Why MIPS Matters: MIPS Insights for Practice Managers

In 2018, I transitioned from managing multiple office locations for a large hospital network to a healthcare consulting role at Medical Advantage. Now I spend my days working with small, independent primary care and specialist offices. Although I knew of MACRA and MIPS before I started consulting, I had no idea how much it affected my day to day role in the practice. In my position as a practice manager, I was constantly being asked to educate staff and providers on new boxes to “click” in our EHR system, but I didn’t always have a strong grasp on why we were making all of those changes. Or exactly what our practices needed to do in order to succeed.

Here are few insights about MIPS and some practical advice that I would have found helpful when I was working in the practice setting – things I share with our MACRA Clients.

1. Understanding the Progressive Financial Impact of MIPS

One of the challenges with MIPS is that it is a complicated program. It might feel like you need a degree in accounting or statistics to understand what is going on. Many providers were frustrated by the lower than expected payment increase, which was projected to be 4 percent, but was decreased to 1.88 percent in order to maintain budget neutrality for the program. This discouraged many practices who felt the incentive was not enough motivation to participate.

Another complicating factor is the MIPS points system. In order to avoid a penalty for 2018 MIPS, practices only needed to score 15 points to break even by meeting the neutrality threshold. The neutrality threshold has doubled for 2019 and is projected to increase by 15 points each year going forward. In addition, it is getting increasingly hard to score 100 points due to many factors, such as:

• Many quality measures that are becoming topped out and deleted.
• The implementation of the new promoting interoperability measures.
• The increasing emphasis on the cost category.
• The diminishing amount of bonus points available.

Although the 1.88 percent incentive may not seem like it was worth all of the effort, practices need to keep working at MIPS to protect their financial future. As the incentive increases, the practice’s ability to meet the neutrality threshold to avoid a penalty will decrease. Therefore, you may want to change your perspective from focusing on the minimal monetary amount you will receive for performing well to the negative financial impact on your practice if you don’t stay ahead of the game.

Advice From A MIPS Expert:

Reach out to your private insurance payers and ask if they have a quality-based reimbursement program or get up to speed on their existing program if you already participate. Many times, their quality metrics will align with your MIPS measures, giving your practice a larger monetary incentive to provide exceptional care to your patients. Be sure to register for the CMS Quality Payment Program newsletter to receive all of the most important updates.

2. Gaining Staff Buy-In

Even with the best laid plans, your practice cannot achieve a desired goal without buy-in from your staff. Just like CMS provides incentives to practices, you must provide incentives to your staff. I am not necessarily talking about financial incentives, although that is certainly a possibility. The key is to find out what motivates your providers and office staff. Individuals are motivated by many different factors, including passion for their work, monetary rewards, making a difference for patients, forming relationships, receiving personal recognition, and so on.

Aligning and connecting your MIPS goals to what motivates your staff is the first step toward achieving those goals. You can try different buy-in approaches such as competitions, monetary incentives, awards, celebration lunches, or educating staff about the impact of value-based care on your patients. If you can figure out how to engage and motivate your team, you can leverage their strengths to achieve your MIPS goals.

Advice From A MIPS Expert:

Choose a quality measure to improve upon and use talking points that will appeal to multiple motivating factors. Educate the staff about why that quality measure is important and how it will positively affect the health outcomes of your patients. Explain what the workflow should be and ask staff for honest feedback. This step is crucial since they are the ones doing the day to day work. Lastly, set a realistic achievable goal and tie it to a fun incentive.

3. Optimizing Your EHR System

One way to reach your MIPS goals is to optimize your EHR system. Optimization identifies the points of contention that your staff has with your EHR system and attempts to resolve as many of those issues as possible. Your EHR should be a streamlined tool that makes it easier for your staff, not harder. Implementing an EHR system is overwhelming to begin with. Once it is over, it is tempting to just sit back and take a few breaths. But that is where the real work begins. Do you ever overhear your staff making the following comments?

• “This process would be more efficient if we could do this…”
• “Why do I have to click this box?”
• “It would be so much easier if we could ___.”

Attempting to learn the ins and outs of an EHR can be very time consuming. That’s where EHR optimization teams come in to play. These teams are designed to assess your workflows and educate your staff on how to use your EHR in the most efficient and effective way. Linking tasks in your EHR system with items that are needed for MIPS performance will ensure that your staff are equipped with the tools they need to make your practice succeed.

Advice From A MIPS Expert:

Start by assessing where you are at with your EHR system. Even a simple survey of your staff can give you a good picture of what areas you want to focus on. Then, hire the experts. Bringing in EHR optimization consultants can help you move through the process more quickly and ensure you get the results you are looking for.

4. Empowering a Quality Champion

As a practice manager, you may feel like you need to be an expert in all areas of the operation. But that is just not realistic. While it is important to have a high-level understanding of how the practice operates, you can make much more progress on long-term initiatives, such as MIPS, if you delegate some of the tasks to another person. Designating one of your staff to serve as the “quality champion” is a great way to gain buy-in and ensure you remain up to date on the latest MIPS requirements.

If you empower your staff to take the reins on achieving your MIPS goals, you may be surprised by the amount of insight your quality champion will provide. Your staff are the ones who are “clicking the boxes” to help achieve your quality goals in the office, which may give them a different perspective from a workflow standpoint. This will help free up your time to focus on monitoring your MIPS dashboards and identifying areas for improvement from a higher level.

Advice From A MIPS Expert:

Choose a staff member who is invested in the health outcomes of your patients and ask if he or she is interested in this opportunity. Set realistic time aside for this individual to learn about MIPS, make changes, and monitor progress. Having a quality champion who is involved in the day to day functioning of the office may help with staff buy-in. Your staff may be more receptive to sharing ideas and receiving feedback from one of their peers who understands their workload.

5. Locating MIPS Resources

Whether you designate a quality champion or decide to do it yourself, keeping up with all of the MIPS requirements and changes can be a challenge. There are many resources available, but some of the best resources come directly from the CMS Quality Payment Program website. Their site includes a MIPS section where you can find high-level information, basic fact sheets, detailed measure specification sheets, and benchmark data for each measure. Their information comes in many different forms such as presentations, webinars, fact sheets, spreadsheets, and newsletters that can be filtered by MIPS category, year, and type of resource. This information comes directly from CMS and is formatted in a way that is easy to understand.

Advice From A MIPS Expert:

Another option if you need help in understanding MIPS is to bring in a consultant for a short-term engagement. Medical Advantage offers pay-as-you-go services where you can purchase consulting resources for a specific topic. This can be a great way to get help with MIPS if you run into areas that you don’t understand.

Here are my top three MIPS-related resources:

• QPP Measure Tool: This tool is organized by reporting year and by MIPS category with a convenient search function. You can look up measure descriptions, benchmarks, and detailed specifications for numerators and denominators.
• QPP Webinar Library: This resource is a vast collection of MIPS webinars on a variety of topics. You can register to watch them live or watch after the fact. They are very user-friendly, and the presenters make the overwhelming topics easier to understand.
• QPP Resource Library: This tool allows you to look-up “fact sheets” for many MIPS topics. They are broken down with wonderful graphics and everyday language that can simplify many of the complicated topics.

I hope you found some practical advice for incorporating MIPS into your daily office operations. As a consultant at Medical Advantage, I see too many practices that are struggling with MIPS or waited too long to get started. Remember, you don’t have to go it alone. Medical Advantage has the resources, tools, and expertise to help you meet your MIPS goals.