Managing MIPS

Create a system of checks and balances to ensure success.

Review reports with each of your providers to ensure overall goals are being met.

Many ophthalmic professionals think beginning the journey toward Merit-based Incentive Payment System (MIPS) reporting is the most difficult process; however, maintaining and managing MIPS performance can be just as daunting. Among the challenges: Keeping up with the myriad of changes CMS makes each performance year and executing those changes.

While MIPS is complicated, there are ways you can successfully manage this program. Here are a few such steps:

Manage processes

One thing we have learned in our practice: Make it as simple as possible for staff and doctors. The simpler and easier it is to locate the data, the more apt they will be to fill in the necessary information. That said, we have found the best way to do this was to modify the EMR templates.

For instance, to fulfill the “Primary Open Angle Glaucoma (POAG): Optic Nerve Eval” quality measure, we changed the font to make these fields appear bold. We also shared the fields onto the “Plan” template, so the provider would have one additional place to look to see that the information was complete. It was something the providers were doing — but often forgetting to document. This simple change increased our quality score from 65% to 88%.

We also created a template that had specific fields for technicians to fill in during the workup. This template included all the measures for which technicians are responsible. They found it easier to remember to record all the information required when it was all in one place. Our scores dramatically increased after this implementation.

Try to incorporate as many workflow changes as possible to improve ease of use. Don’t be afraid to observe work flow and discuss with the staff or doctors what is making it difficult to document necessary elements. You may be surprised at their concerns and suggestions. If you are unfamiliar with template editing, it may be worthwhile to invest a small amount in having that service done for you. (Reach out to your EHR vendor for this service or network with others who may have a referral for you.)

In our practice, we use the IRIS (Intelligent Research in Sight) Registry, a national EHR record-based eye disease and condition registry from the AAO. For participation to be fruitful, it’s essential to understand what fields IRIS is mapping for each measure. To obtain the highest performance score, be certain you are either recording information in the fields IRIS is considering or schedule a call with IRIS and show them how you are gathering that information. In some instances, we were able to have IRIS map a different way to match our workflow, and, in other cases, we had to change where we were documenting in order to capture the required information. This step is time consuming, but essential in order to successfully manage MIPS.

Communicate with providers

Another important step in managing MIPS is to provide feedback to your providers. One way is to develop a report card. Each provider should receive a monthly report on the quality measures the practice is reporting on and her individual score. Even if the practice reports as a group, it’s important for each individual to see how her performance impacts the entire group.

In my experience, you will get better performance on the quality measures if you discuss individual results with those responsible for documenting them. Keep the lines of communication open with your providers so they can ask questions and understand why you are asking them to record certain information.

Monitor progress

Monitoring your progress on a monthly or, if possible, weekly basis is also important to ensure the group or an individual provider is not missing key information. If you wait for six months to look at your results, you will have much less time to effect change — and your scores will likely suffer. Additionally, monitoring results frequently will prevent surprises when you think your providers understand what you are asking them to do but really don’t. Staff can also have a big impact on your numbers, especially scribes. In training, items can be missed; if you are tracking your numbers frequently, you can catch these before it creates a financial impact on your practice.

Tracking performance from year-to-year is also an important part of managing MIPS. If you aren’t sure what your scores were the year before, you will unable to do a comparison. In our practice, we keep a physical binder of all of our quality scores, attestation information, screen shots, in the event we are audited, and conversations and mapping we have done with our registry. This makes it easy to look back at past performance and identify areas to improve.

We also look at the registry average performance in IRIS to compare ourselves to our peers. This is especially helpful when we are discussing performance scores with our providers. Reports can be pulled from both your EMR system and IRIS for these purposes.

Remember the payment year

One other thing to keep in mind is that performance year and payment year are two years apart. That can be difficult to keep straight, as you are looking at the financial impact on your practice. We keep a spreadsheet documenting our scores for each year, along with the impact on revenue. For instance, in 2017, we achieved a score of 100 points. We will be expecting that increase to be added to our reimbursements for 2019. Once it’s verified that we are receiving the increase, we will mark it as verified. It’s easy to overlook a proposed increase, especially if it’s not communicated to the billing department.

Final tip

Get started now! I have found that good planning at the beginning of the year is crucial to success. OP

For more information about MIPS, check the March 2017 issue for “Digesting MIPS,” also by Lisa Shaw, or visit .