To excel in an ever-changing value-based healthcare market, providers across the spectrum will need to develop an advanced analytics strategy. In particular, Medicare Part B providers need to be prepared for Medicare’s Merit-Based Incentive Payment System (MIPS), as their payments will be tied to performance measures.
The implementation of the MIPS — part of the Medicare Access and CHIP Reauthorization Act (MACRA) that was signed into law on April 16, 2015 — repealed the Medicare Part B Sustainable Growth Rate (SGR) and replaced it with a consolidation of three existing programs: Meaningful Use (MU), the Physician Quality Reporting System (PQRS), and the Value-Based Payment Modifier (VBM). This will magnify incentives and penalties for providers based on the performance measures of the three programs.
Medicare Part B providers are given scores in four performance categories that are used to determine their Medicare reimbursement. These scores are publicly available on the Physician Compare website, giving high visibility into how providers compare against their peers on a national level.
Although MACRA was signed into law in the recent years, healthcare providers remain unprepared for this drastic change in reimbursement. “This is a fundamental payment overhaul,” says Leslie Kriegstein, Vice President of Congressional Affairs at the College of Healthcare Information Management Executives (CHIME). Industry experts, including the National Quality Forum, believe that MIPS will continue to reveal gaps in reporting for patient-centered measures, including “patient-reported outcome measures, functional status measures, care coordination measures, and measures that incorporate patient values and preferences.
With Medicare and private payers tying reimbursements to value-based care in the very near future, health systems are in urgent need of advanced analytics. Enterprise data systems can take years to assemble and implement. But an agile, laboratory-based analytics platform can be up and running much more quickly. Learn more in our white paper, Agile Analytics: The Key to Surviving and Thriving After the Medicare Tipping Point.