MEDICARE MIPS REPORTING ESSENTIALS FOR PHYSICAL THERAPISTS

Physical therapists (PTs) are now a breathing part of the Quality Payment Program (QPP). It is a choice they have to make because they can’t back out. Medicare MIPS reporting through a MIPS Qualified Registry or an EHR system can get them through the maze of value-based care smoothly.

The only choice the eligible PTs have is to choose between the Merit-Based Incentive Payment System and an Advanced APM. The popularity of MIPS as an incentive program outweighs the characteristics of the other track. Hence, MIPS is the go-to track.

The PTs who do not meet the low-volume threshold (LVT) can participate voluntarily.

Why?

They must be prepared for what lies ahead and no better way to do it than participating in it.

Medicare MIPS Reporting for Quality and IAs

Good news for PTs is that they are not required to report in all the four performance categories. Instead, they are required to report for only two – Quality and Improvement Activities.

It directly affects the number of measures they need to report to CMS. With all the focus on MIPS Quality measures and IA measures, they can score high and handsome. It also keeps them very much in the game without the possibility of burnout.

A yearlong report against Quality determines the final score, failing to do so; there are consequences in the form of negative payment adjustments.

Medicare MIPS reporting best happens through certified electronic health record technology (CEHRT) or MIPS Qualified registries such as P3 Healthcare Solutions. Please follow us for effective MIPS solutions on LinkedIn – https://www.linkedin.com/company/p3-healthcare-solutions

Advanced APM Participation Track

Physical therapists who follow Advanced APM as their participation track cannot go for Medicare MIPS reporting as it is one track at a time.

Expect an additional reward of +5% to your Medicare earnings of 2019 if the reporting results are at par with the benchmarks set against measures. Additionally, the high scorers have a chance to collect bonus rewards from the $500 million pool.

While PTs become an active part of the value-based payment system, the removal of functional limitation reporting (FLR) is a healthy change adopted by CMS.

P3Care for PTs and PTAs

The submission of MIPS data is unlike any other data submission. It requires your NPI/TIN and account creation on the QPP portal. Health IT consultants at P3Care activate your accounts with ease and with the mutual collaboration; you get to report to CMS. Accuracy is the key here because you can’t undo or redo these submissions. They happen only once so make sure they are accurate.

What about Telehealth?

The final rule doesn’t allow PTs to be reimbursed against Telehealth. The virtual check-ins will remain associated with physicians and specialty-specific clinicians, though P3Care backs the initiative of Telehealth for PTs and PTAs.

Moreover, there are no reimbursements for “Inter-professional Internet Consultations” for them.

Direct Submission Method

PTs can use the registry method for direct submission. For it to happen successfully, the collection type is MIPS Clinical Quality measures (CQMs). Medicare MIPS reporting 2019 returns optimum results if you are both accurate and smart in terms of selecting high scoring measures.

Outcome measures and high-priority measures hold significance in achieving reward and bonus-worthy scores.

For small practices, the clinicians and clinician groups can collect and submit measures for Quality through Medicare Part B claims.

Groups with 25 or more clinicians may use the CMS web interface for Medicare MIPS reporting.

Deadline for the QPP 2019 Program

MIPS eligible clinicians have time until March 31 of the next year after ending of the performance year. In addition, if your mode of submission is through claims, you have until 60 days after the closing of the performance year.

Improvement Activities (IA)

For PTs and OTs, the category holds 15% weight in the total score. It estimates to 40 points and only the top performing clinicians will be able to reach that number. The improvement activities you should consider reporting to CMS are –

  • Care Coordination
  • Patient safety
  • Beneficiary engagement
  • Participation in APM
  • Achieving health equity
  • Emergency preparedness and response
  • Population management

However, take note of the number and format to report in by the following classifications.

  • Two high-weighted measures
  • One high-weighted measure and one medium-weighted measure
  • Four or more medium-weighted measures

After selection of activities to submit, you are ready for Medicare MIPS reporting through QCDR, Qualified Registry or an EHR system. For those interested in the MIPS attestation process on their own, they can submit activities by logging on to the QPP portal.

Do you think you can gather data and report on your own or is it better to hire third-party intermediaries?

Reply in comments below, as we’d love to hear your thoughts.

MIPS 2019 REPORTING IS THE FUTURE OF QUALITY HEALTHCARE

MIPS 2019 reporting doesn’t cost you much but it is a progressive path.

The success of a clinician depends on efficient reporting because they are reaching out to CMS with proof of their performance.

