How practices should evolve their value-based care strategy

I often say navigating the Merit-based Incentive Payment System (MIPS) is like training for a sprint and a marathon at the same time; you have to ensure your performance measures are on track for the current year while looking ahead to identify improvements that can be made in the future. While the race that is MIPS is already a lot to keep track of, an element introduced in 2019 means participants now have spectators.

MIPS performance data is becoming increasingly visible as it’s published to the CMS Physician Compare website. Physician Compare serves the dual purpose of helping patients make informed decisions about the physicians they choose while incentivizing clinicians to maximize their performance. Yet as patients gain access to a practice’s performance measures, so do their competitors and payers.

Here’s a look at how practices can navigate new challenges and opportunities as their performance data is made public to patients, payers, referring physicians and competitors.

Report the Measures That (Really) Matter                                       

Naturally, practices report the measures where they scored the highest, so those will be reflected on Physician Compare. But as insurance companies and referring physicians dig more deeply into this data, it’s crucial that measures reported relate to each practice’s specialty. Oncologists, for example, will be better off reporting data for advance care planning and hospice – measures that can improve a patient’s quality of life and reduce the cost of care – rather than data related to controlling high blood pressure, which is largely managed by their primary care physician.

Commercial insurers with whom a practice contracts will be able to log in to Physician Compare and see this information for themselves, so this new chapter of publicly available performance data means all payers can make decisions about the adoption of value-based care and reimbursement. A practice with a proven record of performing well, or at least focusing on measures specific to their patient population, could end up having a stronger voice at the contract negotiation table.

Another consideration is the visibility of a practice's data to their referring physicians. Reporting measures that matter –  in other words, those that improve outcomes and reduce costs for patients – demonstrates a commitment to the "triple aim" of better care, smarter spending and healthier people. When these goals align with those of a referring physician, a practice could see an influx of new patients. This is why practices should be continuously looking to improve their programs in a purposeful way.

Make Meaningful Changes

So, which measures are going to make the most significant difference for patients? These will vary from practice to practice. They could include initiatives related to depression screening, pain or advance care planning, as long as the practice can score well while improving patient outcomes. These are most important, even if it takes time for them to become top-performing measures.

Moving forward, practices will want to continue monitoring their “back pocket” measures, or processes in place where they score well, but are at risk for becoming topped out or removed from the program. They should begin with a strategic discussion about how to improve the care of their patient population and then select measures to help meet those goals.

Plan for Pitfalls

One challenge practices currently face is the two-year delay from when they submit data to when it becomes available on Physician Compare. Planning for this is a matter of paying attention to which measure they’re submitting – knowing that information about the practice is going to be shared and taken from their payment system for CMS.

Because cost measures are adjusted by risk and specialty, it’s essential to confirm that all information is listed accurately. Including all appropriate ICD-10 codes on claims and verifying that clinicians are listed by the correct specialty will ensure they are scored fairly on cost measures. If a provider is listed incorrectly, it may be because they haven’t updated their Medicare provider enrollment, chain and ownership system (PECOS). And since all information on Physician Compare comes from PECOS, if a practice is doing business under a different name, users won’t be able to find them on the site unless they search by clinician.

Planning ahead is key to making these updates in a timely manner. At the end of the year, each practice has a 30-day period to log in and preview the information that will be on Physician Compare before it’s published and can request a correction if something appears to be incorrect. Practices should also review their MIPS results annually, stay current, and request a targeted review to address any inaccuracies before they’re reported on Physician Compare.

Go Above and Beyond, or Risk Falling Behind

As transparency increases, it’s no longer enough to simply avoid a negative payment adjustment. While payment adjustments are low right now, there’s admittedly not a lot of incentive for practices to score high. In the long run, it’s better for practices to fully participate in the program and implement MIPS performance measures in ways that will make a difference for their patient population. Practices should work on continuous quality improvement with a focus on measures that will improve outcomes that are  meaningful to their specialty. It will be easier to get their clinicians and care teams on board with these measures, too.

Practices don’t have to go it alone. There are solutions available to guide the transition to value-based care, including advisors to support a practice’s MIPS performance through on-site assessment, workflow optimization, tactical planning and other recommendations. Look for a CMS-approved Qualified Clinical Data Registry (QCDR) that can customize your practice’s QCDR measures, like McKesson’s industry-leading electronic health record (EHR) iKnowMed^SM.

We’re still in the early stages with Physician Compare, so it’s difficult for practices to know how beneficial this program will be in the coming years. But as more patients, providers and payers use it – and more information is shared – it’s a risk not to take it seriously now while planning for the future.

Toni Gress is manager of value-based Care education for McKesson.