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

Buzzword of the Day: Value-based Payment

ekg-moneyThe buzzword of the day is “Value-Based Payment”, and everyone is talking about the transition from volume to value. Recently, Becker’s—the leading source of cutting-edge business and legal information for healthcare industry leaders—interviewed SRS’ Lynn Scheps and Lester Parada as part of an article exploring this very important subject. The article discusses what “value-based” means, how the recently proposed regulations supporting the implementation of the MACRA legislation will impact orthopaedists, and how EHRs must evolve to facilitate practice success in the future. Read Value-based payments are coming for orthopedics: Are you ready?

Free-Flow Workflow: How Did This Help with Data Collection?

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

data-flow“Being flooded with information doesn’t mean we have the right information or that we’re in touch with the right people” – Bill Gates

We are able to collect a wealth of information today, thanks to technological improvements over the last couple of years. For a long time, specialists struggled to get the most out of earlier EHR solutions due to the limited data available. This was not so much the fault of EHR vendors but rather of the inherent limitations of the technology at the time. Additionally, the first “templated” EHR systems were specifically designed for primary care and family practice doctors. These systems were not suitable to meet specialists’ different data needs and handle a much higher volume. I did a post recently on the evolution of data capture (read it here).

When it comes to submitting meaningful use data to CMS, however, with all this data available, identifying and collecting it generally takes a long time. There are studies that show an increase in the number of physicians who spend more than one day a week on paperwork, and that indicate many physicians still feel that EHRs do not save time. Although this technology is allowing practices to comply with meaningful use requirements, the cost seems to be too high.

What are we seeing here? Physicians are spending more time capturing data due to regulations, and this is taking up the time available to see patients. How did we get to a point where the physician is spending more time staring at the screen than looking at the patient? I’m not a doctor, but I can imagine that they went into the profession to actually help people as much as they can, so more face-to-face time with the patient is the end goal here.

What is the solution to handling this volume of data? Certainly not reducing the amount of data—it would be hard and time-consuming to distinguish which data to get rid of. The solution must focus on making it quicker to handle this data. This is where free-flow workflow comes into play. Rather than having to go through the laborious process of submitting the data to each application, it essentially reduced the repetitive steps involved, thereby streamlining the submission of data.

This big time saver helps to alleviate the pain, but there are still limitations. Fortunately, we are now at a point where we can get a workflow that isn’t just free-flow, but also adaptive. To find out more about this development and other future trends, you can read our white paper.

Patient-centric Data Capture—Where Is It?

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

hc-prof-blog-image-v2We all know how increasingly important the patient experience is becoming in clinical trials and healthcare. With more emphasis being placed on quality care and patients’ active participation in their own treatment, it follows that this will have an effect on what solutions and services are required to satisfy consumers in this market. Consumers nowadays have a flood of information available at their fingertips—an amount unimaginable even just 15 years ago. And while the ability to look up symptoms online in the middle of the night has undoubtedly increased the number of hypochondriacs, it has also led to a higher number of truly educated patients, and an accompanying need for specialists to respect and involve them in the diagnosis and treatment process.

But what does it mean to be patient-centric? Our good friend Wikipedia defines it as “support[ing] active involvement of patients and their families in the design of new care models and in decision-making about individual options for treatment.” Not much help, is it really?

The Institute of Medicine defines it as “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.” The difference in definitions seems to come down to how involved the patient gets in their healthcare. The first definition suggests that the specialist is at the center of decision making, but supports the patient involvement as well. The latter, at least in my opinion, implies that the specialist actively collaborates with the patient by empowering them with the necessary data to make their own treatment decisions.

By either definition, however, data capture is currently falling short of what it takes to be truly patient-centric, despite how far it has come over the last decade. Electronic Health Record (EHR) solutions have been widely adopted in a variety of healthcare specializations, and although the way they collect data can create friction and inefficiencies with specialists’ workflow, they still provide enormous benefits. They streamline access for the specialists to vast quantities of patient data more quickly than traditional paper-based systems, and they eliminate need for patients to fill out the same forms again and again at each specialist’s office.

With the power of technology growing at an exponential rate, new technology solutions are coming out every day, but the challenge is to figure out how to use these technologies to address the real problems that medical practices are facing. In other words, to provide the right technology solution, one that really works for practices. At the moment, more often than not, EHR software interferes with and takes time away from the doctor-patient interaction. However, by giving specialists data-capture tools that allow them to focus on their traditional role of caregivers and that reduce the time and energy that is diverted away from patients, everyone benefits: specialists win, and therefore so do their patients.

There are already good vendors out there who are designing solutions with specialists’ requirements in mind, and some of these certainly help to give specialists more time with patients. However, to achieve a truly patient-centric solution, data capture will need to both predict and adapt to the data being fed into it in real-time. This would give specialists relevant, up-to-date information right at their fingertips, which they could use both to inform their own decision-making process and to educate the patient on their particular condition. The result would be a collaborative, evidence-based plan of care that—because the patient had participated in creating it—would lead to an increased patient commitment to the plan and a better outcome overall.

That’s what providing a truly patient-centric solution looks like.

To find out more about the evolution of data capture and what to expect in the future, you can read our recent white paper on this topic.