MIPS friendly EHRThe concept of Value-Based Healthcare (VBC) has only recently entered America’s larger awareness and, for patients, at least, it seems to be delivering improvements. According to research by Humana, total healthcare costs for patients on VBC plans are 15 percent lower than for patients on a fee-for-service (FFS) model. Furthermore, patients on VBC plans were more likely to have access to preventative care. For example:

  • Blood sugar control was achieved among 8 percent more patients with VBC plans.
  • Colorectal cancer screening rates were 13 percent higher.
  • Breast cancer screening rates were 8 percent higher.

As a result, patients reported better health outcomes and greater satisfaction with their providers. In fact, providers in VBC networks had 26 percent higher Healthcare Effectiveness Data and Information Set (HEDIS) scores than FFS providers. Humana also reported that its providers had 11 more points on engagement and provider-satisfaction scores. Value-based care has potential to improve quality of care and help some providers become more competitive.

With that in mind, VBC is a significant departure from the FFS model and will, therefore, require a shift in the types of patient data that practices collect, as well as some adjustments to existing revenue cycle management methods. But considering the positive outcomes recorded so far, the shift to VBC is a great opportunity for specialty practices. This is especially true considering the wealth of technological resources that are now available to help practices make the transition.

The Rise of the MIPS-Friendly EHR

The VBC trend is part of the Medicare Access and CHIP Reauthorization Act's (MACRA) Merit-Based Incentive Payment System (MIPS). As of 2017, qualifying providers that demonstrate high-quality healthcare for patients can receive a Medicare reimbursement incentive. Conversely, providers that fail to demonstrate value may see lower reimbursements. In essence, MIPS (and Alternative Payment Models, or APMs) are value-based care incentive programs (read more about MACRA/MIPS here).

This means practices that have already begun preparing for MACRA/MIPS or MIPS APM are the first VBC providers. Every provider that qualifies for MIPS receives reimbursements based on several factors. The most heavily weighted of those factors is "Quality Measures" – in 2018, MIPS practices must select six specific metrics to measure quality of care. Each of these will have a unique criteria for the data collection.

Incidentally, these Clinical Quality Measures (CQMs) focus on the value-based care model. This means that practices using a MIPS-friendly EHR achieve two things at once: They simplify tracking of CQMs while also becoming a VBC provider.

How CQMs Promote VBC

The following represents some of the key areas where CQMs promote VBC:

  • Patient-recorded outcomes: These include but aren't limited to Hip Disability Osteoarthritis Outcome Scores (HOOS), Knee injury and Osteoarthritis Outcome Scores (KOOS), Patient Health Questionnaire (PHQ-9) and pain improvement questionnaires. Patients who complete this documentation provide first-hand feedback of progress following surgery, a medication regimen, therapy and other medical interventions.
  • Showing improvement over time: This consists of benchmarks such as decreased pain, increased functionality and less dependency on medication. All of these will increase a practice's CQM score and therefore improve the chances that the provider will receive higher reimbursement rates. This applies to MIPS-based Medicate surpluses as well as VBC billing, since patient payment is ultimately based on outcome quality.

A MIPS-friendly EHR makes it easier to track the above metrics, both for CQM purposes and for VBC billing enablement. While the former is a requirement for many practices, the latter has potential to help clinicians gradually move away from the FFS model to deliver more value to patients, and ultimately improve patient engagement and financial stability.

Take Steps Toward Value-Based Care with MIPS|assist

AllMeds' MIPS-friendly EHR for specialty practices is a great first step toward a VBC model. Nevertheless, many practices may need additional assistance as they become acclimated to MIPS. Whether you're just trying to boost your Medicare incentive, or you are depending on the results of the Quality measures to improve patient care, the experts at AllMeds will make sure you have the processes, expertise and technology needed to make change simple and painless for your practice.

Click here to learn more about how MIPS|assist™ can help you realize greater Medicare reimbursements and move toward a value-based care model.

 

Sources:
https://healthpayerintelligence.com/news/value-based-care-outperforms-fee-for-service-health-plans

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