Are quality measures and regulatory programs a super highway to better clinical quality or simply a series of dead-ends and roadblocks? Many providers feel quality measures are preventing them from providing actual care for patients.
With a multitude of regulatory programs and contractual measures, providers have every right to give up on actively managing quality measures. With this in mind, the government has created programs that build focus for providers on a single program – The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Simply put, MACRA creates a new approach to payment for eligible Medicare providers or groups called the Quality Payment Program (QPP) which rewards the delivery of high-quality patient care. Still with a single quality program, will providers have incentive to participate and improve scores?
To get providers on board, the government is providing two types of incentives: financial and provider scores. With a long-term upside and downside of nine percent, providers will need to pay attention. In addition, MACRA is attempting to take advantage of providers' competitive nature through a single, clear provider score. Eventually the Combined Provider Score could be used for contracts, bonuses and potentially even patients to select high quality providers. It is critical for providers to create a strategy for not only implementing MACRA, but also enabling higher scores.
As MACRA rolls out, there is still a lot of confusion about the best road to success in 2017, but also beyond, in terms of how to successfully prepare for the future requirements. By streamlining and consolidating several programs, CMS has made it easier for all physicians to find a way to participate. Let's review the four clear road signs for physicians that encourage charting an intentional course in 2017 to come out ahead as the move to value-based care quickly shifts into high gear.
1. Flagger Ahead: Road Repairs Accelerate Quality Care Delivery
CMS delivered on its promise to simplify. It's clear that multiple programs had created confusion and lack of focus for submission and operational delivery. More importantly, multiple programs gave no feedback to the broader public about how well a provider was doing from a quality perspective. To address these shortcomings and accelerate physician participation, CMS consolidated multiple programs while creating new measures and ways for physicians to participate.
Keep in mind, the added flexibility in 2017 will pass quickly, so physicians should implement reporting and communication technology needed to take advantage of it right away. Although MACRA simplifies and consolidates several programs, it also offers many options for compliance. For instance, the reporting period was reduced from a one-year minimum to a 90-day minimum. The performance feedback was reduced from 40 episode-based measures to ten, and CMS adjusted the weightage for the performance categories. The performance threshold has been set to three points with one point for each performance category. Physicians may find it less daunting now to map out a plan to either move slowly in 2017, meet the minimum requirements to avoid negative payment adjustments, or push forward to submit a full-year of data and earn a moderate positive adjustment.
2. Roadside Attraction: A Single Provider Benchmark
What Value-Based Purchasing (VBP) is for hospitals, MIPS is for providers – a clear indication of where future CMS requirements will focus. The goal of MIPS is to give providers incentives for not just quality measures, but for cost savings as well. Ultimately, MIPS creates a score for providers where cost and quality measures converge in one number. The intent is to create transparency for patients using a single value benchmark to compare providers on the quality of the care they deliver.
To be successful, physicians should consider their overall process and workflow, select the measures that fit best in the short term along with technology tools to support them. Physicians will need to invest a little time to understand their options and the impact various measures selection will have on their scores and ongoing improvement.
3. Steep Grade: Ongoing Improvement Ahead
MACRA, like other quality improvement programs, follows a predictable pattern. First, there is a requirement to submit certain data in certain formats to receive payment. From there, the process folds in comparative payments and ultimately payments based on population management. As Deloitte described it in a recent report, Congress intended MACRA to be transformative, like a new highway that transports the healthcare system from its traditional fee-for-service payment model to new risk-bearing, coordinated care models. Hence, MACRA is the first step of many to come.
Soon, sophisticated care coordination integrated with supporting technology will be the norm to support innovative care processes. For example, when a patient leaves the hospital, coordination with a home care agency can be automated. A home care visit occurs immediately to assess fall risks, review medications and implement measures tailored to the patient to assure they take medications correctly. The patient may use a simple app to send vital signs or other information to their provider for monitoring. Because post-discharge falls and medication errors are leading causes for emergency department visits and readmissions, the impact on outcomes could be significant. And it paves the way for applying best practices to other processes to multiply improvements over time.
4. Merge: Provider-Payer Alignment
Looking ahead, government regulations will become bigger and broader, and the combination of technology and process will be a game changer for achieving better patient outcomes. In the current environment, both payers and providers attempt to operationalize proactive care management with questionable success. It's further complicated by regulations – MIPS and HEDIS – that have similar goals, but aren't well aligned.
For example, many payers today take the nurse care manager approach, which is costly and hindered by the lack of ongoing patient relationship. Primary care providers attempt to be proactive, but typically interact with patients in more emergent situations, plus lack the time and bandwidth to spend additional time with each patient. It's clear that incentives for payers and providers will become more aligned, clearing the way for combining IT resources.
Consider the impact on diabetes management. Payers and providers collaborating on a care management plan, coupled with automated technology, can prevent emergent conditions and improve outcomes. For instance, appointment scheduling for lab work and timed check-ups on vision and other key concerns can be automated. Using technology, the provider can reach out to the patient to schedule required visits that include all care management activities, so changes or concerns can be identified early, before the patient's condition escalates.
2017 is the Year to Act
The government shows a clear strategy for making 2017 a MACRA transition year for physicians. "A critical feature of the [MACRA] program will be implementing these changes at a pace and with options that clinicians choose," said Andy Slavitt, CMS Acting Administrator. However, the pace will accelerate quickly toward using value benchmarks to support ongoing improvement and further alignment.
Ultimately, the value-based care environment will employ technology, such as automated scheduling, alerts, notifications and easy-to-use apps to bring the goals of MACRA to life as patients stay healthier, quality indicators clearly reflect value, and margins are positive. Physicians should act now to put the right strategy and supporting technology in place to manage the calculations, communications and collaboration required, because all signs indicate the pace will only accelerate after 2017.
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