Five ways to help support your practice’s performance

If you haven’t already, now is the time to focus on Merit-based Incentive Payment System (MIPS) performance in the practice. This program, which aims to reward clinicians for value over volume based on scored performance points, affects future Medicare Part B reimbursement. Each year the stakes rise as clinicians are scored against moving peer benchmarks.

This year, the traditional MIPS bar is higher than ever, making it the most challenging yet to avoid a penalty and reach bonus reimbursement thresholds. As such, the practice will benefit greatly from having a technician on the MIPS team to support clinical performance.

Here are five ways in which the clinical MIPS lead can help support practice performance.

1. Understand the MIPS program.

There are four required performance categories: quality, promoting interoperability (PI), improvement activities (IA), and cost. Most of these performance measures relate directly to clinical workflows.

The categories requiring the most clinical attention this year are quality and PI:

• The quality category must be reported for a full calendar year, so it should take priority each Jan. 1.
• PI performance can be any 90 days in the year.
• IA is more administrative and straightforward in most cases, also with a 90-day option.
• Cost is completely passive for the practice, as the Centers for Medicare & Medicaid Services (CMS) calculates this from claims data.

Practices can report as individual providers or choose a group option. Generally, group performance is advantageous, as most of the group can carry underperforming individual members.

2. Know the practice’s chosen MIPS measures.

Each performance measure has a CMS specification sheet, which shows you the performance requirements and the attributes that put patients in the numerator and denominator for scoring. It is important for clinical efficiency to choose quality measures that relate to the work you perform daily. It is also essential for the practice to choose high-scoring measures (10 points vs. a maximum of three points). Lastly, there is a requirement to report at least six quality measures, including one high-priority or outcome measure.

An example of an eye-care measure:

• Measure 19: Diabetic retinopathy, communication with the physician managing ongoing diabetes care; high priority measure; a near-perfect score is required to achieve all 10 points.
  • Numerator: Patients with documentation, at least once within 12 months, of the findings of the dilated macular or fundus exam via communication to the physician who manages the patient’s diabetic care.
  • Denominator: All patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed.

3. Evaluate MIPS practice workflows.

The practice should ensure its selected quality measures are performed according to CMS requirements, are as efficient as possible for the practice, and are recorded well.

Workflow design will depend partly on the tracking method. Practices can track their quality measures using AAO’s IRIS Registry, another vendor, and/or their EHR’s MIPS measure tracking system.

• The EHR option often requires complicated workflows built into the software that may not be efficient for practice operations.
• The IRIS Registry is integrated with the EHR, allowing for flexibility in pulling quality measure performance for compliant reporting.

The clinical MIPS lead will work with team members to design MIPS-compliant workflows, which requires balancing daily clinical needs with accomplishing successful measure performance. The best-case scenario is a workflow design that does not detract from patient care, incorporates work the practice is already doing, and adds few additional patient visit steps and keystrokes to the record.

4. Train on the MIPS practice workflows.

Once there is agreement on how quality measure workflows will be performed, providers and staff need to be trained on the workflows, the importance of compliance, and how to monitor performance levels. Training should include each measure’s non-negotiable documentation requirements. The clinical MIPS lead will head measure education and training, serve as a resource for questions, and watch for measure performance hiccups (or associated clinic flow bottlenecks) and spearhead any workflow adjustments.

5. Keep the team updated on performance.

The clinical MIPS lead should have access to and routinely follow the quality performance reports available in the IRIS Registry and/or EHR MIPS dashboards. These dashboards show how each provider is scoring, as well as the group overall. They also help identify missed opportunities in recorded measure performance for individual patient visits.

Weekly and/or monthly reporting of findings to the clinical team is a best practice to ensure continual focus and troubleshooting of any performance issues. Be sure to celebrate successes and support appropriate changes where needed.

Maximum performance

A technician serving as the clinical MIPS lead is invaluable to the practice’s team for maximum performance. Position your practice to perform MIPS measures well by assigning a technician as the clinical lead as soon as possible. OP