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Why Physician Practices Need a MIPS Expert on Staff

Posted on April 16, 2018 I Written By

The following is a guest blog post by Marina Verdara, Sr. Training Specialist for CMS Incentive Programs, Kareo.

Healthcare providers go to school to learn how to care for patients, and that’s what they do best. However, billing processes, performance-based payment adjustments, and payment incentives are typically not included in this education. Being responsible for today’s regulatory complexities and workload may not have been what providers envisioned for their career. And it’s taking a toll. Nearly half of physician practices spend more than $40,000 per full-time physician per year on complying with Medicare payment and incentive programs, according to an MGMA survey. These costs factor in loss of physician productivity and staff training needs, along with IT expenses.

Independent practices must find a way to streamline the CMS incentive program reporting process. One important way to do this is by designating a “MIPS expert” among your staff. This could be your lead clinician or another manager who has oversight of patient encounter documentation.  While 2017 reporting is done, now is the time to specify the MIPS expert so they can ensure compliance throughout all of 2018.  Don’t wait until 2018 is done to specify your MIPS expert.

MIPS Recap

In 2015, The Department of Health and Human Services (HHS) announced new goals for value-based payments in Medicare that changed your practice’s payment structure. The Medicare Access and CHIP Reauthorization Act (MACRA) and the Merit-based Incentive Payment System (MIPS) introduced a system where providers receive payment based on the value and quality of services provided, not the volume. These changes repealed the Sustainable Growth Rate Formula, streamlined multiple quality reporting programs into MIPS, and provided incentive payments for participation in Advanced Alternative Payment Models (APMs).

HHS made these changes as the first steps to creating a Medicare for healthier people. Their goals are to create a Medicare system that will be here for generations to come while also providing open, flexible, and user-centered health information.

Navigating The System

This sounds like a great plan, right? But, how do you keep up with the frequent MIPS changes and alerts while maintaining a successful private practice?

You need a MIPS expert.

You wouldn’t leave your busy practice in the hands of a mechanic, and you shouldn’t leave your billing and incentive payments in the hands of someone who doesn’t understand MACRA and MIPS. You need an internal staff member who is your MIPS champion. This is the person who can partner with your EHR vendor to ensure that the eligible providers in your practice earn the highest incentive available, as well as avoid any negative penalties. In my role of training practices on implementing a streamlined CMS reporting system, I can tell you that practices with a designated MIPS expert are much more successful and efficient in their MIPS reporting process—and these are the practices that are earning the highest possible score.

Invest in the education and training of your internal MIPS expert so you can be confident that your practice is among the highest earners.

3 Reasons You Need a MIPS Expert at Your Practice

1. A MIPS expert will help maximize your payments. MIPS is all about streamlining your practice to become more efficient in how you diagnose and improve patient outcomes. When you do this well and report your data, you increase your chances of earning a positive payment adjustment.  

Participating in MIPS earns you a payment adjustment according to evidence-based and practice-specific quality data. The better the quality of your data, the better your chances of earning a positive payment adjustment.  

Your MIPS expert will understand the details of the MIPS program. They should be familiar with the activities and measures that are most meaningful to your practice. Your MIPS expert can help your eligible clinicians select measures that best apply to the specialty to prove their performance and maximize their payments.

2. A MIPS expert will be your education partner. This staff member should stay educated and informed of the latest regulatory details. Here at Kareo, we notify eligible clinicians and the designated MIPS expert of ongoing education opportunities. These are offered on a set schedule and as needed with new changes to MACRA and MIPS.

3. A MIPS expert will mobilize your practice staff and clinicians. To successfully meet MIPS requirements, the entire practice needs to be engaged. The MIPS expert can partner up with your EHR vendor to ensure that eligible clinicians in your practice understand the MIPS requirements and know how to navigate through the system. In this process, your practice can identify areas where any given workflow should be modified to earn the highest possible score and receive maximum payment for the great care they deliver.

Resources for Your MIPS Expert

As we mentioned above, MIPS experts at independent practices must stay up to date on all MIPS alerts and resources available to you through the Quality Payment Program. They should take time to educate themselves, understand changes, and read all alerts provided by Medicare or by their EHR vendors.

Your MIPS expert should be able to find an education partner using one or both of these paths:   

  1. Your Regional Extension Center: Contact them to ask questions and get connected with a MIPS education partner.
  2. Your Electronic Health Record company: As an example, Kareo has MIPS training specialists who can partner with your MIPS expert to help maximize payments, stay up to date on the latest changes, and provide support. We have training sessions and ideas for implementation of new workflow processes.  