P3 Healthcare Solutions and other Qualified Registries are on a mission to promote quality over quantity. Clutch ranks companies like P3Care on their leaders’ matrix. To see the names of successful companies in the health IT sector, the following link is worth a look – https://clutch.co/bpo/medical-billing/leaders-matrix

When you don’t have benchmarks or companies to look up to, it is difficult to reach a goal or achieve a target. P3Care sets the tone of success for other medical billing companies to follow.

MIPS 2019 Reporting Needs Critical Thinking

As a MIPS Qualified Registry deals with only the registry-associated measures, every submission type has its own list of acceptable measures.

Merit-Based Incentive Payment System is one of the tracks of the Quality Payment Program (QPP) with Alternative Payment Model (APM) as the other one. Both these value-based reimbursement models have their own benefits. However, if you go for MIPS 2019 reporting, it is the more frequent path chosen by eligible clinicians (ECs).

What do the reviewers say about P3?

Clutch.co reports P3 Healthcare Solutions as a leading organization. Reviews are an interpretation of the quality and performance of an organization, and if they are in favor, the company is worth your time and money.

Founder, SunCoast RHIO, Lou Galterio says, “P3 Healthcare Solutions enables our providers to get paid faster, and they make billing consistent and reliable”.

He continues in his interview with Clutch and talks about efficiency and responsiveness.

“They’re incredibly responsive, answering my questions on the weekends and at night. We’re a few hours ahead of them, but they still answer our calls, even when it’s early in the morning for them. They’ve also trained some of our internal team to understand their products.”

Client satisfaction is the maximum output of a company – The ultimate criterion that matters in the end.

Essentials to Report Quality Measures in 2019

Quality is one of the four performance categories of MIPS 2019. It carries 45% weight in the final score. Back in 2018, it was 50% weight, and that was 5% more than the current weight.

Why is that?

It is an effort to reduce the burden of MIPS 2019 reporting requirements of eligible clinicians according to the proposed rule.

First, to fulfill the Quality category, ECs have to undergo MIPS 2019 reporting over a span of 12 months.

Second, there are four ways to submit quality measures:

  • Electronic Clinical Quality Measures (eCQMs)
  • MIPS CQMs (Previously “Registry Measures”)
  • Qualified Clinical Data Registry (QCDR) Measures
  • Claims-based measures for small practices

To report collected data for Quality for at least 6 measures or a specialty set is what is required. One of those six measures is an outcome measure or a high-priority measure.

MIPS as a Group

With the condition to report as a group of 16 or more clinicians, under the 200 Medicare beneficiaries criteria, the administrative claims-based all-cause readmission measure will automatically count as the seventh measure.

Therefore, in order to stay on top of MIPS 2019 reporting, go for at least one submission type. If you report a measure through more than one type, the best score for that measure will add to the final score.

Moreover, P3 Healthcare Solutions connects you with the patients which are your first preference!

With P3Care as your third-party intermediary and reporting on your behalf, you, as a healthcare professional, can focus on your patients. We become part of your cure to people in distress.

The Case of Specialty Measure Sets

MACRA MIPS never falls short of requirements. ECs, as individuals and groups, have the flexibility to choose between a specialty and subspecialty measure set.

In any case, they must tend to data on at least 6 measures within a specific set. If a set has less than 6 measures, the clinician or group should report each measure in the set.

CMS Web Interface users have to report all the 10 required quality measures for the full year (January 1 to December 31, 2019)

As value-based care enters the third year successfully, CMS tones down the reporting requirements for clinicians. It is in response to physician burnout because MDs and other professionals are not able to look after their patients. The lack of patient association and engagement is attributed to difficult EHR handling.

Follow us on LinkedIn https://www.linkedin.com/company/p3-healthcare-solutions for a solid knowledge base in American healthcare.

What do you think is a common problem clinician’s will likely face in MIPS 2019 reporting?

SWITCHING TOWARDS CLOUD SERVICES ISN’T EASY FOR PHARMACEUTICAL INDUSTRY

The modern healthcare industry is the amalgamation of technology and medical services. With this growing trend of health IT, data security and privacy have become the main concern for physicians. Be it, medical billing, MIPS, MACRA, electronic healthcare records (EHRs), digital collection and storage has taken the paramount place.

To take advantage of technology and to support MIPS in healthcare, pharmaceutical companies are interested in going cloud-based. However, they want surety to have a secure transition, which is not as simple as it seems.

The professional mapping of the data flows, frameworks and technology implementation require amazing efforts. While doing all this, a proactive approach, anticipating the potential threats is compulsory.

