Your First MACRA Decision: AAPM or MIPS?

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

Clinicians have two options for MACRA participation—an Advanced Alternate Payment Model (AAPM) or the Merit-Based Incentive Payment System (MIPS).MACRAs-2-Tracks-final

CMS has structured MACRA to encourage AAPM participation, offering clinicians a 5% lump-sum bonus on top of a share in the savings achieved by the organization. The following questions will help you determine whether you qualify for the AAPM option: 

  • Do you participate in an APM? (An ACO or other risk-based healthcare delivery program?)
  • Is your APM an AAPM? The APMs identified in the image above qualify as AAPMs by virtue of the fact that:
    • the hospital and the clinicians use certified EHR technology,
    • the organization bears both upside and downside financial risk, and
    • the providers report quality measures.

NOTE: The CMS CJR (Comprehensive Care for Joint Replacement) program is now considered an AAPM. (According to the CMS Fact Sheet, this program was recently added to the list of 2017 AAPMs.)

  • Do you meet the participation volume thresholds, i.e., do you derive 25% of your Medicare revenue or see 20% of your Medicare patients through one of these channels?

If the answer to all the questions above is “Yes,” you may be a QP (qualified participant) in an AAPM. Talk to the organization’s sponsor (typically a hospital) about your participation in MACRA.

If the answer is “No,” to all, or some, of these questions, your route to MACRA success will be via MIPS, or a MIPS APM, respectively.

For more information about MIPS and MIPS APMs, see the CMS QPP website or contact me at SRS Health. I also invite you to watch (or watch again) my webinar titled, “MACRA/MIPS: The Future Starts Now.”

Outcomes: It’s What’s Inside That Counts

Scott Ciccarelli

Scott Ciccarelli

CEO at SRS Health
Scott Ciccarelli, Chief Executive Officer at SRS, has more than 20 years of diverse management and operations experience garnered as a senior executive at GE, where he headed two of the company’s businesses—most recently, GE Healthcare’s Services, Ambulatory and Revenue Cycle Solutions. His areas of expertise include business strategy, leadership development, operational rigor (Lean Six Sigma), and the delivery of enhanced value for customers through quality improvement and innovation.
Scott Ciccarelli

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lightbulb-gears-blogTwo weeks ago, more than 40,000 people came together to network, share, and learn more about health data management at HIMSS17. As expected, we heard about the latest developments in top tech trends of tomorrow like artificial intelligence, data security and virtual care. One of the hottest discussion topics by this highly focused group was how to improve patient and practice health through meaningful and usable analytics. After much time listening to and participating in conversations on this critical subject matter, we are more committed than ever to helping our clients improve patient care through outcomes, and when it comes to outcomes, it’s what’s inside that counts.

What do I mean by that? This familiar phrase has been shared from generation to generation when describing what’s important about people. So how can these words of wisdom about humanity possibly apply to HCIT and outcomes for specialty medicine practices? It’s more appropriate than you might think…

In an ambulatory setting, specialist teams need the ability to analyze and make decisions within their HCIT ecosystem. They need insight within their workflow. They need to know how to deliver the best care at a lower cost. And the only way to do this in today’s data-driven world is by bringing insight and analytics inside their workflow. Not outside.

External solutions focus on providing isolated results rather than a holistic approach to patient and practice health. What’s an outside solution? It’s anything that requires you to offload data, thereby taking you out of the ecosphere. If that data is not contained in the ecosphere – if the information is not inside the workflow – these solutions are not actionable immediately.

We believe that the only way to achieve the best outcomes is through frictionless data solutions that provide actionable insights that net immediate, holistic results. Of course, too much data can be overwhelming, so how do we maximize data intelligence for specialists without disrupting the quality of patient care?

That very question is what led to the development of SRS EHR Smart Workflows®. We’ve replaced complexity with streamlined data relevancy in a way that helps provide the frictionless clinical experience of the future…today.

So while we continue to hear all about the amazing healthcare technologies that are on the horizon, let’s remember to turn our gaze inward. Because when it comes to best outcomes, the best solutions are about what is on the inside. Just like the best people.

A New Data Has Dawned

Scott Ciccarelli

Scott Ciccarelli

CEO at SRS Health
Scott Ciccarelli, Chief Executive Officer at SRS, has more than 20 years of diverse management and operations experience garnered as a senior executive at GE, where he headed two of the company’s businesses—most recently, GE Healthcare’s Services, Ambulatory and Revenue Cycle Solutions. His areas of expertise include business strategy, leadership development, operational rigor (Lean Six Sigma), and the delivery of enhanced value for customers through quality improvement and innovation.
Scott Ciccarelli

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new-srs-blog-v2As we all prepare for another year of change in the healthcare industry, it is my privilege to share a big change of our own: SRSsoft is now SRS Health!