Don’t be intimidated by the complexity of MIPS. Take time to designate a MIPS expert on your staff and get them connected to their education partner today.

About Marina Verdara
Marina is a Sr. Training Specialist guiding Kareo customers to higher levels of success with their CMS Incentive Program reporting, including MIPS and Meaningful Use. Marina has over seven years of experience working directly with several hundred small practice clinicians on a variety of projects specializing on CMS Incentive programs such as Meaningful Use, PQRS, and MACRA. Kareo is a proud sponsor of Healthcare Scene.

5 Ways Your Certified EHR Can Help Boost Your MIPS Score

Posted on February 5, 2018 I Written By

The following is a guest blog post by Lisa Eramo, a regular contributor to Kareo’s Go Practice Blog.

How did you do in the first year of reporting under the Quality Payment Program? Are you expecting a negative payment adjustment under the Merit-based Incentive Payment System (MIPS)? Or did you only submit the minimum data necessary in 2017 to avoid this adjustment? The good news is that you can get on track to report critical MIPS measures in 2018 that will safeguard and perhaps even enhance your revenue in 2020 and beyond.

In fact, your electronic health record (EHR) technology may already include various features that can help increase your MIPS score, says Marina Verdara, senior training specialist at Kareo. All you need to do is take advantage of them. Verdara discusses five ways in which medical practices should be able to capitalize on their EHR to improve performance under MIPS.

  1. Use an EHR Certified With the 2015 Criteria

Technology certified using the 2015 criteria supports interoperability across the care continuum, and it also enables physicians to earn additional revenue under MIPS, says Verdara. According to the Medicare Access and CHIP Reauthorization Act final rule, physicians earn a one-time bonus of 10 percentage points under the advancing care information (ACI) performance category of MIPS when they report objectives and measures using only 2015 edition certified electronic health record technology during calendar year 2018. In 2018, 25% of a physician’s MIPS score is tied to ACI.

“The federal rule indicates the clinician will earn a 10% bonus to their ACI score if they report using only a 2015 CEHRT, but they will determine this based on the measures submitted,” Verdara explains. “Therefore, a clinician can switch anytime during 2018 as long as they can report at least 90 days for the ACI category.”

In addition to this bonus, clinicians are eligible to receive a bonus of 10 percentage points applied to the ACI category if they report Stage 3 objectives and measures, says Verdara. They can do this if their certified EMR can document and track these measures. Refer to Table 7 in the MACRA final rule for more information about these measures.

  1. Choose Applicable Quality Measures

In 2018, 50% of your MIPS score is based on the quality measures you submit. Your 2015 Certified EHR should support your quality measure selection. “For instance, our physicians have an easy-to-use tool within our EHR that prompts them to narrow down measures that are most applicable for their specialty,” says Verdara. Customers can contact them directly for more information about each measure, its specifications, and what CMS is looking for when calculating numerators and denominators.

When using your EHR to choose measures, Verdara suggests running a report for all of the quality measures your vendor supports, including those you may not plan to submit for attestation. That’s because the data could reveal one or more measures you hadn’t anticipated as advantageous for your practice that could ultimately boost your score, she adds.

Examine the entire report, and identify your top 10 measures (i.e., those on which you’ve performed most effectively). Now dig into the data. Are each of these measures applicable for your specialty? If so, focus on data capture for those 10 measures. If some of your top 10 measures are in other specialties, eliminate those from your workflow and choose ones that are relevant. “Make sure you understand how to document and improve the score for that measure,” says Verdara.

Ultimately, submit all 10 measures to CMS even though only six are required, says Verdara. During the submission process, the CMS attestation website automatically scores each measure based on available benchmarks, and physicians have an opportunity to remove the measures on which they’ve performed most poorly prior to final submission.

  1. Don’t Overlook Reporting Opportunities

Your EHR should be looking out for reporting opportunities so that you can focus on patient care. Verdara provides the example of smoking cessation counseling. Physicians commonly perform this type of counseling but may not receive credit under MIPS because they don’t check the box indicating the work was done. “We have built-in guides to help physicians understand why they might be missing out on a particular quality metric,” says Verdara, adding that physicians should be able to look to their EHR to prompt and guide them to understand where missed opportunities may lie.

