Use the Right Technology to Thrive in a Value-Based Environment

by Adria Schmedthorst

Value-based reimbursement is here to stay. It is being embraced not just by CMS and its Merit-Based Incentive Payment System (MIPS) but also by commercial payers across the board.

By the end of 2018, half of payments will be tied to quality initiatives by CMS while over 90% of commercial payers are already using a mixture of fee-for-value and fee-for-service payment models. This changing healthcare environment creates many challenges for small practices. But, there are affordable, secure technology solutions available to help you thrive as more and more of your reimbursements begin to be tied to quality of care and patient outcomes.

Meaningful Use (MU), the initial driving force to integrate technology into healthcare, is not being replaced with the advent of MIPS—more like upgraded. In fact, for 2017, the first performance year for MIPS, MU will represent 25% of your MIPS score. So, if you have not embraced technology in your practice and adopted a Certified EHR, now is a great time to re-evaluate your options.

Both EHRs as well as billing systems are vital tools to achieve optimum performance for small practices. Not only do they help you to meet MU requirements, they also provide you the data sources needed for reporting your PQRS measures.

If you have not participated in PQRS reporting, you should begin to prepare now for 2016 reporting. PQRS and the Value-Based Payment Modifier (VBM) will represent half of your MIPS score for 2017. This makes reporting PQRS measures the most important determiner of your Medicare reimbursements for the first performance year of MIPS. In addition to the effect it has on your MIPS score, negative adjustments for PQRS and VBM could result in an up to 6% decrease in your reimbursements. This makes having an EHR in place that allows you to access the data you need in the appropriate format necessary in order to maximize your Medicare reimbursements.

Even more, EHRs provide benefits to small practices that have nothing to do with MU or MIPS. They can help you generate patient lists based on specified criteria, allowing you to increase the number of patient visits for preventative and follow-up care. They can reduce front office burden by allowing your staff to spend less time on the phone with patients, pharmacies, and labs. And, they give you the ability to analyze bottlenecks in your practice and improve your workflow. Additional benefits of EHR adoption for small practices include reducing the cost of records management, transcription services, and more. All of this can increase both the efficiency and the profit potential of your practice.

Value-based reimbursement is here, but not without its challenges. Fortunately for small practices, incorporating an EHR and billing system into your office now can allow you to meet MU requirements, easily access data for PQRS measures, improve your workflow, and generate increased revenue. The transition to fee-for-value payments by both CMS and commercial payers means that incorporating the appropriate technology in your practice is more important than ever.