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Avoiding Financial Implications of Quality Payment Program

In order to avoid negative financial implications in the Quality Payment Program, healthcare professionals must utilize strong health IT and EHR use.

By Sara Heath

- In these early days of the first performance year for the Quality Payment Program, healthcare professionals will need to develop a plan that leverages strong health IT use and health information exchange in order to avoid negative payment adjustments.


In a recent op-ed, Jon Law, Executive Director of the Paso el Norte Health Information Exchange in Texas, explains how failing to utilize EHRs and other technologies can have negative financial ramifications for the El Paso area.

If Medicare physicians meet all quality measures included in the Merit-Based Incentive Payment System (MIPS) during this first performance period, those in the area could receive a total maximum payout of $19 million in 2019, Law wrote in the El Paso Times.

However, if they fail to perform well, physicians in the area could lose out on that $19 million. When all is said and done, the area could lose or gain $129 million over the course of four years.

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  • “We need a strategy to keep that $129 million in our region,” Law wrote. “Otherwise, we literally will be sending that money to other communities. MACRA is designed to be budget neutral, meaning that the punishment for one doctor is the incentive for another.”

    The timeline for those goals is already underway. On January 1, Medicare providers began collecting quality measure data for this first performance year. According to an infographic published in the American Journal of Managed Care, the data from this performance period will result in the payment adjustments in 2019.

    Providers will spend all of 2017 collecting performance data. In the interim, Medicare will provide feedback starting in 2018. By March 31 of that same year, eligible clinicians will be expected to submit performance data to receive a positive payment adjustment.

    According to AJMC, eligible clinicians can avoid negative payment adjustments for the first performance year by submitting any form of quality measurement data to CMS. While clinicians may not see a positive payment adjustment for selecting this path, they will not receive a negative adjustment either.

    Clinicians can also submit a partial year of reporting data or a full year of data. These may result in some sort of positive payment adjustment, the size of which will depend upon the clinician’s performance.

    In the El Paso area, the name of the game is getting as much of a positive payment adjustment as possible, Law wrote. Positive or negative payment adjustments have the power to seriously affect how providers in the area can continue to practice medicine. Provided more funding via Medicare part B, eligible clinicians can improve patient care and deliver stronger, more innovative treatments.

    In order to achieve that goal, healthcare professionals will need to leverage EHRs and other health IT.

    “To succeed, doctors in our region need the right health information technology and the right expertise,” Law said.

    “Doctors will need to track and report specific quality measures for MACRA, which is not straightforward. They will also have to make complex choices to ensure that they are on track to succeed. There are strategies that can help doctors automate their systems, prompt them to conduct screenings, and to aggregate data for reporting.”

    To serve the El Paso area, Law says the Borderplex Alliance, a non-profit offering consulting on economic growth, has established its Life Sciences Committee. With Law also serving as a chair of the committee, it aims to determine the financial impacts of MACRA and develop a detailed plan of how health IT can lead to positive payment adjustments.

    Leveraging strong health IT and EHR use will be imperative for all eligible clinicians nationwide. In an address following the Quality Payment Program’s final rule publication, ONC leader Vindell Washington, MD, MHCM, said that all eligible clinicians will depend on strong health IT and health information exchange to successfully report to the program.

    “We make clear that succeeding in Alternative Payment Models requires the effective use of technology,” Washington said. “In short, the Quality Payment Program recognizes and rewards the fact that health IT is foundational to providing quality care.”

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