  1. Use Clinical Decision Support to Enhance MIPS Performance

Your EHR should also provide prompts to remind physicians about age- and condition-specific preventive screenings and care that, when provided to patients, can help improve MIPS scores. Physicians using Kareo, for example, can improve performance on MIPS measures related to influenza and age-specific immunizations as well as screening for clinical depression, high blood pressure, and more, all of which directly translate to higher scores, says Verdara. “It helps the physician provide better care,” she adds. “It’s a win-win for the clinician and the patient.”

  1. Run Clinical Reports to Pinpoint Opportunities for Care Improvement

MIPS reports not only allow for attestation, but they also help practices understand what they do well—and what needs improvement, says Verdara. For example, practices tracking patients whose hemoglobin A1C is greater than 9% during the performance period can use this report for MIPS attestation and to improve outcomes. More specifically, they can reach out to patients with a poor A1C to provide additional counseling and guidance. “This is a good one to track because diabetes is an epidemic,” says Verdara. “It helps practices target patients who are non-compliant.” The same is true for measures related to controlling high blood pressure and asthma.

To learn more about MACRA, visit https://qpp.cms.gov/.

About Lisa Eramo
Lisa Eramo is a regular contributor to Kareo’s Go Practice Blog, as well as other healthcare publications, websites and blogs, including the AHIMA Journal. Her focus areas are medical coding, clinical documentation improvement and healthcare quality/efficiency.  Kareo is a proud sponsor of Healthcare Scene.

Does Your HIPAA Risk Analysis Tool Protect Your Practice?

Posted on December 15, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Fourth quarter signifies more than a countdown to the holidays, many healthcare organizations are met with the realization that it is time to complete HIPAA risk analysis in order to comply with MACRA – MIPS. Of course, HIPAA risk analyses are nothing new, practices should be conducting  them regularly,  in light of the HIPAA Omnibus Rule which gave teeth to the regulations and made  an annual HIPAA risk analysis a requirement for every healthcare organization.

Recently, I was recently reading a blog post by HIPAA One called “Not All Risk Analysis Tools Created Equal” and it made me think about the requirements for a bona fide risk analysis. I realize that HIPAA One provides a risk analysis solution and therefore, approaches the conversation as a vendor would, however, they are also deeply embedded in the HIPAA risk assessment world and have a unique understanding of what’s happening.

I’ve seen first-hand the principle they describe in the post with many medical practices. Most medical practices are so overwhelmed  with the daily grind of dealing with staff issues, schedules, billing, supplies, etc that it’s hard for them to distinguish between a high quality risk analysis tool and one that was built 3 years ago and hasn’t been updated since then.

In HIPAA One’s blog post they offered a list of what you should look for in a HIPAA risk analysis solution and I think this is a great  starting point for any organization that needs a tool or is evaluating their existing tool:

  1. Industry-Certified Auditors on Staff – Verify the vendor has:
    1. Auditors who are certified professionals, such as CHPS, CISSP, HCISPP, CISA, etc. and
    2. Previous experience responding to AND PASSING government and private-sector audits.
  2. Compliance Gap-Assessment – This assessment determines if your workplace meets each of the HIPAA requirements as selected the Office for Civil Rights’ (OCR) HIPAA Audit Protocol.
  3. Mock-Audit – Put your money where your mouth is. If your workplace maintains HIPAA compliance, prove it with proper supporting documents and examples per the OCR’s HIPAA Audit Protocol.
  4. Risk Analysis –Bona Fide security risk analysis which digs into any non-compliant areas along with a calculation tool that addresses which gaps are low, medium or high risk to the organization using NIST-based methodologies (i.e. at minimum NIST800-30 rev1 and NIST 800-53 rev 4).
  5. Remediation Plan – This documented plan answers the questions: “Who will do what by when” in regards to remediating gaps in compliance.
  6. Final Report – Key deliverable proving compliance with HIPAA security risk analysis.
  7. Ongoing Tracking – Track the resolution of those gaps in compliance by proving due diligence in the event of an audit.
  8. Periodic Re-evaluation – Each year take a new “snapshot” performing steps 2-6 on any changes that happened from the previous year.

The item on this list that I see fall short in many solutions and services on the market today is the remediation plan. It’s amazing how many tools only account for a risk analysis, and do not provide any guidance on creating remediation plans for any risks you find. That’s a big deal and could leave you in trouble if your practice is ever audited and hasn’t remediated any of your security deficiencies .