Why would we change our name, our logo, and our tagline? And what does this mean to our clients?

During our 20 years of innovation, the healthcare technology field has been radically transformed. So has SRS. What began as a document management company is now something completely different. We have reinvented SRS as a data solutions company that can help drive better care and better outcomes for our clients today…and in the future. That’s more than an evolution; it’s a revolutionary change worthy of rebranding.

Our Name                                                                                                                         Why did we add “health” to our name? The new moniker comes from our expertise at supporting your expertise: patient health and practice health. Our flexible data platform and integrated best-of-breed approach allows specialists to utilize HCIT in a way that improves the experience for their patients and their practice.

Our Logo                                                                                                                         The orb shape of the logo represents the continuum of engaging patients before, during, and after their visits. It represents the perfect balance of improved efficiency with proven outcomes.  And it represents the unending dedication of our team to remain in motion as we continue to pioneer the HCIT solutions of the future. The fiery color of our logo represents the passion and commitment of our people to ensure client satisfaction.

Our Tagline                                                                                                                             “Intelligent Data Solutions.” For specialists, these three words simply haven’t gone together in a way that provided the types of benefits that SRS Health offers. That’s because the EHR marketplace caters to generalists. Finally, these focused practices can escape the data dark ages with HCIT solutions that are predictive, connective, and exactly what the (specialist) doctor ordered.

To find out more about what’s behind the new SRS Health, I invite you to watch our new video. I think you’ll agree that it really is the dawning of a new data!

Wishing you SRS Health and happiness in the New Year,

Scott

MIPS: The Maximum Positive Adjustment Ship Has NOT Sailed

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

sail-boat-blogYou’ve come out of your eggnog-induced holiday fog and realize that you did not organize your practice for full-year MIPS reporting. With January 1 now in the rear-view mirror, you regretfully—but erroneously—conclude that you have missed out on the opportunity to earn the maximum positive payment adjustment in 2019. This is a common misconception that has been perpetuated in many MIPS-related webinars, blogs, and other communications. (That confusion exists is not surprising, given the spate of changes to MACRA in the last few months and the inherent complexity of the program itself.)

The fact is: Full-year reporting is NOT required to earn the maximum positive MIPS incentive in 2019. Rather, it is performance that counts, i.e. the number of MIPS points you earn and the level of quality you demonstrate, not the length of your reporting period or the amount of data you submit. If you look at the most recent CMS presentations, you will see images and text that clarify this point.key-takeaway-v2

It could be argued—and representatives of CMS have done so—that it might be easier to achieve a high MIPS score with a longer reporting period, particularly on certain quality measures. Perhaps so… but this does not preclude clinicians from achieving an equally high score in a shorter period.

Of course, there is no such thing as a free lunch; and there are consequences—possibly unintended—of CMS’ largess in offering the Pick Your Pace options for 2017. Regardless of how many MIPS points an eligible clinician earns in 2017, his/her 2019 payment adjustment will, of necessity, fall short of the originally planned 4% due to the legislative mandate for budget neutrality. In the Final Rule, CMS estimated that the upward adjustment potential will now be less than 1% for the base performance and under 2.4% when the additional money for exceptional performance is included. (For an explanation and graphic that explains the required “scaling process”, see pages 77340 – 77342 of the Final Rule.)

That said, however, the good news remains: You have not missed the boat! But it is time to get to work to allow yourself the time and flexibility to maximize your performance, identify the optimal reporting period, and earn the greatest reward.

What Are Specialists Faced With Today? Uncertainty and Change!

Ryan Newsome

Ryan Newsome

Vice President of Software Engineering at SRS Health
Prior to joining SRS almost 10 years ago, Ryan started his career as a software engineer for Map Info/Pitney Bowes. Throughout the years Ryan has been an expert in all things web, interoperability, and in agile leadership. He currently oversees all of product engineering at SRS and has led SRS’ transition to an Agile/Scrum Development Methodology. In his free time, you can find Ryan either skiing, cycling or spending time with his family. Fun Fact: Ryan played Division 1 Soccer at Sienna where he attended on a scholarship. Goal!
Ryan Newsome

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Changes AheadRecent Nobel-recipient Bob Dylan wrote “The Times They Are A-Changin’” in 1963—a time of growing social upheaval reflected in the song’s lyrics, which called for listeners to acknowledge and embrace the transformations taking place around them. As I listened to this song over the past weekend, I couldn’t help but draw a correlation to the radical transformations we are currently experiencing in our industry. The past several years have epitomized the term “change” as the nation has taken big steps to transform the delivery of healthcare.

