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Case Study: MIPS/Quality Reporting

Case Study: MIPS/Quality Reporting

Using data to improve care plays an essential role in delivering quality healthcare for patients, and succeeding in the new payment model ‑ The Merit-Based Incentive Payment System (MIPS) to avoid future penalties and work towards achieving an incentive. Performance in past years under three of Medicare’s payment programs - Electronic Health Record (EHR) Incentive Payment Program, Physical Quality Reporting System (PQRS) and the Value Modifier, determined how well a provider would succeed under the new model.  Barriers such as cost, limited staff engagement, lack of understanding of the program requirements and penalties, and cumbersome reporting led to a lack of participation. As a result, providers were hit with multiple payment adjustment to their Medicare Fee Schedule. This is exactly what happened to a group of long term Conventus member providers! They did not know what penalties they were seeing and had no idea where to start to make changes.
The providers called on the Conventus’ Practice Resources Department to help them determine what was going on and how they could make adjustments to minimize their penalties, improve patient outcomes, and increase staff engagement.
Identify Penalties being applied and understand quality reporting programs
  • We started working with the practice to determine their overall knowledge of the payment programs and what, if anything, they had done. We first took a close look at three months of remittances to determine what penalties were being applied.
    • We found that each provider was experiencing upward of 8% in penalties for non-participating in existing quality programs, PQRS the EHR Incentive Program and the Value Modifier
  • We educated the practice on:
    • The current reporting requirements,
    • How to begin to participate, and;
    • Planning for future and continued improvement activities
Use an organized approach (e.g. use of PDSAs, Model for Improvement, Lean,) to identify and act on improvement opportunities and create big wins
  • We reviewed the practice’s use of their EHR system and their current quality improvement activities.
  • We determined that the practice:
    • Had not fully configured their system;
    • Had a lack of knowledge of their EHR system use;
    • Did not fully understand the documentation and workflow process and;
    • Had staffing issues and motivation problems
  • We started by setting two common goals to measure improvement:
    • Improve EHR system use, and;
    • Engage staff in identifying quality improvement activities
Build Quality Improvement capability in the practice to empower staff participation
  • Together with the staff and providers we identified areas within the practice that needed improvement
  • We worked with EHR vendor to configure the system, provide training to the staff to improve system use, and to ensure information entered was being input appropriately
  • We selected meaningful quality measures that were appropriate for the practice’s patient base and goals
  • We implemented workflows to incorporate selected measures into the practice’s daily activities.
  • Refined and improved tracking, follow-up and communication of referrals and lab/test results to improve patient outcomes and increase care coordination
  • We measured results monthly and shared with staff to show the effectiveness of improvements made.
  • We created a plan to facilitate continued change, when necessary, through information sharing and staff engagement.
Through working with the practice on improving their EHR system use and overall approach to quality improvement, we were able to show:
  • Improved efficient EHR system use
  • Minimized impact of future payment penalties, for reporting year Medicare Part B charges
    • E.g., In 2017, if the total Medicare Part B charges are 2017 $1M a 4% adjustment in 2019 would equal $40,000; in 2020 5% would equal $50,000; 2021 7% would be $70,000
  • Improved operational efficiencies
  • Increased accuracy and appropriateness of quality measure documentation
  • Improved patient safety outcomes
  • Positive staff engagement through the improvement process
  • Successfully positioning for participation in future transformation models