What steps should be taken to have a safe cloud-based technology?

  • Take Measures for Security Breaches

Same as physicians have to protect patients’ data, and other sensitive information from hackers in the MIPS program, the pharma industry has to pay attention to security threats.

It is estimated that during the shifting process of the hand-written data to the cloud-based database, many incidents of data breaches will be experienced. Security experts that are well-aware of the data sensitivity and actively take measures against breaches are one of the major hurdles in implementing this migration.

A connected and heterogeneous cloud-based storage system is a complex process. Therefore, not just secure database is to be designed but also with an efficient backup system.

Security failures can only be prevented when there will be the right personnel with the right expertise for this job.  Therefore, before moving towards cloud-based technology, the pharma industry needs to have a proper execution plan.

  • Be Prepared To Manage Risks

Translating the manual database to a cloud-based database may disturb the entire pharma company. Therefore, calculation of the internal and external risks is equally important for the effective functioning of cloud-based technology in the pharmaceutical industry.

A reasonable solution is to convert data step-by-step until the whole staff gets comfortable with it. Test the cloud technology implementation and highlight errors that don’t meet the standard. Manage risks and measure return-over-investment.

  • Research about the Implementation Protocols

Pharma industry will not just face problems regarding the right technology.  In addition, it needs to research all the pros, cons, and the working process of technology implementation. Vulnerabilities come across as major setbacks in an efficient running system. If there will not be a proper channel or sequence of operations to enter, fetch, and share data from the system, what will be the point?

In order to support MIPS in healthcare, that is one of the leading value-based incentive programs, pharma companies need to have a front role in understanding all the implementation details.

Healthcare industry is already sensitive, and pharma being its part can’t be separated from its rules and obligations. There is a reason that the regulatory authorities highly govern this industry.

SaaS – Software as a Service model is getting popularity in the pharma industry. However, there is a need to develop the understanding that implementation of the cloud-based services without seeing the capability of the system will cost more than ever.

Thus, flexibility is required but with the hint of sensibility to predict different case scenarios and the associated cost to check if this is the best-suited solution.

Surely, the pharma industry should move forward with the changing times. Nevertheless, the change should be transitive and be able to generate constructive results while making sure of all the security aspects.

In your opinion, what steps should be taken to ensure reliable implementation of cloud technology in the pharma industry?

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BILL GATES SELECTS SIX HEALTHCARE TECHNOLOGIES FOR 2019

The article lists technologies to look out for in 2019, according to Bill Gates. After analysis of the MIT Technology Review’s yearly content around emerging technologies, he was able to select 7 of them with the most impact. These special applications have a future in healthcare because they come from none other than the maestro himself.

Bill Gates besides the selected bunch of applications wrote:

“We’re still far from a world where everyone everywhere lives to old age in perfect health, and it’s going to take a lot of innovation to get us there.”

“For now, though, the innovations driving change are a mix of things that extend the life and things that make it better.”

Healthcare IT makes the use of technology for better outcomes. Such applications will facilitate the reimbursement process and providers in general. P3, as a MIPS consulting service, assimilates with technology to report on behalf of the providers and value-based care will only benefit from these technological marvels. Please follow us on LinkedIn for a vitalized experience and find the latest information on the Merit-based Incentive Payment System (MIPS).

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The revolution is in their essence, and, nobody will be able to deny their absolute magnificence once the rollout of the benefit in public.

  1. The $10 Blood Test

We attribute this invention to the bioengineer, Stephen Quake of Stanford University.

What does it do?

Physicians will be able to identify women who are set to deliver before time.

Extraordinary, as it sounds, it will ease the pain of the parents, especially the mothers. Children born prematurely have a less chance of survival, but, due to this test, the survival rate is going to increase, big time!

When we talk in terms of MIPS Quality measures, such creations can improve, the mortality rates and reveal better population health outcomes. Patient satisfaction levels will go up while keeping healthcare quality-driven.

  1. Screen Environment Enteric Dysfunction (EED) Disease

The probe developed by Guillermo Tearney, MD, Ph.D., and a professor at Harvard Medical School, physicist and pathologist at Massachusetts General Hospital in Boston is going to show you evidence of this degenerate disease.

What does EED do?

It slows down or stops the absorption of nutrients.

Furthermore, the probe will replace the expensive endoscopy used in gastrointestinal cases.

Amazing, isn’t it?

The third world or poor countries have a reminiscent amount of EED patients. Therefore, this goes out to you – time to heal is soon, very soon.

