HCOs must strengthen their quality improvement initiatives to reach elevated MIPS thresholds. An advanced performance analytics solution can collect and standardize data for value-based care performance measures.

Advanced analytics can help you optimize efficiency, improve quality, and maximize MIPS incentives.

The Merit-Based Incentive Payment System (MIPS) is one of two payment tracks under the Medicare Access and CHIP Reauthorization Act (MACRA), which went into effect in 2017. MACRA replaced the Sustainable Growth Rate formula in determining Medicare payments for doctors.

In today’s rapidly changing health care landscape, the push toward value-based payment models leaves providers dissatisfied with MIPS. The most common complaint is that the program is too complex due to its heavy reporting requirements.

And now, performance requirements have been elevated as well. While the Centers for Medicare & Medicaid Services (CMS) recently announced that 98.4% of eligible clinicians participated in MIPS reporting in 2018, for 2019, the agency increased the performance threshold for “positive financial adjustment” and for “exceptional” performers from 70 to 75.

Also, the negative penalty threshold doubled, from 15 to 30 points. This means that providers will have to meet these higher thresholds in order to avoid penalties and to earn the designation of “top performer.”

Maximizing MIPS Success With Data Analytics

For MIPS reporting on value-based care performance measures, you need to extract detailed clinical and operational data from EHRs and other sources. To do that, HCOs need the right analytics solution to collect and standardize data. Using advanced analytics can help streamline data acquisition to support MIPS reporting, normalizing, cleaning, and integrating it into a comprehensive data set. The data set can then be used not only for reporting via a qualified registry but also to provide timely feedback in advance of the reporting period – leaving time to improve the composite score.

How can physicians and other providers use data analytics to meet CMS’ Triple Aim Goals (improving health and experience of patient care while reducing costs)? The following strategies can help HCOs align MIPS with their existing workflows to earn positive payment adjustment and avoid the negative 7% reduction in Medicare reimbursement:

  1. Targeting at least 10 relevant quality measures to allow flexibility in meeting the required six. d2i’s Performance Analytics Application gathers your data, evaluates it, and helps you decide which quality measures to track and report.
  2. Harmonizing your data so that you’re comparing apples to apples across your practice. d2i integrates, cleans, and harmonizes data from multiple sources, including various EHRs, so you have consistent data elements, measuring tools, and performance scores at your disposal to accurately reflect results across sites.
  3. Mining data with core competencies in mind. Data mining allows Emergency Medicine departments to not only report on MIPS but to have an active ongoing quality improvement program. It allows teams to understand when, who, where, and why MIPS measures are or are not being met in order to discover opportunities for process and behavior change to improve MIPS compliance.
  4. Gaining buy-in from staff physicians. Our comprehensive toolset can also facilitate physician buy-in through operational reviews, peer comparisons, and identification of training opportunities. d2i also enables physician engagement with dashboards that are transparent and timely.
  5. Monitoring your data throughout the year. d2i monitors performance against established targets and thresholds. We help our clients get the most from our solutions by providing quarterly check-ins to help them develop appropriate action plans. This includes an in-depth review of performance metrics and ongoing initiatives.

No matter what regulatory changes go into effect, d2i’s data analytics solutions can help you optimize performance, avoid penalties, and improve efficiency, patient safety, and provider performance. See why no other health care business intelligence tool or EHR system even comes close. Contact us for more information about our analytics tools, or to schedule a 30-minute demo.