Professionals treating patients with chronic care needs should remain mindful of the increased risks of over medication by working with their patients to ensure a proper review of all medications prescribed. By being cognizant of the possibility for polypharmacy, healthcare professionals can help patients achieve better health outcomes.
Dr. Cynthia C. Nwaubani, BCGP, CMTM
The decision to enter the medical profession is personal—and for most of us, it precluded mountains of paperwork and coils of red tape. It had to do with people, healing and working for the greater good. As a pharmacist and CEO, it is easy to envision why business planning so often takes a back seat to patient care.
But as 2018 draws to a close, business plans for 2019 are demanding attention, especially for practices who treat a high volume of Medicare patients. Magnitudinous changes to reimbursement models are imminent, but there is still time to accelerate your MIPS plan and ensure it is aligned with 2019 practice objectives.
Of the myriad of concerns I have heard from stakeholders during past months, reducing physician burden tops the list. Studies show 28% of physician’s time is spent on non-clinical paperwork, translating to lost revenue for practices and increased physician dissatisfaction. It trends as a hashtag on Twitter for good reason—the role of the physician has expanded to include serving as a steward of the healthcare economy—no small task. And, success in the new healthcare model relies on between-visit care, which adds exponential demands on physician time.
If diving into the 2019 QPP requirements on CMS.gov feels daunting, read on. Caveat—consider this a conversation starter rather than an exhaustive list.
Quick Tips to get MIPS ready:
Check your eligibility status. CMS requirements change from year to year, so this may vary over time. Remember, you can participate as an individual clinician or as part of a group. According to CMS.gov, “to be excluded from MIPS, clinicians or groups would need to meet one of the following three criterion: have ≤ $90K in Part B allowed charges for covered professional services, provide care to ≤ 200 beneficiaries, or provide ≤ 200 covered professional services under the Physician Fee Schedule (PFS).
Choose your track: MIPS or APMs.
Select six measures based on your patient population; focus on quality measures, as they will have the greatest impact on your final MIPS score. Improving patient care means quality measures will become increasingly stringent over time. Cost measures are weighted at 30% for the 2019 performance year and will increase over time—a cost-reduction strategy is a crucial element of a successful long-term plan.
Innovate. In the context of the profound paradigm shift, physicians open to innovating their care models are most likely to thrive. CMS’ approval of several codes for chronic care management services via telehealth is a nod to the critical nature of innovation. Explore partnering with a third party CCM provider, such as PharmD Live, to shoulder between-visit care, adding value for patients and serving as a seamless extension of your practice.
Earn. In 2018, physicians could earn up to 5 extra points for caring for complex patients. CPT codes 99487 and 99489 allow reimbursement for CCM for complex patients, which can be outsourced to a third party vendor, such as PharmD Live, to optimize clinical and financial outcomes.
As January 1 approaches, explore evidence-based solutions, such as implementing pharmacist-led CCM services to meet and track quality measures. Clinical pharmacists are equipped to manage complex medical pictures, and make high-level clinical decisions to support your care plan.
Ready or not, change is coming.
By: Dr. Cynthia C. Nwaubani, BCGP, CMTM
January 1 is the hallmark of new beginnings—and for physicians and hospital clinics, this year will be no different. January 1, 2019 marks the first opportunity for eligible physicians and hospital clinics to earn penalties and incentives for performance through one of Medicare’s Quality Payment Programs, the Merit Incentive-Based Payment System (MIPS).
MIPS replaces the PQRS (Physician Quality Reporting System), the Value-Based Payment Modifier and the Electronic Health Record (EHR) incentive program. Borne from the Medicare and CHIP Reauthorization Act (MACRA) of 2015, MIPS and APM (Alternative Payment Models) are the two available options for quality payment tracks. MIPS is the default track, and its performance categories include Quality (60%), Improvement Activities (25%) and Promoting Interoperability (15%).
In theory, value-based care makes perfect sense. Catalyzing the best outcome at the lowest cost seems straightforward and reasonable by any measure. The Centers for Medicaid and Medicare Services (CMS) couches it as a four-step process: “Collect data, Report data, Feedback available, Payment adjustment.”
But moving from theory to practice has presented challenges, sowing frustration in physicians driven by patient care. Physicians and practice administrators envision stacks of paperwork, a quagmire of regulations and processes ad nauseum.
And studies reveal physician’s fears and perceptions are based in reality. Research by Weill Cornell Medical College and the Medical Group Management Association (MGMA) in 2016 showed physicians spent 15.1 hours every week processing quality metrics. Time spent on the intricacies of reporting, tracking metrics and understanding accompanying regulations cuts into patient care.
Success in the value-based framework requires deft planning and patience—which demands the scarcest resource for many physicians: time. As you know, value-based care is not an ephemeral trend; rather, a way of providing care that will catalyze a seismic change in its provision.
To begin planning for 2019:
Review the timeline of implementation.
Review quality measures and compare against current top-performing practice areas.
Review your business model. Get acquainted with new reimbursement codes which enable telehealth.
Choose a third party telehealth chronic care management provider, such as PharmD Live, adept in streamlining billing reports and quality measures data and providing care coordination and management.
Many physicians and hospital clinics have chosen to partner with a third party care management team, such as PharmD Live, as an element of their MACRA strategy. PharmD Live serves as a seamless extension of your practice, providing turnkey, pharmacist-led chronic care management services to boost quality metrics, increase revenue and streamline care. To learn more about PharmD Live’s pharmacist-led care, schedule a consultation.
This article is the first in a series dedicated to helping physicians and hospital clinics prepare for MIPS in 2019.