  1. German Cancer Vaccine

The next invention comes from Germany, and, it is against cancer that has spun the world over its head. In 2019, BioNTech and biotech giant Genentech are having clinical trials for the first cancer prevention vaccine. It is going to destroy cells with cancerous elements attached to them.

Tremendous achievement, as it is, we are one up against the illness, and, now cancerous growth will find a legitimate challenger to stop things from going south.

  1. Reduce Greenhouse Gases

The next invention is going to reduce greenhouse gases and slow down the process of climate change. Intense weather conditions, too much heat or too much cold are weather conditions attributed to climate change.

David Keith, Ph.D., a climate scientist at Harvard University in Cambridge, Massachusetts implements ways to store carbon dioxide from the environment and convert it to synthetic fuels. Public health has only one way to go, and that is up!

  1. Toilets with Cleaner Outputs

Time has come for toilet wastes to stay away from disposal into water resources. Energy-efficient toilets are in focus as an effort to stop contamination of the environment. One of these models comes from Tampa, University of South Florida and the other from sanitation enterprise Biomass Controls.

The two toilets are self-sufficient and don’t need water to move fecal waste to the disposal site.

Water contamination causes the disease to spread from one population to another.

Nevertheless, with the help of these innovative waste stations, we will be able to process waste without using water and put an end to water-borne illnesses.

  1. Alexa – The Amazon’s Marvel

Despite intense marketing campaigns for the device, Alexa proves to be a helpful companion for real. The voice-enabled assistant has features which benefit hospitals and practices to understand speech in both emergency and normal situations.

The artificially intelligent gadget can be the difference between sickness and wellness, expanding its role in patient care.

We would love to see you come up with healthcare inventions we’ve missed in the comments below.

THE ROLE OF CLINICAL QUALITY MEASURES FOR PHYSICIANS

Since the healthcare industry has taken serious measures to revamp healthcare services, the emphasis on incentive payment programs has increased. MIPS, MACRA, and more offer facilities to physicians that regular payment method can never provide.

Such incentive payment programs come with various quality measures against which clinical data is needed to report. The number of clinical quality measures is so large that it is difficult to manage them for each healthcare provider. Moreover, the requirements for each program be it Meaningful Use (MU), MIPS or others and the implementation of reporting criteria can be quite confusing.

The Center for Medicare and Medicaid Services (CMS) states Clinical Quality Measures (CQMs) for incentive payment programs. The result is not just to pay physicians but the value-based healthcare improvement efforts. These clinical quality measures also put their part in various government or private development projects.

Need of CQMs

Eligible physicians and hospitals submit data to CMS as in MIPS. In return, CMS estimates their performance and reward accordingly while checking that patients are getting the deserved attention from physicians. In addition, it works in favor of the healthcare industry to improve performance categories, falling short in terms of efficiency and quality.

What factors determine success in Clinical Quality Measures Submission?

As per the CMS website, it checks the following parameters to score CQMs.

  1. Use of available resources
  2. Compatibility to healthcare standards
  3. Healthcare outcomes
  4. Patient’s safety and welfare
  5. Coordination among physicians
  6. Patient’s engagement level
  7. Population & overall health standard
  8. Healthcare clinical processes

To maintain the accuracy and transparency in the healthcare system, ONC, Office of the National Coordinator for Health Information Technology (US Government Health and Human Services), monitors the use of EHR and other technologies.

The Development Process of Clinical Quality Measures (CQMs)

National Quality Forum

Many healthcare industry leaders and stakeholders take part in developing CQMs. However, measures standardized by the National Quality Forum (NQF) are considered as the top priority. Most of the incentive payment programs use their measures because their development process involves extensive research.

Another reason for adopting NQF quality measures is their work and objectives that match with that of CMS. Moreover, their initiative boosts the use of electronic healthcare records (EHRs).

Development Process via CMS

CMS also has its own measure development project known as The Measures Management system. This system is always in its evolution stage and sets values for business processes. The deduced measures also support MIPS and other incentive payment programs and provide an opportunity for their growth.

Real – Life Implementation of Quality Measures

Clinical quality measure reporting accounts for many uses, but its major reliance is on EHR technology usage or Meaningful Use. However, many healthcare providers deem Meaningful Use to be stressful and demanding. Moreover, not every quality measure is for everyone. Thus, there should be some flexibility in the reporting criteria.

CMS has gone to great lengths to overcome reporting issues and streamlined measures under seven categories.  When physicians are reimbursed and incentivize, it becomes obligatory for them to maintain their performance instead of giving quality as a onetime shot.

