SPHA has the expertise and solutions to ensure MIPS success



 

 


 

Driving quality program success for more than 24 years

 

Partner with the Population Health Solution Experts


 


 

MIPS MaxTM is a suite of solutions that can help you maximize Medicare reimbursements and avoid the negative penalties from the new Merit-Based Incentive Payment System (MIPS). Our solutions minimize workload and administrative burden, while helping you improve your MIPS Composite Performance Score. Depending on your readiness, MIPS Max can improve your scores in any one or all of the four MIPS categories: Quality, Improvement Activities, Advancing Care Information, and Cost.

Timeline for MIPS value-based incentives

Act now to ensure you capture every MIPS point to boost your composite score. Each year, CMS will set a new performance threshold (PT) number of points to avoid a negative payment adjustment. Each additional point above the PT earns higher incentives, and each point the final score is below the PT incurs proportional penalties. Therefore, every point translates directly into higher or lower reimbursement.

 

Contact us for a free consultation, and start maximizing your MIPS score today.

 

 

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

 

Quality: 60%

Clinical Quality Measure reporting is a significant component of value-based care, contributing 60% of the total 2017 MIPS Composite Performance Score. The new Quality category has replaced the previous Physician Quality Reporting System (PQRS), with more emphasis on performance compared to reporting. Better performance on quality measures means more MIPS points awarded.

SPH Analytics (SPHA) is a Qualified Clinical Data Registry (QCDR) that can validate and aggregate clinical data from multiple EHR systems and benchmark the data against other registry clients. The data collection process is streamlined to alleviate labor-intensive, manual processes for practices and providers. The solution helps providers gain visibility into their quality measure results throughout the year, so proactive steps can help improve performance before annual submission to CMS. By monitoring and improving quality measure performance throughout the year, QCDR Plus helps providers avoid possible financial penalty by protecting revenue tied to performance reporting and measures.

QCDR Plus features include:

    • Collection and validation of data from various EHR systems
    • Library of eCQMs (electronic clinical quality measures) and registry-based measures to choose from
    • Option to build new measures
    • Clinical Measure Dashboard with data refreshed monthly or bimonthly
    • Drill down to patient list to close care gaps and improve performance
    • Annual CMS submission of quality measures (6 measures including 1outcome)
    • Trending against benchmarks and goals
    • Bonus points in the MIPS Quality scoring section for eCQMs gathered and reported via a QCDR
    • Data submission to CMS for both MIPS Quality and Improvement Activity categories

Advancing Care Information: 25%

The MIPS Advancing Care Information category is carried over from the EHR Incentive Program, aimed at increasing the adoption of CEHRT (certified electronic health record technology) among Medicare and Medicaid providers. The Advancing Care Information category measures the meaningful use of CEHRT.

Using SPHA’s QCDR Plus to submit eCQMs, providers can earn a 5% bonus in the Advancing Care category, as well as earn credit for the Clinical Data Registry Reporting measure. Our Population Care health solution earns providers credit for the Specialized Registry Reporting measure.

Improvement Activities: 15%

The Improvement Activities category is a new concept under the Quality Payment Program. These activities have proven associations with better health outcomes, and clinicians can choose the most relevant activities. In 2017 there are some 90 available improvement activities, and the category contributes 15% of the total MIPS Composite score. SPHA offers several solutions that can help clinicians earn maximum credit for the Improvement Activities category.

QCDR Plus

A QCDR can submit data for Improvement Activities on behalf of clinicians, but also leveraging a QCDR provides several opportunities to earn credit for Improvement Activities across several subcategories. SPH Analytics’ QCDR Plus displays measure performance across Medicare and non-Medicare patients to support all payer quality improvement initiatives.

CAHPS® or Other Patient Surveys

SPHA holds multiple certifications for providing patient experience surveys for regulatory or elective purposes, including CAHPS for PQRS. SPH Analytics provides complete survey administration through our onsite call center and mail fulfillment facility, as well as innovative dashboard analytics for monitoring quality.

The CAHPS for MIPS Survey (anticipated to replace CAHPS for PQRS) consists of the core CAHPS Clinician & Group Survey developed by the Agency for Health Care Research (AHRQ), plus additional questions to meet CMS program needs. CAHPS for MIPS may count for either a MIPS Quality measure or an Improvement Activity, where it is counted as a high-weighted activity in the Patient Safety and Practice Assessment subcategory. When used for the Quality category, clinicians may report any five measures within MIPS, plus CAHPS for MIPS, to achieve the six measure requirement.

Population Care™

Population Care is a population health analytics platform that aggregates clinical data to create a primary care-based patient registry. The application is used to risk stratify the population and to monitor performance measures in near real-time. Population Care helps practices close care gaps with workflow tools and patient care summaries. It is the technology solution chosen by the largest Practice Transformation Network (The Consortium for Southeastern Hypertension Control – COSEHCTM), funded by the CMS Transforming Clinical Practice Initiative (TCPI).

Population Care can earn credit for two Population Health Improvement Activities: 1) Population empanelment, and 2) Chronic care and preventative care management for empanelled patients. In addition, Population Care can earn ten auto-credits toward PCMH accreditation. Certified PCMHs receive full credit for the MIPS Improvement Activity category.

CG CAHPS Survey and Discharge Call Program

High quality and targeted patient experiences can help improve clinical outcomes. That is why there are more than 20 different MIPS Improvement Activities in the Beneficiary Engagement category. SPHA’s CG CAHPS Survey and Discharge Call Program can earn credit for two medium-weighted activities:

1) Regularly assess the patient experience of care through surveys, advisory councils, and/or other mechanisms and
2) Engage patients and families to guide improvement in the system of care.

Cost: 0%

The Cost category will become more important in future MIPS performance years and is already critical for ACOs and other integrated provider groups who are managing the total cost of their population.

SPHA offers an optional Financial Risk Analytics Module that provides financial risk analysis based on claims/administrative data. Our advanced analytics are powered by Milliman tools which:

    • Provide stratification of population risk to identify high risk/high cost groups
    • Identify chronic condition groups and gain insights with Milliman Advanced Risk Adjusters (predictive analytics: risk of admit and ER visit)
    • Display monthly trends for per capita expenditures by beneficiary type and category
    • Compare your PMPM costs to industry leader Milliman benchmarks
    • Address increasing utilization rates by category (IP, OP, ED, Rx)

Share the page