There has been a lot of talk about the fate of small practices in the current healthcare environment, with many saying that small practices are under threat and have to fight to survive. It’s certainly still possible for small practices and individual providers to succeed in the new valued-based healthcare landscape, however, they will need to adapt and take advantage of the Merit-Based Incentive Payment System (MIPS).
By Lisa R. Esch, Chief Population Health Innovation Officer
Under MIPS, practices of all sizes will be able to join in the bonus pool, and in so doing they have an opportunity to turn major risk into reward.
The new MIPS program, which is one of the major paths to payment under the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA), will measure physicians on 1) quality, 2) advanced care information, 3) clinical practice improvement, and 4) resource and cost.
While first year CCM results have not yet been published by CMS, there is evidence to show that a chronic care management (CCM) program can help practices move the needle on all four of these measures. That’s because in a value-based healthcare environment, reducing avoidable admissions and expense is imperative. How can this be done with limited staff and resources? Through engaging patients beyond the four walls of the physician’s practice, while balancing technology and human resources to optimize patient impact.
The following are ways CCM helps practices prepare for each of the 4 MIPS categories and take advantage of the additional bonus that is open to eligible practitioners with exceptional performance (also referred to as the 25th percentile of possible values over the composite performance score threshold):
- Quality (representing 50%): As the largest part of the upcoming mandate, CMS’ Quality Measure Development Plan (MDP) strives to ensure the largest changes in improved care and healthier outcomes among the highest expenditure populations. Specifically, the MDP will focus on six quality domains: clinical care, safety, care coordination, patient and caregiver experience, population health and prevention, and efficiency and cost reduction. Not only will Chronic Care Management help engage patients along every stage of their healthcare journey – enhancing the connection beyond the hospital – physicians also have the ability to reduce the administrative strain, focus on providing value-based care, and be more strategic in achieving the highest scores and better outcomes for their patients. Shifting focus on quality through CCM can truly be a differentiator as providers are measured against their peers who don’t make any change in current practice or care management.
- Advanced Care Information (representing 25%): While doing away with Meaningful Use, CMS intends to ensure connectivity and interoperability among physicians and their networks. Essentially, emphasizing the delivery of information between patients and their care teams is becoming a top demand among patients and their care takers who want to understand and participate in their care, establishing a back and forth of mutual checks and balances accessible through CCM. Streamlining the information-exchange process will translate to real transparency and better decisions among care teams centered around the patient.
- Clinical Improvement Activities (representing 15%): With 90 proposed areas of activities under the MIPS rule, this can feel like blessing or a curse. Too many rules to focus on may stretch the practice thin, and with practices already at their limit in terms of workload, it’s next to impossible to fit more into the routine. Thankfully, CMS makes it possible to concentrate on subcategories that help to alleviate some of the load. For example, operating Chronic Care Management within a practice affects four out of eight subcategories, specifically Population Health, Care Coordination, Beneficiary Engagement and Extended Access to Care.
- Resource and Cost (representing 10%):This area of focus by CMS will continue to expand, growing to 30% by 2021 and leveling out with Quality. Patients with multiple chronic conditions have the highest risk for cost escalation. By staying in touch with the patient, care coordinators as part of their CCM engagement, can help the patient get ahead of health issues before they intensify, e.g., treating asthma in the office instead of the emergency department. Doing so helps maintain control over the overall cost of care around a patient. By delivering CCM to all qualified patients, a provider has the greatest opportunity to manage cost versus providers who continue with the status quo.
While there is no doubt that small practices face challenges, there is broad commitment to help them not only survive but thrive. Indeed, Congress has set aside $20 million annually from 2016 to 2020 for technical assistance available to help practices with 15 or fewer professionals improve MIPS performance or transition to Advanced Alternative Payment Models (APMs), which will come into effect from 2019.
Small practices also have a unique advantage over larger medical establishments, which is the affinity and personal connection patients experience with their physicians over time. They also have the ability to do something now, ahead of larger organizations and groups that move more slowly. Additional support to solidify an existing infrastructure and ensure full compliance of MIPS by delivering CCM provides an opportunity to strengthen ties with patients, improve their outcomes and position the small practice for big wins. Whether leveraging the tools already in possession or working with a partner to walk alongside during these changing times, it’s imperative to do something today that can help both the practice and the patients on the journey to value-based care.