Clinical quality measures are also a great aspect of Physicians’ Quality Reporting System. Physicians are met with penalties when they don’t report according to the standards.

Thus, MIPS, MACRA, and other payment incentive programs can’t perform their actual functions without efficient marking of clinical quality measures. The key to success is the selection of accurate measures according to the practice and the value-based approach of practicing physicians towards patients.

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A 2019 GUIDE TO TOP-RATED PODIATRISTS IN NEW JERSEY (NJ)

The talk about podiatry or medicine that relates to podiatry is common in households in the US. We have a growing amount of aged population, and that means the feet and ankles are at risk. Moreover, the younger generation needs help in this regard at times. Since it is our health on the line, we want the best podiatrists in New Jersey and the best medical care in general.

In an era of value-based care, podiatry has to deal with the Merit-Based Incentive Payment System (MIPS) before anything else. The track offers MIPS Quality measures and measures for other performance categories for podiatry. To enable maximum participation of podiatrists in MIPS 2018/19, P3 Healthcare Solutions facilitates reporting duties for them. If you are a podiatrist in New Jersey, please find and follow us on LinkedIn – https://www.linkedin.com/company/p3-healthcare-solutions.

MIPS in 2018/19 – The Differentiating Factor

 In order to remain the best podiatrist in New Jersey, you ought to revisit your participation level in MIPS. MIPS in healthcare is an evaluation criterion of your credibility as a physician and a healthcare professional. The Quality Payment Program – QPP’s final score at the end of each evaluation period publishes on the Physician Compare portal and influences your authenticity as eligible professionals.

The Best Podiatrist in New Jersey vs. Participation in MIPS

The 2019 participation and a score above 70 out of 100 can get you incentives and a vote of confidence in 2021. Despite the selection of the best criteria for measures, talking to qualified HIT consultants paves the way for incentives and bonuses. Therefore, staying in touch with organizations trained to provide value to your practice under MIPS turns out to be a wise decision.

How to Find the Right Podiatrist in NJ?

The million-dollar question that is worth answering any time of the day!

We have an authorized entity in the form of CMS – Centers for Medicare and Medicaid Services. At a time when the MIPS track of the Quality Payment Program impacts healthcare outcomes, the Physician Compare portal is worth a shot. You’ll be able to pinpoint top-rated podiatrists nearby. It is a way to materialize your search for the best doctor.

Find the best podiatrist through https://www.medicare.gov/physiciancompare/ – An official Medicare resource of providers who currently bill Medicare and participate in the MIPS 2018/19 program.

Your health deserves the top podiatrist and nothing can make you qualify for anything less.

Authoritative Websites to Facilitate the Search for Podiatrists

One of these websites is www.njdoctorlist.com.  Here, you will find the top providers registered and credentialed and the State of New Jersey back them up in the best interest of the locals.

If the weather shows minimal snow and zero warnings of a snowstorm, it is easy to head out to the nearest practice.

Foot and ankle centers in New Jersey have a knack of curing patients, especially the ones found through these portals. The stamp of authenticity is enough to satisfy the patients while the cure speaks on behalf of the treatment.

American Medical Association (AMA) supports DoctorFinder and finds the best doctors in town for patients in NJ.

As patents, they don’t need any introduction and Google promotes them significantly.

Big Names in the Industry

The US healthcare industry passes through a critical time when the clinicians gradually ascend towards value-based care and adopt the cost-saving methods nationwide.

MIPS Quality measures for podiatrists include obligations that are mandatory for every physician with a few exceptions. We will cover them in detail in the upcoming articles.

According to Google and webpages on the first page, there are many physicians making the list of top podiatrists in New Jersey.

The foot and ankle specialists of New Jersey include names like:

  • Dr. Eric J. Abrams
  • Dr. Craig A. Shapero
  • Dr. Jordan Drucker
  • Dr. Stephen Guiliana
  • Dr. Nicholas R. Taweel
  • Dr. Jerry A. Silberman

The top 6 podiatrists according to ratemds.com, another gem of a website mentions them with grandeur.

The deadline for MIPS 2018 data submissions, April 2, 2019, continues to be a constant reminder. If you are a podiatrist who has MIPS reporting pending, call 1-844-522-3227 for immediate assistance.

EVALUATING VIRTUAL REALITY (VR) IN HEALTHCARE

Virtual reality (VR) has taken over the digital world. It was supposed to revolutionize gaming, but it has also entered into a sensitive field like healthcare. Physicians are using various technologies to provide high-quality medical facilities to patients. From assisting remote patients to medical billing to MIPS submission methods, technology is giving a new dimension to this field.