The American Recovery and Reinvestment Act, signed in 2009 by President Barack Obama, was one of the catalysts for this transformation by requiring the “meaningful use” of digital systems in healthcare. Since then, change has been the only constant that we have been able to count on. Government regulations, payment models, and product innovations have continued to evolve in disruptive ways—both good and bad. As soon as we become comfortable with one wave of change, another wave is already threatening to drench us to the bone (for us, the next big one is MACRA & MIPS).

So, coming off nearly a decade of constant uncertainty, what’s next? Well, you guessed it—more change! Starting in 2017 we will have new policy leaders in place who have promised to significantly restructure the incumbent’s healthcare programs. President-elect Donald Trump’s appointment of Tom Price as the head of HHS may be indicative of the changes on the horizon. Price, a 6-term congressman from the Atlanta, Georgia, area, was formerly an orthopedic surgeon. Will a specialist at the helm help make government programs, that have typically been focused on primary and in-patient care, more meaningful for specialists?

Time will tell, but the one thing that is certain is that, as the song says, the wheel is still in spin. In other words, the times they are still a-changin’.

The Right Tools for Relevant Results

Adam Curran

Adam Curran

Product Marketing Manager at SRS Health
Adam Curran is a Product Marketing Manager at SRS. He oversees marketing intelligence to support the development of strategic marketing plans. Prior to joining the organization, he was a key member of a pharmaceutical software company’s Clinical Development Business Unit, specializing in the clinical data management elements of the drug development lifecycle. He was also the editor for their microsite’s blog. Adam has also held roles at the UK’s National Energy Foundation and Skills Funding Agency.
Adam Curran

surgical-tools-315pxThere is discussion in the industry about the effectiveness of healthcare information technology (HCIT) solutions. And so there should be; although we have seen improvements in HCIT solutions, a significant number of physicians are not happy with their current systems. Perhaps it is because some vendors feel that they know what’s better for their practice, and build the system around their vision at the expense of how the doctor likes to do things. Or maybe it’s because vendors sell practices solutions that aren’t specialized to their requirements—leading to complexity, fatigue and frustration. In either case, doctors are forced to use tools that are inappropriate to their needs and slow them down.

It’s not rocket science: doctors want tools that help them do their job effectively. Like the stethoscope—it’s one of the oldest medical tools still in use today, but it continues to perform an essential task, even in an era of high tech, and there is nothing complicated about it. Although it was originally invented to spare a young physician the embarrassment of putting his ear directly up against the chest of a young woman, it turned out to have enormous diagnostic value. Because of that, the stethoscope quickly caught on with other doctors.

Another good example is molecular breast imaging (MBI). Mammography was a good way to detect breast cancer, but MBI turns out to be three times more effective at finding tumors in dense breast tissue. MBI is simply a tool that has produced better results.

What about laser surgery? Developed at first for eye and skin surgery, it has expanded its range to include different medical and cosmetic procedures, from cosmetic dermatology to the removal of precancerous lesions. Laser surgery allows doctors to perform certain specific surgeries more safely and accurately—again, a new tool that provides better results.

When it comes to HCIT solutions, however, the reception has been decidedly less enthusiastic. Maybe that’s because, in contrast to the examples above, it hasn’t been clear what the purpose of HCIT solutions actually were. To help doctors collect data on patients, or to help administrators collect data on doctors? To make practices more efficient, or to simplify the government’s monitoring of public health? Without a clear task to perform, it’s not surprising that HCIT solutions have produced mixed results. It’s hard to assess the value of a tool when you aren’t sure what it is supposed to do.

It turns out that, like the stethoscope, electronic health record solutions were a tool designed for extra-diagnostic reasons, and then later repurposed. However unlike the stethoscope, the adoption of EHRs has been driven not by doctors who found them helpful, but by hospitals, insurance plans, and government agencies who sought to control skyrocketing costs and standardize healthcare. This disparity has been an underlying cause for ineffective workflows within the systems. And even when EHRs were designed with physicians in mind, they were designed for primary care physicians, leaving the specialist community underserved.