The good news is that HIPAA risk analysis tools have come a long way over the years. ]  Much like you need to make sure EHR vendors are updating and improving their systems to meet your needs and comply with changes in government regulations, the same is true with HIPAA risk analysis tools. Make sure you take the time needed to ensure the quality of the tools and services you’re using. Ignorance is not bliss when a HIPAA audit occurs.

Note: HIPAA One is a Healthcare Scene sponsor.

MACRA/MIPS: Chutes & Ladders 2.0 – #HITsm Chat Topic

Posted on November 14, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 11/17 at Noon ET (9 AM PT). This week’s chat will be hosted by Jim Tate (@jimtate) from EMR Advocate and MIPS Consulting on the topic of “MACRA/MIPS: Chutes & Ladders 2.0.”

As Meaningful Use fades into the sunset we witness the arrival of the MACRA/MIPS program. The most significant change in Medicare Part B reimbursement in a generation has arrived. Fueled by the shift to “pay for value”, this zero-sum legislation guarantees there will be winners and losers. I am reminded of the childhood board game, Chutes & Ladders, where you were either climbing up or sliding down.

Join us as we dive into this topic during this week’s #HITsm chat using the following questions.

Topics for This Week’s #HITsm Chat:

T1: Is MACRA/MIPS fair to providers? #hitsm

T2: How prepared are Eligible Clinicians for MACRA/MIPS? #hitsm

T3: What are the potential impacts of the MIPS Composite Performance Scores being made public? #hitsm

T4: Part B drugs will be included in MIPS eligibility and reimbursement calculations. What are the possible consequences? #hitsm

T5: Will MACRA/MIPS deliver better care at a lower cost? #hitsm

Bonus: If you had the power to change anything, what would you change with MACRA/MIPS? #HITsm

Upcoming #HITsm Chat Schedule
11/24 – Thanksgiving Break!
Show some gratitude on Thanksgiving by thanking someone in the #HITsm community!

12/1 – Using Technology to Fight EHR Burnout
Hosted by Gabe Charbonneau, MD (@gabrieldane)

12/8 – TBD
Hosted by Homer Chin (@chinhom) and Amy Fellows (@afellowsamy) from @MyOpenNotes)

12/15 – TBD
Hosted by David Fuller (@genkidave)

12/22 – Holiday Break

12/29 – Holiday Break

We look forward to learning from the #HITsm community! As always, let us know if you’d like to host a future #HITsm chat or if you know someone you think we should invite to host.

If you’re searching for the latest #HITsm chat, you can always find the latest #HITsm chat and schedule of chats here.

Inspector General Says CMS Made $729 Million In Questionable EHR Incentive Payments

Posted on June 16, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

A new report from the HHS Office of Inspector General has concluded that over a three-year period, CMS made roughly $729.4 million in EHR incentive payments to providers who didn’t comply with program requirements.

To determine whether the incentive program was functioning appropriately, the OIG audited payments made between May 2011 to June 2014.

After sampling payment records for 100 eligible professionals, the agency found 14 EPs, who received payments totaling $291,022, who didn’t meet incentive criteria.  The auditors found that the 14 had either failed to meet bonus criteria or didn’t provide proof that they had.

Then, the OIG used the data to extrapolate how much CMS had spent on invalid payments, which is how it arrived at the $729 million estimate. In other words, given the margin of error across the sampled incentive payments, the OIG assumed that 12% of all incentive payments were in error. (The analysis also concluded that CMS mistakenly paid $2.3 million to EPs switching between Medicare and Medicaid programs.)

Not surprisingly, the OIG has recommended that CMS recover the $291,000 in payments made to the sampled providers. It also suggested that the agency review EP payments issued during the audit period to see what other errors were made. Of course, the ultimate goal is to get back the approximately $729.4 million the agency may have paid out in error.

In addition, the OIG  called on CMS to review a random sample of self-attested documentation from after the audit period, to determine whether additional inappropriate payments were made to EPs.

And to make sure the EPs don’t get payments under both Medicare and Medicaid incentive programs for the same program year, the report urged CMS to conduct edits of the National Level Depository system.

As part of this report, the OIG noted that allowing providers to self-report compliance data leaves the incentive payment program open to fraud, and recommended keeping a closer eye on these reports. CMS seems to have had at least some sympathy for this argument, as it apparently agreed partly or fully with all of the OIG’s suggested actions.

One side effect of the OIG report it brings back attention to the Meaningful Use program, which has been eclipsed by MACRA but still clings to life. Eligible providers can still report either Modified Stage 2 or Stage 3 in 2017, the main difference being you need a full year of data for Stage 2 but only 90 days for Stage 3.