VR has opened new opportunities for clinicians to analyze diseases and severity of illnesses via 3D modeling. Moreover, it is a source to lessen pain caused by chronic diseases or severe burn injuries.

VR is Reliable

With successful research and trials, VR has proved itself a reliable technology in healthcare. This trend is not in its testing phase but is operational in some areas. Thus, it hasn’t remained a research-based project but is facilitating in a number of ways, changing human perception for improving quality of care services.

For Example,

Cedars Sinai is a non-profitable healthcare organization in Los Angeles that is successfully running a clinical VR program for more than 3,000 patients.

Despite the numerous benefits that virtual reality offers to healthcare, some challenges also exist while implementing this technology to the full potential.

How the healthcare system uses this technology?

According to physicians, virtual reality can provide a different environment for the patient’s healing process. It has the ability to take patients away from the clinical setting through an interactive experience. Via VR, patients are able to reduce their stress and pain and learn new techniques that may help them afterward for a better lifestyle.

The purpose of VR is not to create a fantasy world for patients but making them able to learn new skills to cope with real-world problems. Hence, it serves as therapy.

In what capacity virtual reality works in healthcare!

Currently, VR is working in three different sectors as follows:

  1. Stimulates Relaxation and Calmness

Virtual reality helps in achieving the same goals, which are derived from cognitive behavior therapies. Depressed, traumatized patients with intense situations, mentally ill, or people with phobias can seek solace and get back to their regular lives.

  • Relieves Pain

Doctors have tested several virtual reality techniques against abdomen pain, back pain, and more. The results were astonishing. A pain-specific application, Pain RelieVR has shown great effects in this context. The result showed around 24% of reduction of pain after 10 minutes.

Moreover, patients can be taught to cope with pain via special techniques and generate positive change in their habits.

  • Sharpens Memory

VR is a survival tool for patients with dementia or memory loss. It enables connecting patients with reality and sharpens their memory via therapeutic exercises.

In addition, it also helps in differentiating between reality and hallucinations.

The struggle for controlling a craving is real. VR can also support the process of damping signals that might be harmful to you as in weight management.

Impact of VR on Medical Practices

To utilize this technology, physicians and hospitals require special training to streamline this technology in the real world. VR not only help in above-mentioned healthcare sectors but can support other healthcare applications as well.

VR is an amazing technology that benefits patients but also physicians. With the implementation of VR in the medical practice, quality of healthcare is improved which consequently fill up physicians’ pockets. Moreover, physicians can also earn incentives and rewards for utilizing new technology via MIPS.

It’s set up and the equipment placement remains the issue. However, with efficient planning and investment, it can be solved. Moreover, patients complained about the headsets being uncomfortable, but who knows with the passing time, VR gadgets become smart, and the healthcare system becomes more advanced.

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LOOKING BACK AT EHR MEANINGFUL USE FROM A NEW PERSPECTIVE

ARRA – The American Reinvestment & Recovery Act was legalized on February 17th, 2009. It aimed to revolutionize many economic and social sectors including healthcare. Health Information Technology for Economic and Clinical Health (HITECH) Act was also one of its considerations. This act was in great support of the meaningful use of the electronic healthcare records (EHRs), an initiative by the Centers of Medicare and Medicaid (CMS) and the Office of National Coordinator for Health IT (ONC).

Its emphasis on the implementation of EHR technology throughout the USA. Moreover, it is also in accordance with the MIPS quality measure Promoting Interoperability (PI) in which physicians use innovative methods to improve the quality of care services. It requires the use of certified EHR technology to provide a secure exchange of healthcare information.

Plays an Important Role in MIPS Data Submission

Meaningful use of EHR technology also helps physicians to efficiently submit MIPS data to CMS. On the other hand, physicians using this technology can also report measures regarding value-based services to the Secretary of Health & Human Services (HHS) and get incentives.

The Need for Meaningful Use (MU) Act

This act is helpful in generating five possible outcomes for the betterment of the healthcare industry.

  • Improvement in public health
  • Improved coordination in healthcare sectors
  • Increased engagement of physicians and patients
  • Protect patient’s private data from unauthorized use
  • Improved services, safety, and efficiency of the healthcare system

What benefits physicians have for meaningfully using EHR technology?

