his role as President and CEO at SRS. He possesses a breadth of knowledge and expertise in the healthcare and technology sectors earned through a career that has spanned the globe. His passion for collaboration, strategic development, and delivering healthcare IT solutions that make it easier for medical professionals to deliver care while navigating the ever-changing healthcare industry, inspires and motivates his team, while positioning SRS Health clients for current and future success. Khal has a B.S. degree in Computer Engineering from the University of Cincinnati, and an M.S. degree in Electrical Engineering from Purdue University.
Khal Rai

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ceo-spring-blogThree months have passed since I took over the reins at SRS Health, and what I have enjoyed most over that time is sharing in our clients’ successes, as well as learning about the challenges they face, their experiences, and their visions for the future. So far this year, I have had the pleasure of speaking with many of them on the phone and off traveling around the country to meet others in their practices or at conferences like ADAM, AAOS, AAOE, The OrthoForum, and HIMSS.

One recurring theme that has been a part of every conversation is the need to embrace change—to look forward, to anticipate, and to strive for improvement. Our mission is to help our clients do just that. We are excited to share the innovations SRS has been working on to help our clients excel at the practice and the business of medicine. Here are a few examples:

SRS Health launches the first end-to-end integrated clinical and financial solution suite for high-performance enterprise practices

I am pleased to announce that SRS recently debuted a unique and powerful new addition to our end-to-end software suite that leverages both clinical and financial expertise. What makes this solution unique is the integration that addresses true episodic care. SRS’ roots in the orthopaedic market combined with the new financial management capabilities offers a seamless set of tools for enhancing workflows, adapting to regulatory changes, adopting risk-based models, managing the increase in patient economic responsibility, and expanding programs in the employer market.

The Opioid Crisis and Drug Monitoring

As you know, the opioid crisis has become a top-of-mind political, social, and policy challenge. SRS has committed to joining the fight by being the first specialty EHR to offer PDMP (Prescription Drug Monitoring Program) checking and documentation integrated within the prescribing workflow—delivering a 67% time savings over current methods. More than 40 states already have PDMP mandates and it won’t be long before they all do. This is a great step in keeping our clients ahead of the curve.

Improving Our Clients’ Experience

While working on innovation, we haven’t forgotten about our clients’ day-to-day experience. To ensure their success, we have been formalizing the structure of the SRS Client Success Program. This year we’ve launched the Client Success Training Program and the Features Improvement Team. In addition, we have increased our clients’ ability to integrate with registries, HIEs, and more. These programs ensure that they have the knowledge and skills to fully leverage their HCIT solutions, the facility to share knowledge across their organization, and the connections to exchange information with optimal efficiency.

Medicine continues to put more and more demands on physicians, clinicians, and other healthcare professionals, and we’re excited that our integrated solutions suite optimizes performance and care before, during, and after the patient encounter. Our goal is to help our clients by taking care of the business of medicine, so they can focus on what matters most—their patients.

The Opioid Crisis

Barbara Mullarky

Barbara Mullarky

Director, Product Management at SRS Health
Barbara has had a successful career in the healthcare industry, working for both vendors and healthcare provider organizations. She has held roles in sales, marketing, product management and professional services, working with EMR and department-focused solutions for the laboratory and imaging.

Prior to becoming the Director of Product Management at SRS, Barbara was with GE Healthcare (now GE Digital), where she held the positions of Senior Product Marketing Manager for Centricity imaging products, Product Marketing Manager and Customer Collaboration Leader for what is now Caradigm, and Upstream Marketing Manager for Centricity Laboratory. Barbara also worked at the University of Arizona Medical Center, where she managed a team that was responsible for implementing and maintaining 27 departmental IT solutions, the ambulatory EMR and the patient safety initiatives.

Originally from New Jersey, Barbara now lives with her husband in Tucson, AZ. She is a graduate of the West Virginia University College of Medicine and is a registered Medical Technologist. When not at work, she loves traveling, taking photographs, watching football and spending time with her two Brittanys.
Barbara Mullarky

It’s not news that America is facing a crisis with opioids and narcotic abuse—public service announcements are running on every network; the president has declared it a health emergency; and an increasing number of Americans have had personal experiences with a family member or friend who has become addicted.

