Help­ing docs cope with fed­eral re­forms

Modern Healthcare - - INNOVATIONS - By Beth Kutscher

Over the next seven years, the CMS plans to have 75% of Medi­care pay­ments flow­ing through value-based pay­ment mod­els that re­ward providers for de­liv­er­ing lower-cost, higher-qual­ity care.

With both bonuses and penal­ties at stake, it’s risky for hos­pi­tals and health sys­tems to fall be­hind in preparing for pay­ment re­form. Now some com­pa­nies are step­ping up to help providers op­ti­mize their rev­enue un­der those changes. They are as­sist­ing them in track­ing the right met­rics, ac­cu­rately re­port­ing per­for­mance and im­prov­ing their ef­fi­ciency and qual­ity.

Chicago-based SA Ig­nite got its start in 2009, the year Congress ap­proved a mas­sive in­cen­tive pro­gram to ex­pand the use of elec­tronic health records and es­tab­lish mean­ing­ful-use re­quire­ments for them.

“We were start­ing to see that mean­ing­ful use would have a huge re­port­ing re­quire­ment,” said Tom Lee, SA Ig­nite’s founder and CEO. “It ba­si­cally gave rise to the idea that some­one needed to build a Tur­boTax for mean­ing­ful use. Based on that suc­cess, we’ve been able to re­al­ize our broader vi­sion.”

SA Ig­nite’s MU As­sis­tance soft­ware au­to­mates the track­ing and re­port­ing com­po­nents of mean­ing­ful use. The plat­form is de­signed to re­duce the ad­min­is­tra­tive bur­den on providers.

The soft­ware pulls data from providers’ EHR sys­tems to give health­care or­ga­ni­za­tions a point-in-time pic­ture of whether their physi­cians are com­pli­ant with mean­ing­fu­luse rules. The data can be fil­tered by site or re­gion, or by in­di­vid­ual physi­cian. The pro­gram shows the ex­tent to which physi­cians are meet­ing core and menu mea­sures for mean­ing­ful use and how they com­pare to the group av­er­age.

The ven­ture-backed com­pany cur­rently does busi­ness in 30 states.

Lee said the new Medi­care merit-based in­cen­tive pay­ment sys­tem (MIPS) will be a new fo­cus for his com­pany’s busi­ness. Un­der leg­is­la­tion passed ear­lier this year, MIPS re­places the sus­tain­able-growth-rate for­mula as the pri­mary method for de­ter­min­ing pay­ment for physi­cian ser­vices. It is heav­ily qual­ity-based, also tak­ing into ac­count the cost of care. And it wraps the cur­rent mean­ing­ful-use pro­gram into the new for­mula.

SA Ig­nite plans to help providers make sure they’re meet­ing MIPS’ met­ric re­quire­ments, as well as de­ter­mine where to fo­cus their ef­forts for max­i­mum rev­enue im­pact.

Many ques­tions still re­main about how MIPS will be cal­cu­lated when it goes into ef­fect in 2019. But so far, it has es­tab­lished four per­for­mance cat­e­gories: mean­ing­ful use, qual­ity, clin­i­cal-prac­tice im­prove­ment and cost or re­source use.

“It’s go­ing to be hard in MIPS to do really well in all four cat­e­gories,” Lee said. “You have to really look at each com­po­nent. What is the amount of ef­fort per MIPS point?”

MIPS con­sid­ers providers’ costs of de­liv­er­ing care. Un­der MIPS, the CMS will give bonuses to Medi­care-el­i­gi­ble providers who have low cost and high qual­ity, said Dr. Bill Bithoney, a man­ag­ing di­rec­tor with BDO Con­sult­ing, who has closely tracked MIPS. “This is noth­ing short of a revo­lu­tion,” he said.

Quincy (Ill.) Med­i­cal Group, a mul­tispe­cialty clinic with 105 physi­cians in 16 ru­ral lo­ca­tions, is heav­ily de­pen­dent on Medi­care pay­ments, which ac­count for more than 40% of its rev­enue. The group has been work­ing with SA Ig­nite for the past three years on mean­ing­ful-use at­tes­ta­tion.

As the CMS changes its Medi­care pay­ment pa­ram­e­ters, Quincy, with SA Ig­nite’s help, is track­ing its in­di­vid­ual physi­cians’ per­for­mance. It re­ceives monthly re­port cards on each provider, look­ing at fac­tors such as whether they are pre­scrib­ing med­i­ca­tions elec­tron­i­cally and whether they are print­ing out post-visit sum­maries for pa­tients.

“Oftentimes, (physi­cian) of­fices do things, but they’re not do­ing them in a way where we can record it in the met­rics,” said Dr. Richard Sch­lep­phorst, Quincy’s chief med­i­cal of­fi­cer.

The new pay­ment sys­tem could cause as much as a 30% swing in a provider or­ga­ni­za­tion’s pay­ments, Lee said.

MIPS also will pub­licly re­port how providers score on per­for­mance tar­gets. Lee said provider or­ga­ni­za­tions need to think care­fully about what that means. “Once a con­sumer gets in their mind that ‘Dr. Jones’ has 30 points out of 100, they’re not go­ing to want to see Dr. Jones again,” he said.

That pub­lic re­port­ing is likely to sharpen com­pe­ti­tion be­tween physi­cian groups over their qual­ity of care.

“We see right in front of us an ex­plod­ing rep­u­ta­tional and fi­nan­cial risk for providers,” Lee said. “MIPS is a win­ners-and-losers game.”

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