BMN Blog

MAY 17
The Merit Based Incentive Program- Small Practices-Big Decisions

As we approach the beginning of summer, our minds are likely not on summer vacation. The process of assessing our electronic medical record vendor, absorbing the details of MIPS, and making the decisions on how to prepare, is overwhelming for small practices.  The transition to value based medicine has been evolving over the last 10 years in stages; adopting electronic health record, Quality Reporting, and Meaningful Use.  Many administrators and physicians did not realize the importance of each project; from choosing the right EMR, to implementing it properly, therefore achieving best practice workflows.


Over the last few years, we have experienced some small practices fail in quality due to the reliance on claims based reporting. The billers were burdened with maintaining revenue and trying to add quality measures to claims to satisfy PQRS.  The Meaningful Use project was generally assigned to a designated clinical person who had no authority to hold physicians and other clinicians accountable.  Those who attested for Meaningful Use collected millions of dollars through incentive payments, but after Meaningful Use audits revealed a 22% fail rate among eligible providers, many stopped attesting.


Our healthcare team has traveled throughout the south since January speaking to physicians and managers on the details of MIPS. Managers have realized they have a poor electronic medical record; and some EMR vendors have reached a roadblock in development.  I received a call from one manager stating her vendor had left the market.  I am working with one group who essentially has to re-launch their EMR due to poor workflows, which inhibited their ability to collect quality metrics and other data. 


Physicians, in many cases, have pushed these projects to someone else and focused on the volume of patients needed to secure a certain level of revenue. We are currently in a fee for service environment and reimbursement is unstable due to decreased payments from insurance carriers through high deductible plans.  This year we begin the transition to value; by 2019, our claims will be assessed for cost efficiency putting 30% of reimbursement at risk. Small practices should seek education; managers should attend MGMA meetings, roundtables and view webinars to stay abreast of timelines.  There are resources specifically for small practices through the Centers for Medicare and Medicaid Services (CMS).  Your local medical society can also direct you to resources in your area. Review your Quality and Resource Use Report from CMS to gain knowledge of your past performance in cost and quality. Another good resource is your specialty’s academy, most have a quality program or qualified clinical data registry you can explore.


Physicians must be a part of the team to ponder these decisions and hold the administrator accountable for a successful project. The physician must be willing to make changes and support training efforts.  MACRA is game of winners and losers, it is projected the losers will come from practices with less than 20 providers because these practices lack infrastructure to yield a high success rate.  We are challenging physicians and managers to work together and lead your team to success.

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