Helping docs cope with federal reforms

Over the next seven years, the CMS plans to have 75% of Medicare payments flowing through value-based payment models that reward providers for delivering lower-cost, higher-quality care.

With both bonuses and penalties at stake, it's risky for hospitals and health systems to fall behind in preparing for payment reform. Now some companies are stepping up to help providers optimize their revenue under those changes. They are assisting them in tracking the right metrics, accurately reporting performance and improving their efficiency and quality.

Chicago-based SA Ignite got its start in 2009, the year Congress approved a massive incentive program to expand the use of electronic health records and establish meaningful-use requirements for them.

“We were starting to see that meaningful use would have a huge reporting requirement,” said Tom Lee, SA Ignite's founder and CEO. “It basically gave rise to the idea that someone needed to build a TurboTax for meaningful use. Based on that success, we've been able to realize our broader vision.”

SA Ignite's MU Assistance software automates the tracking and reporting components of meaningful use. The platform is designed to reduce the administrative burden on providers.

The software pulls data from providers' EHR systems to give healthcare organizations a point-in-time picture of whether their physicians are compliant with meaningful-use rules. The data can be filtered by site or region, or by individual physician. The program shows the extent to which physicians are meeting core and menu measures for meaningful use and how they compare to the group average.

The venture-backed company currently does business in 30 states.

Lee said the new Medicare merit-based incentive payment system (MIPS) will be a new focus for his company's business. Under legislation passed earlier this year, MIPS replaces the sustainable-growth-rate formula as the primary method for determining payment for physician services. It is heavily quality-based, also taking into account the cost of care. And it wraps the current meaningful-use program into the new formula.

SA Ignite plans to help providers make sure they're meeting MIPS' metric requirements, as well as determine where to focus their efforts for maximum revenue impact.

Many questions still remain about how MIPS will be calculated when it goes into effect in 2019. But so far, it has established four performance categories: meaningful use, quality, clinical-practice improvement and cost or resource use.

“It's going to be hard in MIPS to do really well in all four categories,” Lee said. “You have to really look at each component. What is the amount of effort per MIPS point?”

MIPS considers providers' costs of delivering care. Under MIPS, the CMS will give bonuses to Medicare-eligible providers who have low cost and high quality, said Dr. Bill Bithoney, a managing director with BDO Consulting, who has closely tracked MIPS. “This is nothing short of a revolution,” he said.

Quincy (Ill.) Medical Group, a multispecialty clinic with 105 physicians in 16 rural locations, is heavily dependent on Medicare payments, which account for more than 40% of its revenue. The group has been working with SA Ignite for the past three years on meaningful-use attestation.

As the CMS changes its Medicare payment parameters, Quincy, with SA Ignite's help, is tracking its individual physicians' performance. It receives monthly report cards on each provider, looking at factors such as whether they are prescribing medications electronically and whether they are printing out post-visit summaries for patients.

“Oftentimes, (physician) offices do things, but they're not doing them in a way where we can record it in the metrics,” said Dr. Richard Schlepphorst, Quincy's chief medical officer.

The new payment system could cause as much as a 30% swing in a provider organization's payments, Lee said.

MIPS also will publicly report how providers score on performance targets. Lee said provider organizations need to think carefully about what that means. “Once a consumer gets in their mind that 'Dr. Jones' has 30 points out of 100, they're not going to want to see Dr. Jones again,” he said.

That public reporting is likely to sharpen competition between physician groups over their quality of care.

“We see right in front of us an exploding reputational and financial risk for providers,” Lee said. “MIPS is a winners-and-losers game.”