But MACRA does change things, as its performance standards will test providers in new ways. This year, providers have a chance to get situated with either the MIPS or APM track, and those who jump in now are likely to benefit.

Meanwhile, the future of Meaningful Use remains fuzzy. To my knowledge, the agency has no immediate plans to restructure the current incentive program to audit provider reports in depth. In fact, given that providers are more concerned about MACRA these days, I doubt CMS will bother.

That being said, it’s fair to assume that incentive payouts will get a bit more attention going forward. So be prepared to defend your attestation if need be.

AMIA Shares Recommendations On Health IT-Friendly Policymaking

Posted on April 17, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

The American Medical Informatics Association has released the findings from a new paper addressing health IT policy, including recommendation on how policymakers can support patient access to health data, interoperability for clinicians and patient care-related research and innovation.

As the group accurately notes, the US healthcare system has transformed itself into a digital industry at astonishing speed, largely during the past five years. Nonetheless, many healthcare organizations haven’t unlocked the value of these new tools, in part because their technical infrastructure is largely a collection of disparate systems which don’t work together well.

The paper, which is published in the Journal of the American Medical Informatics Association, offers several policy recommendations intended to help health IT better support value-based health, care and research. The paper argues that governments should implement specific policy to:

  • Enable patients to have better access to clinical data by standardizing data flow
  • Improve access to patient-generated data compiled by mHealth apps and related technologies
  • Engage patients in research by improving ways to alert clinicians and patients about research opportunities, while seeing to it that researchers manage consent effectively
  • Enable patient participation in and contribution to care delivery and health management by harmonizing standards for various classes of patient-generated data
  • Improve interoperability using APIs, which may demand that policymakers require adherence to chosen data standards
  • Develop and implement a documentation-simplification framework to fuel an overhaul of quality measurement, ensure availability of coded EHRs clinical data and support reimbursement requirements redesign
  • Develop and implement an app-vetting process emphasizing safety and effectiveness, to include creating a knowledgebase of trusted sources, possibly as part of clinical practice improvement under MIPS
  • Create a policy framework for research and innovation, to include policies to aid data access for research conducted by HIPAA-covered entities and increase needed data standardization
  • Foster an ecosystem connecting safe, effective and secure health applications

To meet these goals, AMIA issued a set of “Policy Action Items” which address immediate, near-term and future policy initiatives. They include:

  • Clarifying a patient’s HIPAA “right to access” to include a right to all data maintained by a covered entity’s designated record set;
  • Encourage continued adoption of 2015 Edition Certified Health IT, which will allow standards-based APIs published in the public domain to be composed of standard features which can continue to be deployed by providers; and
  • Make effective Common Rule revisions as finalized in the January 19, 2017 issue of the Federal Register

In looking at this material, I noted with interest AMIA’s thinking on the appropriate premises for current health IT policy. The group offered some worthwhile suggestions on how health IT leaders can leverage health data effectively, such as giving patients easy access to their mHealth data and engaging them in the research process.

Given that they overlap with suggestions I’ve seen elsewhere, we may be getting somewhere as an industry. In fact, it seems to me that we’re approaching industry consensus on some issues which, despite seeming relatively straightforward have been the subject of professional disputes.

As I see it, AMIA stands as good a chance as any other healthcare entity at getting these policies implemented. I look forward to seeing how much progress it makes in drawing attention to these issues.

Study: Health IT Costs $32K Per Doctor Each Year

Posted on September 9, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

A new study by the Medical Group Management Association has concluded that that physician-owned multispecialty practices spent roughly $32,500 on health IT last year for each full-time doctor. This number has climbed dramatically over the past seven years, the group’s research finds.

To conduct the study, the MGMA surveyed more than 3,100 physician practices across the U.S. The expense number they generated includes equipment, staff, maintenance and other related costs, according to a press release issued by the group.

The cost of supporting physicians with IT services has climbed, in part, due to rising IT staffing expenses, which shot up 47% between 2009 and 2015. The current cost per physician for health IT support went up 40% during the same interval. The biggest jump in HIT costs for supporting physicians took place between 2010 and 2011, the period during which the HITECH Act was implemented.

Practices are also seeing lower levels of financial incentives to adopt EHRs as Meaningful Use is phased out. While changes under MACRA/MIPS could benefit practices, they aren’t likely to reward physicians directly for investments in health IT.

