I’m a health IT consultant and I have to be honest. 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. We are smack dab in the middle of a MAJOR shift from volume-based care to value-based care. What does that even mean?
First, we’ve already proved that the fee-for-service (or volume-based pay) did not work. When we paid clinicians based only on the number of services they provide to patients, we essentially incentivized physicians to order more tests, require more visits with patients, and complete more procedures instead of solely delivering 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, which was the projected budget set aside by Congress to pay clinicians for their Medicare services and the model that had been in place for 20 years prior to this shift to value proved that if we continued down the SGR 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.
So we know that we can’t go back to the old model. Whatever model we choose to move forward with will require EVERYONE in healthcare to experience some form of change and/or disruption.
Add in the number of Baby Boomers entering into Medicare, the need for healthcare on a whole to level-up in terms of technology and interoperability, and we find ourselves in the middle of a perfect storm.
The U.S. healthcare system is complicated. Why would we expect the “fix” to be simple?
The predicament we find ourselves in reminds me of that Winston Churchill quote about democracy:
No one pretends that democracy is perfect or all-wise. Indeed it has been said that democracy is the worst form of Government except for all those other forms that have been tried from time to time.…
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
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 these #annualmanuals? Why have I printed out the 1000+-page final rules and studied them like I’m preparing for an AP English exam?
A: So that you don’t have to!
No kidding, I was an English major in my undergrad and took AP English in high school. I am not a doctor. I don’t work in a healthcare setting. But I have a special set of skills that healthcare professionals might appreciate.
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.
Look, here’s proof (also pictured, my very supportive husband):
For the 2018 rule, I literally stayed in a hotel for three days so that I could accomplish this:
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. It also includes worksheets to keep you on track. For MIPS Manual 2019, I broke it up into seven different workbooks, so that your practice can truly divide and conquer each category or if you have multiple staff members spearheading different aspects of MIPS.
Healthcare has lots of problems, no doubt. QPP and MIPS have their own set of unique challenges too.
As an expert in the Quality Payment Program space, I would not be doing my part to solve the problem if I didn’t provide easy-to-understand guidance at an affordable price that makes MIPS success possible for everyone.