The Trouble with Medical Data

As an educator in healthcare, I am struck by the sheer volume of information that must be collected and submitted by clinicians. Courses we develop are designed to make that job easier, but wow! Seriously, this is complicated stuff. And while I believe that most clinical providers are educated and more than capable of managing complex tasks, it seems to be a serious burden on them to juggle all that is required while continuing to do their primary job, which is to provide quality patient care.

Take the MACRA-MIPS (Merit Based Incentive Payment System) program for instance, formerly dubbed “Meaningful Use” by CMS. This unwieldy set of instructions includes measures, bonus points, hardship exceptions and percentages. Details that would, in my opinion, give a PhD college math professor a headache. An entire industry of online tools and skilled consulting firms have cropped up to help, but without spending money to navigate mandates and meet detailed requirements, a provider could end up with serious financial penalties.

The new and recently updated “Promoting Interoperability” (PI) program for instance, makes up 25% of the MIPS score. The CMS webpage addressing this aspect of the program tries hard to simplify instructions regarding submission of data, but this sample of the most basic information on the site – relies on a participants’ understanding of prior year programs and assumes a level of comprehension that may not be in place for a new provider or someone fresh to the payment system: “Beginning in 2019, you will submit a single set of Promoting Interoperability Objectives and Measures to align with 2015 Edition CEHRT. This single measure set includes new and existing Promoting Interoperability performance category measures organized under 4 objectives. Measures are no longer classified as base score or performance score measures.”

Huh? OK, so I am not a clinical provider, but I am the learning officer who reviews course content submitted by our subject matter experts on this topic. I will tell you that if I were a practitioner, I would consider ditching the Medicare/Medicaid payment system altogether. At a time when the healthcare community needs MORE service providers, many are sidestepping these complicated programs by refocusing on insurance and cash pay clients. Resulting in a smaller pool of skilled resources to deal with our growing national demand.

What I am concerned about, as a healthcare consumer and future Medicare recipient, is that these programs may be asking too much. The population is aging rapidly, which is changing the healthcare landscape. As Medicare expands to meet the growing demand of this population, will practitioners be encouraged or discouraged from addressing the need?

According to CMS, MIPS was designed to tie payments to quality and cost-efficient care, drive improvement in care processes and health outcomes, increase the use of healthcare information, and reduce the cost of care. The question is, are we sacrificing adoption and encouraging growth in the industry to meet the increase in demand, or are we regulating practitioners to such a degree that they are reluctant to engage in the reimbursement model at all?

With all of that said, until that question can be answered, 4MedPlus provides simplified training to address the understanding of these programs. There are a number of self-paced online certification programs in our incentives catalog here:

Also available are LIVE instructor-led online webinar workshops, including one that begins tomorrow addressing the PI category which can be found here:

4MedPlus Blog Readers may apply coupon code 4MED25RM at checkout to receive a 25% discount off any available MACRA-MIPS title or your entire training cart.

Author:  Wendy Whitmore, CLO