The incentive payment ranges from $44,000 for 5 years to $63,750 for 6 years (Starting from 2011).   Eligible physicians (EPs) and eligible hospitals (EHs) demonstrating adaptation and efficient use of EHR, get valuable rewards. To encourage physicians to go for EHR meaningful use and reduce the burden for healthcare providers, it is classified into three stages.

Stage 1 of Meaningful Use

The requirements of this stage are divided into the 15 core set and 10 menu set objectives. There is an option of choosing 5 out of 10 menu set objectives with the compulsion of at least one population/public health measure.

Stage 2 of Meaningful Use

CMS and ONC have also set standards for the second stage of meaningful use (MU). It released final rule for incentive programs of Medicare, Medicaid and EHR technology in August 2012.

For this stage, eligible physicians are required to meet for the exclusion to 17 core objectives and 3 out of 6 menu set objectives.

Whereas, it was must for eligible hospitals and Critical Access Hospitals (CAHs) to qualify for an exclusion to 16 core objectives and 3 out of 6 menu objectives.

Stage 3 of Meaningful Use

In the modified version of stage 2 meaningful use for 2015-2017, clinicians attest to any combination of 2 measures out of 3, while EHs and CAHs attest for any combination of 3 measures out of 4. For stage 3, submitting data for meaningful use was obligatory in 2018.

ONC along with HHS (Department of Human Health & Services) released a final rule in the context of meaningful use and gave certification to 2015 edition of electronic healthcare records (EHRs). This initiative allowed diverse types of healthcare organizations to get access to healthcare IT.

Thus, medical practices that adopted EHR technology in previous years are now in benefit and can target more incentives, as they have completely understood this method. To get incentives and adopt healthcare IT, physicians should invest their efforts in this system respectively.

HITECH provides high opportunities for healthcare providers to improve their medical practice. The phased approach of three stages allows room for improvement in the public health sector. Moreover, it sets the base of the healthcare system with fewer discrepancies and controls chronic diseases.

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3 TYPES OF PAYMENT MODELS, PHYSICIANS PROBABLY DON’T KNOW!

Value-based healthcare services have not only changed the patients’ healthcare standard but also the physicians’ payment model. Value-based reimbursement models encourage clinicians to adopt methods that make healthcare easy and efficient. Programs like MIPS, MACRA, and more depict value-based care system and allow physicians to achieve rewards and bonuses. The purpose is value-based reimbursement models are to;

  • Straighten up physicians’ revenue cycle management
  • Make patients empower the healthcare system where they choose their desired service

We have heard many of the benefits and the need for value-based healthcare models, but the proper information about the available models is not very common. Let’s review that.

What are the Available Value-Based Care Models?

There are a few types of value-based payment models with a variety of risks attached and the benefits.

1. Accountable Care Organizations (ACO)

It is a system of hospitals, clinicians, and other healthcare providers to provide organized and high-quality services to Medicare beneficiaries. It was started to help patients receive up-to-the-mark services at the most appropriate time. It means that in case of emergencies or other scenarios, patients don’t have to wait to get to the relevant doctor.

This organization ensures that patient only bears expenses for those services that are absolutely necessary to treat an illness. Redundant medical services are reduced by eliminating medical errors that occur while diagnosis or treatment.

Healthcare providers volunteer in this program to get shared savings if the ACO fulfills the standardized healthcare criteria with reduced expenditure.

Risk Factor Involved in ACO

It is not like ACO volunteers always end up adding a bonus to their revenue cycle, but the financial risk is also involved. When able to meet the requirement, physicians have a jackpot, but on the other side, they also have to bear shared losses if any.

For shared loss, healthcare providers have to pay Medicare as compensation for not delivering value-based care to patients.

This value-based reimbursement model is not just about value-based medical procedures but also support volume-based services. However, the evaluation is based on quality, safety, and experience.

2. Bundled Payment for Rendered Services

This payment model pays physicians not for each service but as a whole series of services. Clinicians receive collective reimbursement for treating a medical condition, including all the charges for physicians and the types of rendered procedures.

For Instance,

If a patient undergoes a surgical procedure, CMS (The Centers for Medicare and Medicaid Services) sets a collective payment for surgeons, an anesthesiologist. It then pays a total amount rather than paying separately to each clinician.

Risks Attached with Bundled Payment Model

A certain level of risk is also involved with this type of payment model same as the ACO. Physicians get to full their pockets when they collectively reduce the incurred cost. Otherwise, they get will have to bear the loss.

Thus, this practice requires standardized procedures so that, all stakeholders get the rightful reimbursements.

