With a grace period in place for compliance, now is the perfect time to get up to speed.
Value-based care (VBC) programs reward providers for quality of care over volume, and for participation in alternative payment models (APM). When it comes to VBC readiness, hospitals are eclipsing physician practices in adopting successful strategies. Many physician practices struggle to keep up, even though they know VBC participation is necessary. While hospitals are participating at a rate of 84%, physician practices show a much smaller 51% rate.
The Centers for Medicare & Medicaid Services (CMS) sponsors a suite of patient care-centered programs that focus on health care quality improvement and value, including the Merit-Based Incentive Payments System (MIPS) for physician clinics. MIPS is set up to reward value in two areas:
- Performing well on a number of clinical quality measures and improvement activities
- Participating in an Advanced APM and earning incentive payments
For some physician groups, participation in MIPS is optional, and they may not have the resources to commit to a program. Others meet participation criteria at the last minute each year by submitting the bare minimum required to remain compliant. Neither of these options takes full advantage of intended rewards for meaningful participation in VBC.
Performance data is not only directly linked to payment, but it is publicly available. Performing well helps HCO partners meet their goals. In this digital age, more and more patients are checking out their options online before making care decisions. Poor or no ratings not only are bad press but also jeopardize HCO contract retention.
In addition to patients, payers use metrics to decide which practices to engage with. Organizations that can invest in and perform well in data-driven VBC programs are able to demonstrate and prove their value and position themselves more favorably to payers.
Barriers for Small Clinical Practices
Pulling the data to participate in VBC programs can be an arduous task. Not only is data reporting required, but improvement from one reporting period to the next is needed to earn a good score. Larger health systems and hospitals have staff and support to maximize VBC for higher reimbursement, bonus payments, and better payer negotiations. How can smaller physician practices leverage their data to compete and reap these same rewards?
Data-Driven VBC Improvement
It all starts with data. No matter the size of the practice, data is being entered daily. Once it’s stored, then what? That data must be harvested and leveraged into meaningful insights. To lead health care transformation, it’s important for physician practices to not only meet VBC requirements, but to exceed them.
For example, one of the many past MIPS measures required practices to show an improvement in patient fall prevention. One practice routinely assessed every patient for fall risk. When patients scored in a high category, an intervention took place. Patient education was performed, perhaps a walking aid like a cane or walker was ordered, and physical therapy was prescribed if needed. With such follow-up, the practice knew it could meet the measure.
This is just one of dozens of examples of how access to the right data analytics tools can transform what was once a tedious task of manual data abstraction.
The problem was pulling all of that data over a span of time, from a variety of locations, then connecting the dots to show the results. With an advanced data analytics solution, providers can work with their electronic health record (EHR) system and combine it with other data such as billing data to generate VBC measures along with underlying details that reveal actionable insights.
Time to Get Started
Due to COVID-19, CMS is currently offering flexibility with regard to participation in MIPS and some practices are taking advantage of waivers. Also, physician clinics that have participated in COVID-19 data collection and clinical trial improvement activities can receive MIPS credit for that activity in 2020-21. With almost a year left until the next deadline, now is the time to form a game plan for VBC success.
This grace period creates a great opportunity for physicians to push reset and get up to speed on VBC. Many practices need a partner to help them realize the payments they have been missing, along with preparing for a world where most reimbursements will be tied to value. Contact our domain experts or request a demo to get an under-the-hood look at our analytics applications.