BEST PRACTICES

Reporting compliance success in an age of challenges

This Pa. practice explains how it’s done.

By Elizabeth Holloway

In an era of continuous regulatory and compliance mandates, many practices are overwhelmed at the changes in quality reporting programs. For those that haven’t opted out of Medicare all together, they now must learn a new value-based reporting system under which they will be reimbursed for their medical services. For the 2017 reporting year, practices that accept Medicare are tasked to learn either the Merit-Based Incentive Payment System (MIPS) or the Alternative Payment Models (APMs), which will affect reimbursements in 2019.

Though the task of keeping up to date with the increasing complexity and changes in quality reporting is daunting, many practices are successful. One practice that is having compliance success in the quality reporting arena is Laurel Eye Clinic, which has 10 locations throughout rural Pennsylvania. In 2014, Laurel Eye participated in the second year of the value-based payment modifier (part of the Affordable Care Act), which is geared toward groups with 10 or more eligible providers. Based on their 2014 performance, groups expect to receive an upward, neutral or downward adjustment to their Medicare payments in 2016.

Chart from CMS website: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs.html

Adjustments are based on the group’s performance on quality and cost efficiency measures. The upward adjustment factor in 2016 is +15.92%.¹ Laurel Eye was one of just 128 groups nationwide that exceeded the program’s benchmarks and received a tier one positive adjustment of +15.92%.

SUCCESS PEARLS

As further details unfold for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), practices need to understand how to master the program. To learn some of Laurel Eye Clinic’s strategies for reporting compliance, I interviewed IT manager Lisa Shaw, COE, NCP, EPM/EHR. A 15-year veteran of Laurel Eye, Ms. Shaw is a super-user of its EHR software and has become a champion of quality reporting. Below, she shares some tips that have made Laurel Eye Clinic’s positive Medicare reporting performance a reality.

• Keep your eye on MIPS. CMS is expected to finalize this rule’s reporting measures in fall 2016, and these measures will affect all eligible professionals. Physicians and administrative staff will need to stay connected with information about MACRA Quality Payment Programs. Ophthalmology trade associations such as AAO and ASCRS diligently help ophthalmologists understand how these measures impact their medical specialties. CMS also provides webinars, videos, staff training slide decks and a quality payment program Listserv.

• Understand the correlation between reporting year and payment year. Providers need to understand the quality reporting program in which they are currently participating (i.e., understand what the impact on their reimbursements will be several years down the road). Using Laurel Eye as an example, its positive 2016 adjustment resulted from work completed in 2014. Practices that are now focused on MIPS or APMs will start their reporting for these programs on Jan. 1, 2017. They will receive positive, negative or neutral adjustments to their Medicare payments in 2019.

• Review practice performance throughout the year. The Laurel Eye team members do not leave compliance to chance. They are vigilant in looking at their reporting measures and making sure their providers are meeting the compliance requirements. If the practice is not meeting a specific measure, staff examines the issue and determines why. By being proactive, Laurel Eye can resolve reporting issues in its electronic health records or provide additional training to providers and staff.

• Supply updates to providers. Laurel Eye holds quarterly provider meetings. At each one, Ms. Shaw gives EHR and compliance updates. She creates a progress bar to visually demonstrate how the practice and individual providers are completing their measures. Having timely performance updates allows the providers to have healthy competition in their compliance reporting. At the quarterly meeting, Ms. Shaw also provides a regulatory update so providers are aware of upcoming changes in legislation and how they will impact practice operations.

• Communicate “the why” to staff. While many staff members have become more tolerant to continuous changes in quality reporting, it is not an easy task to remember all these details while still providing a patient-focused eye exam. Ms. Shaw recommends focusing on explaining “the why” behind each measure to help staff understand the importance of each issue. For example, tobacco cessation was a key measure that technicians needed to report, and knowing a patient’s smoking history can impact patient care. Ms. Shaw made sure that she understood how the reporting of this measure would affect the technicians in the lanes and then developed a strategy to help them be successful.

• Attend seminars. To stay current, Ms. Shaw attends conferences such as the annual meetings for AAO, ASCRS or local medical association groups. She finds it imperative to stay connected to other medical professionals and key instructors who review new compliance measures and implementation. Practices should also take advantage of Medicare’s Learning Network (MLN) that frequently posts informative videos on YouTube. (Link to CMS’ MACRA video: https://www.youtube.com/watch?v=n9zAn0jZEVc)

• Work with your EHR vendor. Vendors can be a valuable resource in understanding the required reporting measures and how your system is capturing that information. Practices should consider having a team member trained as a super-user of the system. Ms. Shaw notes that it is important to run reports from your EHR system to ensure that you are capturing data accurately. Your EHR vendor can assist if changes in your templates are needed.

GREAT EXAMPLE

As Laurel Eye Clinic well knows, any success to be realized with compliance reporting requires dedication of time and resources. By focusing on the key items discussed above, Laurel Eye has become successful over the years, and is now reaping the benefits of remaining compliant. With consistent communication and attention to detail, Laurel Eye Clinic is a great example of “what good looks like.” OM

REFERENCE

Ms. Holloway is a senior consultant with BSM Consulting in Clearwater, FL. Her current certifications include Professional in Human Resources (PHR) and Certified Patient Service Specialist (CPSS).