3. Patient-Centered Medical Homes (PCMH)

It represents the healthcare payment model in which a primary care physician coordinates the patients’ healthcare. This payment model manages and handles all the needs of the patient in a centralized setting.

It’s certification highlights that the physicians are capable of providing healthcare in a patient-centered setting with team-based methods. Moreover, it also ensures consistent care quality for patients.

Patients are allowed to develop a one-to-one relationship with their physicians, and it governs on the medical and environmental factors.

This payment system has shown great potential in reducing the un-necessary cost expenditure. According to a Maryland – based PCMH, via the efficient practice of this reimbursement model, they were able to save up to $98 million and enhance their quality standards by 10%.

Alternative payment methods other than the fee-per-service are not very popular practices. However, physicians are unable to meet their financial requirements. Thus, they are devising ways to incorporate new technologies into their system to speed up the workflow.

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THE POPULAR FAQS ABOUT MIPS – EXPLAINED!

Providing value-based healthcare services to patients and having a penalty-less spot in MIPS 2018 requires great effort. However, if strategize properly, physicians can get themselves incentives and bonuses from this program.

Knowing the MIPS program better and accordingly report MIPS quality measures to increase your chances of payment rate from CMS. Therefore, it is always the best to resolve any misconception that might disturb later.

Given below are some of the important FAQs about MIPS that might answer your MIPS queries.

Is saving from penalties in MIPS is not enough?

2018 was the second operational year of MIPS and the minimum threshold for penalties was 15%. This bar is expected to rise in the coming years with strict reporting criteria.

70 MIPS points are the threshold set to get incentives. However, when achieved score higher than that, physicians can qualify for the bonus pool of $500 million. Physicians’ score is displayed on website www.medicare.gov/physiciancompare. The high scorer physicians get an extreme reputation and well-renowned authorities like Medicare, AARP, and CMS endorse them as a brand in the healthcare industry.

Thus, targeting incentives rather than just aiming for a penalty-less spot can open success gateways.

If physicians are still eligible for MIPS, when not using EHR technology?

If you don’t use the 2014 version of EHR technology, physicians may not be able to earn points for Advancing Care Information (ACI), now known as Promoting Interoperability (PI). For maximizing your score, physicians can earn from MIPS quality measures of Quality and Improvement Activities (IA).

Does reporting data for more than 90 days increases chances of getting higher MIPS score?

Physicians can choose to report clinical data for 90 days or more for up to 12 months. However, your result is solely based on the performance you showed throughout the performance year.

Thus, choose report for the period that best suits your requirements and helps to increase the score.

What is the best practice, reporting as a group or an individual clinician?

Both practices benefit clinicians in their own manner so before deciding the best approach, consider the following points.

  • While reporting data to CMS in a group, all physicians will have the same payment rate. However, as an individual clinician, you’ll get your own payment rate. You have to decide which practice will benefit in more revenue generation.
  • Moreover, if any physician has a low-volume threshold, he will not be considered as an individual but as a member of the group.
  • In a multi-specialty group, some providers may find measures that are suitable for their practice, and conversely, they may not be suitable for others’ practice. In such cases, you have to choose measures that suit the single specialty of the medical practice.

Is there any exclusion for MIPS?

YES! Physicians are only excluded from the participation of MIPS when,

Medicare allowable is less than $30,000 or less than 100 Medicare patients in 12 months

The healthcare service provider is already a participant of Medicare Advanced APM

Hospital-based healthcare providers are exempted from ACI (MU) category. For them, 25% weight of this category is reassigned to Quality category making its worth to 85% in the final MIPS scorecard

What happens when a physician moves to another medical practice in the payment year?

MIPS score moves with the physician. Even, if you have moved to a new working place, your score will be based on the data reported in the last year, no matter what the medical practice is.

When you work in two different medical practices in the same year, your payment rate under the new TIN (Tax Identification Number) will base on the higher score among both.

What factors should be in mind while selecting MIPS Quality Measures?

Choosing the right MIPS measures, according to your practice is a difficult task so research properly about the following points.

There are 250 quality measures and 5 MIPS submission methods and some quality measures are only available for specific reporting methods, so how will you collect data and report to CMS?

Never report for a measure that has less than 20 eligible cases or no benchmark will receive 3 points.

Each reporting method has its own benchmark; thus, determine score by using the correct benchmark. For Example,

The same measure may have less benchmark when reported via a qualified registry as compared to EHR technology.

Above-mentioned points are the most frequently asked questions (FAQs). This article is all about clarifying those misconceptions, which may confuse physicians and block their way of success.

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