As an experienced practice manager, you’re likely familiar with the intricacies of MIPS (Merit-based Incentive Payment System) and its impact on your practice – particularly if you’re in musculoskeletal specialties like orthopedics, podiatry, or physiatry, where Medicare covers a substantial portion of the patients.
The aging population, who are often grappling with orthopedic and mobility issues, relies heavily on Medicare for comprehensive healthcare coverage which adds to complexities in MIPS scoring. While you have a basic workflow in place, it is often labor-intensive, draining your team and distracting from patient care. Staying on the cutting edge is essential to keep all systems running smoothly and in place while avoiding MIPS penalties.
So if you’re looking for some innovative, less-known strategies to enhance your MIPS quality and improvement scores, this post is for you! Here’s a breakdown of the significance of MIPS scoring, its financial implications, and how you can leverage a good EMR to help streamline the process and determine financial outcomes.
The Role of MIPS Scoring in Practice Management
You already know that understanding the financial penalties and incentives associated with MIPS is key to scoring high each year. MIPS scores directly impact reimbursement, making it imperative for practices to optimize their performance.
The specific MIPS score needed to avoid penalties can vary yearly, as the Centers for Medicare & Medicaid Services (CMS) adjusts performance thresholds. If a provider’s MIPS score falls below this threshold, they may be subject to negative payment adjustments. Here are the penalties and incentives based on MIPS scores.
- Negative Payment Adjustment: No participation or failure to meet requirements leads to a negative adjustment on Medicare Part B payments.
- Non-Reporting Penalty: No MIPS data submission results in a penalty, leading to a negative adjustment in Medicare payments.
- Positive Payment Adjustment: Achieve or exceed MIPS requirements for a positive adjustment to Medicare Part B payments.
- Exceptional Performance Bonus: Demonstrate exceptional performance for bonus payments, recognizing and rewarding excellence.
- Exceptional Performance Adjustment: Additional adjustment by CMS for consistent high performance, reinforcing the value of quality care.
- Small Practice Bonus: Additional support for small practices, offering bonus points to contribute to a more favorable MIPS score.
- Complex Patient Bonus: Bonus for providers managing complex cases, earning additional points for a more positive MIPS outcome.
Picking the Right Measures for Scoring
Tips for Choosing Measures:
- Choose measures that reflect areas where your practice already excels. For instance, in podiatry, documenting patient-reported outcome measures for heel pain, hammer toe pain, etc. will be much easier than measures for blood pressure regulation, bone density, etc.
- Analyze your patient demographics and select measures aligning with their common conditions.
- Focus on measures that yield the highest MIPS scores with the least effort.
Some choices may not significantly contribute to your overall MIPS score. However, through careful analysis, you can identify and prioritize measures that genuinely enhance performance, ensuring an easier path to success. Sometimes you may unknowingly focus on measures that are no longer active, like measures for flu shots, fall screening, etc. Staying up-to-date helps to confidently invest your efforts in measures that truly matter, avoiding pitfalls associated with outdated criteria.
A good EMR can make data collection much simpler. Most EMRs can automate the data collection and submission process, reducing the administrative burden on practitioners. This efficiency translates into improved MIPS scores and financial outcomes.
While it can sometimes get hard to follow all the conditions to get MIPS points, periodically checking your progress and filling up gaps can significantly help improve your overall score.
Mastering MIPS measures requires a strategic approach and the right tools. Leveraging EMRs like Populate and existing systems to navigate these measures optimizes scoring, ultimately ensuring financial success.
Strategies to Guarantee High MIPS Scores
- Integrating MIPS into Everyday Practice: Let’s say your practice prioritizes BMI calculation as a key MIPS measure. Instead of scheduling separate times for this, smoothly incorporate it into your daily flow. Make it a standard procedure to capture patients’ height and weight during intake—EMRs will seamlessly calculate BMI. This not only guarantees consistent BMI data collection but also sidesteps the need for a time-consuming, separate workflow. Incorporating MIPS-related tasks into daily routines like this minimizes extra steps, making the process more efficient.
- Consider Group Reporting: If there is more than one provider in the practice, consider group reporting. When reporting as a group, practices can leverage their collective strengths. If one provider struggles in a specific performance category, others’ strong performance can balance it out, potentially qualifying the entire group for bonus points.
- Pin Relevant MIPS Codes: Quick access to MIPS measures is crucial. Pinning relevant codes ensures quick and easy retrieval when needed.
- Utilize Templates for Efficient Planning: Save time by using templates within your EMR. Efficiently draw up plans required for scoring without spending too much time typing them out every time.
- Encourage Online Patient Intake: Optimize data collection by encouraging patients to complete online intake before encounters. It ensures all valuable information is collected beforehand and providers can identify any necessary steps required to meet specific measures early on.
- Regularly Check Progress Reports: Periodically checking progress reports helps identify and fill gaps to enhance scores. This helps tasks from piling up at the end of the year when providers don’t have enough time to fill up all the gaps, in turn helping them avoid penalties. These strategies form a robust framework for MIPS success when integrated seamlessly throughout your workflow. From collaborative group reporting to efficient code access and patient engagement, these ground plans are designed to make your MIPS journey easy, helping your practice achieve and maintain high scores.