Laws have been put in place or are being considered at every level of the government to help address the problem. One approach to helping doctors continue to care for their legitimate patient requests while identifying drug seekers or “doctor shoppers” is the PDMP, or Prescription Drug Monitoring Program.state-of-market-041718-600px

1 Interstate Data Sharing: http://www.pdmpassist.org/pdf/Interstate_Data_Sharing_20170920.pdf
2 PDMP Hub-to-Hub Interoperability Updates: http://www.pdmpassist.org/pdf/Interstate_Data_Sharing_20170920.pdf
3 PMP Gateway: https://apprisshealth.com/solutions/pmp-gateway/

PDMPs are state-run databases containing patients’ prescription histories. PDMPs now exist in all states, and more than 40 states have laws making it mandatory to check the PDMP before prescribing a narcotic. Some states require documentation that the doctor not only checked the PDMP, but also counseled the patient. And some states are starting to identify doctors who prescribe high numbers of narcotics, and are putting programs in place to counsel those providers. The College of Healthcare Information Management Executives (CHIME), a branch of HIMSS, recently met and recommended that the Center for Medicare and Medicaid Services (CMS) include the use of Electronic Prescribing of Controlled Substances (EPCS) as part of the MIPS portion of the Quality Payment Program (QPP) in 2019. They also recommended that CMS and Office of the National Coordinator (ONC) focus on interoperability and removing the burden for clinicians.

Another method to help control the crisis is the use of EPCS. Unfortunately only 17 percent of physicians in the US are EPCS enabled. [1] While 90 percent of standard prescriptions are processed electronically, only 14 percent of controlled substance prescriptions are electronically delivered. [2]

Does your EHR offer PDMP connectivity? Does it allow for EPCS? The technology to automatically complete PDMP checking and documentation does exist—today—providing physicians with the option of making their prescribing and compliance workflows seamless. Providers who use EPCS with PDMP should automatically be presented with the patient’s prescription history any time they prescribe a narcotic. The system should also automatically connect to the state database, retrieve the history, display it to the physician, and record that the physician checked the PDMP. This can be up to a 67 percent time savings over the current process of logging into the PDMP directly. [3]

SRS has committed to joining the fight by being the first specialty EHR to offer PDMP checking and documentation integrated within the prescribing workflow. This is a great step in keeping our clients ahead of the curve.

What are you doing to address the opioid crisis?

 


Are You PDMP Ready?

According to the United States Centers for Disease Control and Prevention, opioid addiction claims 115 lives and sends more than 1,000 people to emergency rooms every day, and has killed 64,000 people in 2016. It is the leading cause of death for Americans under 50 years old.

Prescription opioids are a main factor in the crisis. Although there has not been an overall change in the amount of pain reported by Americans, opioid prescriptions have quadrupled since 1999.

What’s being done to help?  Prescription Drug Monitoring Programs (PDMPs) are state-run drug-monitoring programs that collect and track controlled-substance prescriptions in a searchable database. They provide physicians with intelligence about prescribing and patient behavior that can help them make appropriate prescribing decisions. Learn how you can get PDMP ready:infographic-srs-pdmp

The More Things Change, The More They Stay The Same

Lester Parada

Lester Parada

Vice President of Operations at SRS Health
As the Vice President of Operations, Lester brings over 10 years of increased management experience in operations and product management to the team having held roles in Product Management, Business Development, and Project Management. Lester often visits clients to ensure their SRS Health experience is positive and that they are optimizing their solutions to meet the needs of their practice. Lester frequently attends conferences and tradeshows where he shares his vast product and industry knowledge to educate, while learning from clients and attendees as well.

Lester earned a BS Finance and Management from Montclair State University and an MBA in Marketing Management from Rutgers. In addition, he is a certified PMP (Project Management Professional), CSM (Certified Scrum Master) and CSPO (Certified Scrum Product Owner).
Lester Parada

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Earlier this month, SRS Health attended the 2018 American Academy of Orthopaedic Surgeons (AAOS) Meeting. For us, it is an opportunity to spend time with our clients, make new connections and most importantly keep our finger on the pulse of the industry. Each year, we come back home with a list of hot topics or trends and ensure that we are addressing them. This year however, I felt a sense of déjà vu. So, I went back to the 2017 post-AAOS blog and found that the high level topics were almost identical to what I would have written myself.

  • prescription safety
  • data mining/outcomes;
  • cost reduction/operational efficiencies; and
  • MACRA/ MIPS readiness.