As MGMA sees it, this is bad news, particularly given that practices still have to keep investing in such infrastructure: “We remain concerned that far too much of a practice’s IT investment is tied directly to complying with the ever-increasing number of federal requirements, rather than to providing patient care,” the group said in a prepared statement. “Unless we see significant changes in the final rule, practice IT costs will continue to rise without a corresponding improvement in the care delivery process.”

But the MGMA’s own analysis offers at least a glimmer of hope that these investments weren’t in vain. For example, while it argues that growing investments in technologies haven’t resulted in greater administrative efficiencies (or better care) for practices, it also notes that more than 50% of responders to a recent MGMA Stat poll reported that their patients could request or make appointments via their practice’s patient portal.

While there doesn’t seem to be any hard and fast evidence that portals improve patient care across the board, studies have emerged to suggest that portals support better outcomes, in areas such as medication adherence. (A Kaiser Permanente study from a couple of years ago, comparing statin adherence for those who chose online refills as their only method of getting the med with those who didn’t, found that those getting refills online saw nonadherence drop 6%.)

Just as importantly – in my view at least – I frequently hear accounts of individual practices which saw the volume of incoming calls drop dramatically. While that may not correlate directly to better patient care, it can’t hurt when patients are engaged enough to manage the petty details of their care on their own. Also, if the volume of phone requests for administrative support falls enough, a practice may be able to cut back on clerical staff and put the money towards say, a nurse case manager for coordination.

I’m not suggesting that every health IT investment practices have made will turn to fulfill its promise. EHRs, in particular, are difficult to look at as a whole and classify as a success across the board. I am, however, arguing that the MGMA has more reason for optimism than its leaders would publicly admit.

Has MU Been Useful? A Review of MU and Merit-Based Incentives – Breakaway Thinking

Posted on March 16, 2016 I Written By

The following is a guest blog post by Lori Balstad, Learning and Development Specialist at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Lori Balstad
Is it really the end of Meaningful Use? According to Andy Slavitt, Acting Administrator for the Centers for Medicare and Medicaid Services (CMS), it’s time for a change in incentive programs and 2016 may be the year for it. Alternative Payment Models and Merit-based Incentive Payments (MIPS) as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) may be replacing the complicated layers of requirements in Stage 1, 2, and 3 of Meaningful Use.

While CMS works on rolling out a new set of regulations, you may be wondering if this will ease the lingering pain of the past years. Will the program be easier to understand, navigate, and comply with?

First, let’s do a quick review:

CMS’s Meaningful Use Incentive program was rolled out in 2011 to incentivize eligible professionals and hospitals to adopt electronic health records (EHRs).

The goal was three-fold:

  • Improve quality, safety, efficiency, and reduce health disparities
  • Increase patient engagement and satisfaction
  • Improve care coordination, and population and public health

Stage 1 dealt with data capture and sharing, Stage 2 focused on advance clinical processes, and Stage 3 was to bring us to improving healthcare outcomes.

Achieving these goals is not an easy or quick process, but there have been many noteworthy accomplishments. As of 2015, 95 percent of all eligible and critical access hospitals have demonstrated meaningful use of certified health IT through participation in the CMS EHR Incentive Programs. Ninety-eight percent of all hospitals have demonstrated meaningful use and/or adopted, implemented or upgraded any EHR. As of January 2016, more than 484,000 health care providers received payment for participating in the Medicare and Medicaid EHR Incentive Programs, according to the CMS.

There have also been bumps along the way. Clinical quality reporting is controversial due to unrefined standards and a lack of a comprehensive strategy around the measures. Providers struggle to balance healthcare reform efforts with patient engagement and education under Stage 2. Eligibility determination issues in the CMS website threatened some physicians and other eligible professionals with Medicare payment penalties in 2015. Physicians are at the point where the regulations are so difficult that they feel like they are unable to focus on patient care.

So what’s next?

CMS has been working closely with physicians and healthcare organizations to address their needs and concerns, and plans to share the new regulations this spring under MACRA. They will work towards keeping the original ideologies while establishing new critical principles. The most important improvement will be moving away from incentivizing providers for the mere use of the technology towards the actual outcomes achieved with their patients. Other goals include allowing for flexibility to customize health IT to ensure physicians are supported instead of distracted.

Meaningful Use is not going away, just the way it’s measured and incentivized. Moving toward quality outcomes instead of measuring technology adoption levels will hopefully move us closer to the original goals of Meaningful Use. It all comes back to what physicians and healthcare organizations do on a daily basis – strive to provide the best possible care for patients.

Xerox is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training.