What is clear is that, when an HCIT solution is designed with the primary purpose of helping doctors, the industry does see value in them. According to the latest Black Book survey of specialty-driven EHRs, 80% of practices with specialty-distinctive EHRs affirm their confidence in their systems. The same survey reported that satisfaction among users who had switched to specialty-driven EHRs has shot up to 80%. And finally, 86% of specialists agreed that the biggest trend in technology replacements is specialty-driven EHRs due to specialist workflow and productivity complications.

The statistics show what we already knew; doctors want the technology and tools that give them relevant results. Like earlier great medical inventions, HCIT can play a vital role too. One positive development is that EHRs, like the lasers used in surgeries, have evolved to serve a variety of specific purposes. Just as there isn’t a single type of laser that is used by both ophthalmologists and dermatologists, EHRs are increasingly specialty specific.

This means that specialists are no longer forced to use systems designed for primary care physicians that collect every piece of data that every type of doctor might possibly need. That sort of all-inclusive data collection doesn’t lead to better results; if anything, too much data causes unnecessary clutter, making analysis more difficult. What is crucial is having more RELEVANT data. Specialists need EHRs that collect the data that is relevant to them, and only the data that is relevant to them. They need an HCIT solution that is driven by their specialty, that respects their workflow, and that has the flexibility to handle their practice’s unique requirements.

To find out more about developments in HCIT solutions that are improving patient care, check out our latest whitepaper, “Healthcare: How Moving from Paperless to Frictionless is Improving Patient Care”.

OBSERVATIONS FROM AAOE 2016

Scott Ciccarelli

Scott Ciccarelli

CEO at SRS Health
Scott Ciccarelli, Chief Executive Officer at SRS, has more than 20 years of diverse management and operations experience garnered as a senior executive at GE, where he headed two of the company’s businesses—most recently, GE Healthcare’s Services, Ambulatory and Revenue Cycle Solutions. His areas of expertise include business strategy, leadership development, operational rigor (Lean Six Sigma), and the delivery of enhanced value for customers through quality improvement and innovation.
Scott Ciccarelli

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alcatrazAAOE was nothing short of amazing—and not just because the show took place in beautiful San Francisco. In fact, what happened inside the expo halls rivaled many of the sights of the City by the Bay.

As always, attendees were excited about the opportunity to network, learn from industry experts, and be inspired by the keynote speakers. The exhibit hall was crowded, giving us a chance to meet new AAOE members along with spending time with old friends and valued clients. The majority of orthopaedic executives we spoke with were concerned with the same challenges: How do they

  • remain profitable in a value-based world?
  • collect more data without being slowed down?
  • unravel the complexities of regulatory compliance?
  • demonstrate the value of their services through analytics and outcomes?

This made the introduction of our new patent-pending Smart WorkflowsTM Data Platform a big hit. More than simply our latest release, this revolutionary technology helps high-volume specialists bust out of the cage of traditional data capture and practice medicine the way they believe is best. For some, that is as liberating as escaping from Alcatraz itself.

How can an HCIT solution provide such freedom? By putting specialists back in charge of the data capture process instead of allowing them be held hostage by it.  The Smart Workflows Data Platform is designed to capture relevant data at the point of care—based on role, specialty, or practice requirements. In other words, it lets the specialists decide when, where, and by whom data should be collected. The result? Dramatic increases in productivity and efficiency, and an enhanced ability to focus on patient care rather than data input. In addition, Smart Workflows gives specialists the power to determine exactly which discrete data points are relevant to their practice, and to change those data points if and when desired. This eliminates the risks of being locked into one system in a constantly changing regulatory and compliance landscape.

Orthopaedists at AAOE didn’t have to take our word for it—as they visited our booth, they saw first-hand the difference Smart Workflows can make in their practices, and it felt good to see the reactions of physicians and executives as they learned more about Smart Workflows. The platform is the first major achievement of our client-collaborative development process, which makes it a significant leap forward, but it’s also just another step by SRS in helping to prepare our clients for success, both now and in the future.

Of course, we are more than just a technology company, as many AAOE attendees learned when they heard our own Lynn Scheps unravel the complexities of MACRA/MIPS. One of the foremost experts in the industry, Lynn is constantly diving into the ever-changing rules surrounding compliance. Her knowledge helps inform our updates from a regulatory standpoint, and she also provides our clients the human guidance they need to ensure their compliance.

A lot has happened since my last blog post. At AAOE, we were finally able to share the latest breakthrough innovation we’ve been alluding to for months. I was truly proud to unveil our Smart Workflows Data Capture Platform. I hope that, like a lot of the AAOE attendees who stopped by our booth, you are ready to unshackle yourself from the cognitive-data burden that has been dragging you down and coming between you and your patients. If so, we’ve got the key