Does this mean there has been no progress in the 12 months since the last conference? Not at all.

Prescription Safety – in 2017 really translated to Electronic Prescription of Controlled Substances (EPCS). In 2018, we find that although 91.9% of pharmacies now support this technology nationwide, only 22.9% of providers are EPCS-enabled. More importantly, in 2018, new complexities have been added as many states now also do or will require checking Prescription Drug Monitoring Programs (PDMPs) before prescribing certain medications.

Outcomes in 2017, outside of hospital and research settings, was limited to the basic assessment for the purposes of meeting some requirement like a quality measure, CJR or BPCI. In 2018, adoption by larger groups is starting to gain momentum. Rather than just focusing on the minimum government requirements, practices are beginning to see the value in being able to improve the quality and efficacy of care through evidence and solid data.

Cost Reduction/Operational Efficiencies in 2017 meant actual hard cost-cutting or expanding business lines to bring more of the continuum of care under the practice’s control. In 2018, not only do we see a continuation of those two strategies but more and more practices are looking to justify spending. They are looking at the value of each technology, each partner, and deciding what they can change, combine or cancel.

MACRA/MIPS in 2017 was a transition year and HCIT vendors warned providers not to be complacent. We warned that you should be ready to jump into the program in 2018 and beyond. Well, in 2018 Congress enacted the Bipartisan Budget Act of 2018. This act pushes out the full implementation, effectively making 2019, 2020, and 2021 three more transition years.

Although change management, especially in healthcare, is often slow, having the right technology to address the challenges and opportunities we face—at the right time—is key to optimizing patient care, practice performance, and population health.

At SRS Health, we’ve developed and delivered a specialized end-to-end solution that addresses the topics above, so that we are ready when you are!

Providers Heard Promises and Warnings at HIMSS

Lynn Scheps

Lynn Scheps

VP, Government Affairs & Consulting Services at SRS Health
Lynn Scheps is a leading resource on MACRA, MIPS, and Meaningful Use. She is the SRS liaison with government policy makers. Representing the voice of specialists and other high-performance physicians, she develops strategies to respond effectively to government initiatives.
Lynn Scheps

Latest posts by Lynn Scheps (see all)

I just spent three days in Las Vegas at the annual HIMSS conference, with 43,000 of my closest friends. As the Vice President for Government Affairs at SRS Health, my goal in attending this conference each year is to get a heads-up directly from the leaders of CMS and ONC regarding what the government has in store for physicians. While no secrets are leaked in the sessions or meetings at HIMSS, several government program–related themes clearly emerged this year—topping the list was interoperability and burden reduction.

  • Seema Verma, Administrator of CMS, promised a “complete overhaul” of Meaningful Use, and (I assume) by extension, the ACI portion of MACRA. She was purposely short on details, so we don’t know exactly what that means, but subsequent conversations with her team confirmed what it does not mean: MACRA is not going away; MU3 is not disappearing; and the use of 2015 CEHRT is not off the table. I don’t expect that we will see major changes, but we will have to wait for the details to be revealed in the rulemaking that comes later this year.
  • Interoperability will be the focus going forward, and providers were warned that measures are being developed to identify and prevent information blocking, as required by the 21st Century Cures Act, going so far as to impose fines for willful actions in this regard. Patient data must be shared freely between providers; and it must be made easily—and electronically—available to, and controllable by, the owners of that data, i.e., the patients themselves, through programs like the newly announced MyHealthEData initiative.
  • Promises of regulatory relief and clinical burden reduction were abundant, and were offered within various contexts, including the overhaul of MACRA to reduce the time providers devote to compliance, streamlining documentation for the E&M coding/billing process, and the introduction of the Meaningful Measures initiative to increase the validity and efficiency of quality measurement and reporting. ONC and CMS led several ”listening sessions” in which they sought feedback on burden reduction—I sensed hopeful optimism tempered by healthy skepticism on the part of attendees.
  • The opioid crisis is on everyone’s mind. As one Congressional staffer put it, this is the “issue du jour.” It is being addressed at the national level as well as by the states, the majority of which are already mandating PDMP checking before a physician can write a prescription for a controlled substance. One challenge here will be for HIT and EHR vendors to automate this process so that the problem can be tackled without creating a new task that providers will perceive as yet another burden. 

It will be interesting to see what progress is made in all of the above areas when HIMSS reconvenes in 2019.