Why I Write Annual MIPS Manuals

After working in health IT for a decade, I have yet to hear any doctor or healthcare staff member say they actually like any of the quality payment programs that the government has introduced. Whether it was Meaningful Use back in the day or now the Merit-based Incentive Payment System (MIPS), doctors are not happy with the models that are shifting their pay.

I’ve heard from docs for years, things like:

  • I want to focus on my patients, not clicking around in an EHR
  • This is not what I got into medicine for
  • The effort isn’t worth it for the payout
  • Doctors should unionize
  • Doctors should opt-out of Medicare altogether
  • Doctors should opt-out of commercial insurance altogether and just offer concierge services

Here’s the thing. The fee-for-service model isn’t particularly hard. Neither is the value-based-care model. It’s the transition between the two that is so difficult.

Unfortunately, that’s where we are now–in the middle of a transformational shift from a healthcare system based on volume to one based on value.

What does that even mean?

First, we’ve already proved that the fee-for-service (or volume-based pay) does not work. When we paid clinicians based only on the number of services they provide to patients, we essentially incentivized physicians to prescribe and perform more of everything, because that’s how they got paid. It paid better to order more tests, require more visits, and complete more procedures instead of finding the most efficient and effective ways to deliver high-quality care. Ultimately, that’s not a system that puts patient well-being at the center. That’s where you hear people referring to our health system as “sick-care” system.”

Additionally, the Sustainable Growth Rate (SGR) model, proved that if we continued down that path, the government would either go bankrupt or they would have to reduce the reimbursement rate to clinicians by more than 20 percent. Neither of those options is actually sustainable, even though the name of the payment model says otherwise.

The U.S. healthcare system is complicated. Some would even say it’s broken. Why would we expect the fix to be simple?

Enter MACRA, the Quality Payment Program, MIPS, and value-based care.

This new model:

  • attempts to put patients at the center of their care
  • funds itself (aka it is budget neutral in the eyes of Congress)
  • incentivizes implementing and using more sophisticated technologies
  • prioritizes continuous improvement
  • offers a crawl, walk, run approach to make it easier for organizations to transition with an iterative approach, responding to real-world feedback provided by different healthcare stakeholders
  • provides a standardized approach to comparing doctors and clinicians across the country

QPP/MIPS is in no way perfect, complete, or even close to achieving its ultimate goals of improving patient outcomes while also reducing the cost of care. However, this is it. This is what the experts have come up with. No other alternative models have been identified that could possibly keep the Medicare trust solvent.

Like it or not, the Quality Payment Program (QPP) is the hand clinicians have been dealt. And by design, the QPP rules and requirements for participation change every year.

Q: Why do I write the  MIPS Manual each year?

A: To save you valuable time and resources, so that you don’t have to put the pieces from CMS together yourself.

I ingest the finalized materials that CMS releases each year, do my best to understand the logic behind their decisions, then take time to cut through the jargon and both translate and compile the information clinicians or practice administrators need to succeed in the program.

Since 2015, I have written a book for each quality performance year except for the main transition year: 2017. My main goal from the beginning has been to support clinicians where they are at, so they can spend more time with patients and less time trying to decipher this stuff. I understand that managing a practice is all about trade-offs. Saying yes to one thing means saying no to others. I don’t want you to have to make that compromise, at least not with MIPS.

In this year’s manual, I’ve added lots of lessons learned from years of working in the field and ways to address common issues that our clients have faced. It includes suggested questions and conversations to have with your EHR vendor, your biller, your registry and much more. MIPS Manual 2020 offers straightforward guidance at an affordable price that makes MIPS success possible for everyone.

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