MIPS Strategic Recommendation #1: Pursue a Reimbursement

Posted by Blake McWilliams on 2018-03-19

Last month, we discussed the challenge of achieving a positive MIPS reimbursement adjustment. This week and next, we’ll discuss two fundamentally different approaches to defining success under MIPS (and to achieving that success).

The first approach focuses on achieving a reimbursement under MIPS. The second will cover strategies to avoid a negative adjustment, collect relevant quality data for orthopaedics, and incur minimal workflow disruption.

For the purposes of this two-part series, we will focus on MIPS Quality and CPIA. Recall, for performance year 2018, quality makes up 50% of the composite performance score (CPS) and CPIA constitutes 15%.

First, the good news: OBERD is a CMS-certified QCDR whose primary function is collecting patient-reported outcomes (PROs) data for orthopaedics. Collecting MIPS quality data is an ancillary function of the platform. However, because our clients collect PROs using OBERD and because OBERD is a QCDR, we can satisfy the entirety of the CPIA component, **guaranteeing clients will avoid a negative MIPS adjustment. **

**Strategic Recommendation: Achieving Reimbursement: ** Pursue high a performance rate in cross-cutting quality measures.

Measures such as influenza, tobacco use and alcohol use may or may not impact orthopaedic care but they carry high deciles. High compliance collecting these measures is a valid path towards reimbursement.

**How OBERD Clients Utilize This Strategy: ** By using OBERD’s proprietary, short electronic quality form. It is a single electronic form that clients deploy to all patients to collect 9 cross-cutting quality measures. It is dynamic, serving patient education for tobacco use, for example, when a patient identifies as a tobacco user.

Measures included:

  • 155 - Falls: Plan of Care
  • 318 - Falls: Screening for Future Fall Risk
  • 111 - Pneumococcal Vaccination Status for Older Adults
  • 128 - Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
  • 110 - Preventive Care and Screening: Influenza Immunization
  • 226 - Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
  • 431 - Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling
  • 402 - Tobacco Use and Help with Quitting Among Adolescents

To be eligible for reimbursement, a provider or institution must achieve a high rate of compliance. For some measures with high deciles a > 99% performance rate is necessary.

**Reimbursement Strategy Under OBERD: **

Pros:

  • Contention for achieving high compliance
  • Automated deployment of a single, short quality measure form
  • Educational requirement satisfied with dynamic education content served to patient from within the form
  • Establish benchmarking data
  • Submit to CMS using a QCDR

Cons:

  • Extremely high compliance required
  • Data collected may be less relevant to orthopaedic providers and practices
  • Workflow disruption: clients must devote staff time to achieving high compliance

If  you and your orthopaedic practice or institution want to pursue a reimbursement under MIPS, take measures to maximize compliance while collecting cross-cutting quality measures via electronic, patient-reported modes.

Follow-up with us in a week for our next post: strategies to avoid a negative adjustment, collect relevant quality data for orthopaedics, and incur minimal workflow disruption.

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