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Providers Sound-Off on Quality Payments Program Policies

August 14, 2018

CMS has proposed changes to Evaluation and Management payment codes, including streamlined documentation for office visits, less unnecessary supervision of radiology assistants by physicians, and major changes to Medicare physician payments and the Quality Payment Program. The agency said it would save doctors 51 hours per year if 40 percent of patients are enrolled in the Medicare program.

Meanwhile, representatives from the healthcare industry recently participated in Congressional House Subcommittee hearings regarding the Quality Payment Program. Many offered compelling suggestions for practical ways to improve MACRA and MIPS for the ultimate benefit of patients.

Relieve Administrative Burdens

The consensus expressed was that despite efforts by CMS to consolidate and simplify it, the Quality Payment Program still places unnecessary administrative burdens on the healthcare industry. More than 80 percent of MGMA survey responders lodged that complaint.

Others noted that nine Advanced APMs is insufficient to facilitate a transition of physician practices from the legacy fee-for-service payment model into more efficient alternative payment models (APM). One suggestion was to offer more Advanced APMs specifically tailored to healthcare specialists.

Modify MIPS

MIPS was cited as a culprit when it comes to administrative burdens, particularly in the category of Promoting Interoperability performance. Industry experts suggested reducing how many MIPS Quality performance measures a physician must report; allowing providers to report for a minimum of 90 days in all MIPS performance categories; and including providers in all types of settings in the “facility-based” definition.

The Promoting Interoperability (PI) category was critiqued for limiting its focus on certified electronic health records, instead of leveraging technology to build more comprehensive patient records. Technology could also make them more widely available to appropriate healthcare providers at the point of care. That should be feasible, considering that there are, for example, already flexible and compliant technological solutions to safeguard patient data securely and confidentially.

MIPS Should Be More Inclusive

Currently, more than 55 percent of healthcare providers are excluded for 2019, according to recent proposals regarding the MACRA rule and Quality Payment Program. Experts complained that is not nearly enough. They also told the subcommittee that they want to see providers get reimbursed more for their investments in providing top-quality, high-value care. It was suggested that small providers in rural areas be offered inclusion in MIPS, too, via less burdensome evaluations more tailored to their availability of resources.

Prioritize Patients Over Paperwork

A primary area of concern voiced by participants was the clinical relevance of MIPS and its metrics of quality. One example used to illustrate this issue was the fact that surgeons are often evaluated based on their patients’ immunization records. It was suggested that CMS reporting should focus on reduced administrative burden and an increased focus on patient care. As CMS Administrator Seema Verma put it, “put patients over paperwork, by enabling doctors to spend more time with their patients.”

Even when faced with current CMS compliance challenges, there are certainly customizable reporting solutions that can help reduce administrative burden and free-up more time to spend with patients. Systems can help shrink the number of rejected claims and overdue payments, while cutting administrative time, labor and overhead. There is even user-friendly software that lets patients create their own payment plans, within a provider’s policy guidelines.