Tuesday, 26 July 2016 06:41

Three Summertime to-dos for a Successful Value-Based Year

Written by


If you listen to all the association, media, and blog buzz, “uncertainty” seems to be the theme for summer in healthcare. No one really knows what will happen Jan. 1, 2017, in the brave new world of the Medicare Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).

But several things we know for sure: with the exception of meaningful use, the changes won’t grossly affect the current reporting year. The requirements will apply to you whether you’re a Medicare participating or non-participating provider. And by focusing your summer to-do list on meaningful use, quality data capture, and patient engagement, you’ll be better prepared for the MIPS/APM future when it finally arrives.

Step No. 1: Perform a quarterly electronic health record (EHR) meaningful use checkup..

One possible change affecting physicians and hospitals in 2016 wasn’t included in the proposed physician fee schedule. Instead, the change to a continuous 90-day reporting period for EHR meaningful use attestation was part of the proposed Medicare Hospital Outpatient Prospective Payment System.

Under current guidelines, physicians and hospitals must collect data and report performance over the entire 2016 calendar year. For many, this significantly increases the number of instances in which performance should be scrutinized, requiring a more consistent approach to meet and exceed attestation thresholds. Thus, the proposed change to a continuous 90-day reporting period is a welcome reprieve for the majority of Medicare providers.

But whether the reporting period is a calendar year or 90 continuous days, July is the perfect time to find out how each of your physicians and/or your overall hospital is doing on their respective objectives. Individual provider education, like that offered by SCG Health, can help you get your numbers up.

Through quarterly checkups, SCG Health has found that workflows can break down, system glitches can prevent the flow of data, and clinical staff can simply get lazy. Clients tend to experience two major sticking points. One is secure electronic prescribing of controlled substances. Some find it easier to just keep the prescription pad out for all drugs rather than switching back and forth between paper and the computer.

The other sticking point is computerized provider order entry. Different staff appear to enter orders in different ways, creating entirely separate workflows. This is especially true on orders for outside services like MRIs or CT scans, when a paper form may be used because the service provider isn’t set up to accept electronic orders in that system.

Step No. 2: Capture and report your quality data.

The big 2016 deadline for physician groups and health organizations to sign up to report Medicare quality data under a single TIN has passed. This is called the Group Practice Reporting Option (GPRO). Failure to report data in 2016 for the Physician Quality Reporting System (PQRS) means a 2-percent penalty in 2018. This same failure then adds on an additional 4-percent penalty from the value-based modifier. So now is the time to answer these questions:

  • Have you signed up your TIN for an accountable care organization (ACO) reporting mechanism for 2016?

This year, three SCG Health clients – who had no idea they were in an ACO – discovered that an individual physician had signed up their provider group for ACO participation. Always remember that ACO designation is listed by the parent TIN. Don’t know if you have an ACO designation? To confirm it, have an authorized person from your office call QualityNet, the Medicare PQRS support vendor, at 1-866-288-8912. Your registry and data partners can’t call on your behalf.

  • How will you report your data?

As noted above, it’s important to find out if you’re reporting individually as an NPI/TIN unique combo or as a TIN for all Medicare credentialed NPIs (GPRO). You’ll also need to determine which method to use to get your data to Medicare. For example, you may think you’ll use claims-based reporting. But if you haven’t started yet, it will be tough for you to meet the requirement to include data on 50 percent of your Medicare claims on the first submission. Other options, which require a per-clinician fee, include using the certified electronic health record system to submit electronic clinical quality measures, which is a much skinnier list than that used for PQRS, registry reporting, and Qualified Clinical Data Registry reporting. You’ll find a list of recognized entities on the CMS website at www.cms.gov/PQRS. Just keep in mind that registration fees are often cheaper the earlier you sign up.

Prev Next »

Last modified on Tuesday, 26 July 2016 08:59

Jennifer is the Founder and CEO of SCG Health. Previously Jennifer was the Vice President of External Provider Relations for UnitedHealthcare, a Minnesota-based health insurance company. From 2007 to April 2011, she established and led the Provider Communications & Advocacy unit. This enterprise asset reviewed and approved communications for the commercial, Medicare and Medicaid participating providers in the UnitedHealthcare network. She also solicited direct feedback on how to improve payer operations from the physician and hospital community, which resulted in higher provider satisfaction rates with the national insurance company during her tenure at UnitedHealthcare. Prior to this, Jennifer served as the External Relations Liaison for the Washington, DC-based Government Affairs Department of the Medical Group Management Association (MGMA). As the External Relations Liaison, Jennifer coordinated MGMA advocacy efforts with other specialties and medical organizations. She also was the Government Affairs Representative for the Eastern & Southern Sections. She began her work with MGMA in August of 2001. She serves on the board of the Maryland Medical Group Management Association and is a clinical adviser for Informatics In Context.