You know about MIPS by now, but do you know about the CMS Physician Compare site? At Patient360, I have spoken with many clients who decided not to participate in Merit Based Incentive Payment System (MIPS) in 2017, and to “take the hit” so to speak.
Doing the minimum to get by in 2017 was a risk some practices chose to take. However, moving forward with that strategy will make it nearly impossible for a practice to remain profitable with neutral or negative fee schedule adjustments. With the Sustainable Growth Rate (SGR) gone, providers were relegated to a 2002 fee schedule in a budget neutral program. You can’t get paid what you made 16 years ago and have a sustainable business when everything around you is rising in cost. It’s Business 101.
This unsustainable strategy for MIPS and CMS Quality programs has many implications. With penalties escalating annually and a two-year lag, not performing now takes 5%, 7%, and ultimately 9% of future year, higher fee schedules. It makes this ‘take the hit’ strategy one that will ultimately hurt a practice. AND, this “hurt” is not just on CMS reimbursement. Read on.
The MACRA legislation of 2015 and subsequent rollout of the QPP and MIPS in 2017 was an attempt to move from a purely fee-for-service payment structure to one that is Value Based. Data obtained from MIPS reporting will be posted on the CMS Physician Compare site and shared with third party sites like HealthGrades, Yelp, and Google. The 2017 Quality Payment Program (QPP) and MIPS data is targeted to be added late this year. Many providers have not felt the impact of internet reviews as they are busy or too full – save for the occasional nasty review one may have to manage. Yet, think about the last time you tried a new restaurant, booked a hotel, or bought something on Amazon? Guaranteed, you looked at the ratings before you purchased or booked.
As more and more consumer activity is being researched and reviewed online, so too, will the healthcare landscape follow. Family physicians who made house calls and could cure every ailment have gone the way of the white whale. Replacing them are specialty-centric providers doing primary care, hospitalists, hyper-specialized surgeons and medical specialty providers. These specialists rely on referrals (from not just providers but also patients) for practice growth and survival.
Word of mouth is still one of the most solid ways to build both a practice and a reputation, but it will only take you so far. Having a positive online presence is imperative for attracting new patients. Like any other industry, managing an online presence is critical and once the QPP data goes public, those data are part of the overall picture.
This online review study by Software Advice, shows that consumers evaluating physicians look first at Patient Rankings, but a close second is Quality of Care information. This aligns tremendously with the QPP and MIPS programs. Further, this online research is not done just by prospective patients but also by doctors (and their staff) that are your referral base. Under the new Cost category, the cost of care provided to patients is 10% of the total MIPS evaluation. To date, CMS has not explicitly defined how it will be measured. We do know the care your patients receive at a hospital or from another provider will impact cost scoring for all providers who care for that patient. A low Quality score implies poor quality performance, typically associated with higher cost. Higher cost of care means patients seeing the higher cost providers will be identified as receiving low quality, high cost care. And, all providers seeing those patients… even those doing well with quality reporting in their private practice… will be dinged on the cost category. Still think quality reporting doesn’t matter?
The shift to value-based care ties provider compensation to the value and quality of care, not the volume of patients seen or number of surgeries/diagnostics. Sites like HealthGrades, Yelp, Google, and Vitals are available to the general public researching physicians and their provider choices.
A doctor who receives a low score in MIPS… whether from not participating, performing poorly, or just doing the minimum (achieving only 15 points in MIPS 2018)… will look the same to the end-consumer and to your referral source(s). Both the consumer and the referral sources (perhaps the latter even more so as there is potential “money on the table”) will reconsider who the best consulting team should be and as a result adjust referral patterns. Compare that with a provider in your area who has a good or great score on their MIPS performance and a higher “star-rating” and, well, it will speak volumes. All things being equal, if you really knew nothing about the providers you were considering, which doctor would you choose for your own care? The higher or lower ranked? Easy answer is the higher-ranking provider.
The takeaway: Reporting for reporting’s sake won’t cut it as the Quality Payment Program continues to evolve. Reporting the minimum year over year under MIPS will not allow a practice to compete with their colleagues, attract new patients, and stay fiscally sustainable. One could continue to ignore it or just do the minimum (i.e., Patient360’s MIPS for Beginners) but understand that the Quality Payment Program is more than just a burden and an annoyance to practice workflow. The “spirit” of the QPP is to improve clinical outcomes and quality of care for patients while reducing system wide expenses. If you are not feeling like you have “team spirit”, and you just want to get by, that’s perfectly acceptable BUT buyer beware. As Medicare goes, so go the others payers. Looking at the big picture and conceptualizing that private payers/insurers will likely follow the QPP model means getting a system in place now—not later—is imperative.
Talk with Patient360 about your plan, or if you don’t yet have one, talk to us about your goals and we will help you get there.