Optimize quality program performance and management for MIPS success
The first performance year for the Merit-based Incentive Payment System (MIPS) began January 1, 2017, and the race is on to earn top scores. MIPS is a competitive program that scores clinicians across multiple performance categories: Quality, Advancing Care Information (ACI), Improvement Activities (IA), and Cost (in 2018). Each category is scored, weighted, and combined to determine a total final score. CMS then uses the final score to analyze performance across clinicians and awards Medicare Part B incentives and penalties.
The adjustments increase over time, from +/-4% for the 2017 performance year up to +/-9% for the 2020 performance year. With an expected 600,000 clinicians expected to participate in MIPS and the level of financial risk escalating, the competition will increase, as more clinicians strive to improve their scores to receive incentives.
Although parts of MIPS are based on historical programs, including Meaningful Use and PQRS/VBM, MIPS has evolved those programs and introduced more elements. Some of the key MIPS challenges include:
- Complexity: Each category has its own set of measures, requirements, and scoring so there are a myriad of critical decisions that need to be made, including whether to participate as a group or individual, what measures are optimal, what reporting method will have the best results, and more.
- Clinician Data: Most EHR, population health, and other resources are focused on patient/interaction data, not clinician data. Subsequently, clinician information required for critical analyses is scattered across organizations/systems.
- Evolving Regulations: While the final rule was published in 2016, MIPS continues to evolve, with additional comment periods and updated policies. Keeping track of complex regulations while trying to actively manage the programs can be overwhelming.
With an ever-increasing set of variables and potentially millions of dollars on the line, it is essential for organizations to automate.
SA Ignite brings predictive analytics and regulatory compliance together in the IgniteMIPSSM solution to enable healthcare organizations to gain efficiencies, improve scores, avoid penalties, and increase revenue for value-based programs. Using an integrated suite of cloud-based software and advisory services, IgniteMIPS Fire Edition provides an opportunity to manage every stage of the process. Key features on the platform include:
- Clinician Data Repository: Consolidate your clinician information, including common attributes such as name, NPI, program, and more, to manage data across multiple value-based programs.
- Eligibility Analysis: Quickly determine which clinicians are eligible for a given program and calendar year and set and track clinician attributes that drive both eligibility and program scores.
- Score Calculation: Easily calculate projected program scores based on the current regulations at both the individual and TIN/group level to understand areas of excellence and improvement.
- Financial Impact: Using projected final scores and Medicare Part B payments, estimate the financial impact at both the clinician and group levels to set organizational expectations and goals for improvement.
- Measure Analysis: Determine which measures will meet program requirements and yield the highest score against the benchmarks as well as which clinicians are at risk.
- Measure Leverage: Focus your improvement efforts by determining which measure gains will generate the largest score increase.
- Monitoring: View organizational performance via a comprehensive suite of dashboards and drill down to individual scores and measures to examine trends and identify low performing clinicians.
- Scorecards: Proactively share individual and organizational performance metrics along with corrective actions to coach clinicians for improvement.
- Method Selection: Model different scenarios to determine which reporting methods, including group or individual, and submittal methods – EHR Direct, registry or QCDR – are going to produce the best results.
- Pre-submittal workflow: Use a quick, guided workflow to collect data in advance of submission and retain an audit trail. Clients who wish to outsource submittal can work with SA Ignite to evaluate options and add submission to their subscription.
Plus, IgniteMIPS is based on the IgniteQ platform, which enables organizations to manage multiple value-based programs on a single platform and ensures that the latest regulatory updates are in the rules engine. Along with powerful cloud-based analytics and program management software, SA Ignite’s unmatched team of Quality Payment Program experts provide advisory services to help you understand regulatory implications, make strategic decisions, and create a plan for success.
To download this information in PDF format, please click here.