Receiving a letter from the federal government saying your faculty practice will be reimbursed an additional $1.8 million next year can really improve your day.
That’s just the news Megan Sullivan, director of quality improvement at the UC College of Medicine, received recently from the Centers for Medicare & Medicaid Services. The additional funding to UC Physicians Company (UCPC) is due to an extremely high score the College of Medicine’s 850-member faculty group practice received in the CMS’ Quality Payment Program.
"We ended up with a 99 score out of a possible 100,” Sullivan says. "We were really pleased and could never imagine we’d be that high. This demonstrates that when we measure on quality and outcomes, we really fare well. Enough so that Medicare will pay us more.”
CMS’s Quality Payment Program
is the result of a 2015 law known as the Medicare Access and CHIP Reauthorization Act
that sets payments for Medicare clinicians based on quality care. Based on the UCPC practice size, specialty, location and patient population, it is part of the Merit-based Incentive Payment System
, or MIPS, within the Quality Payment Program. MIPS rewards physicians on value and outcomes. Performance is measured through data physicians report in three areas: quality, improvement activities and patient engagement and use of electronic medical records. (For 2018, CMS will add cost as a fourth criteria.)
The score UCPC just received was from patient care activities during calendar year 2017. The additional payments UCPC will receive will come during the 2019 calendar year.
Sullivan says quality was the most important section. This includes such things as whether physicians routinely screen for depression, conduct cancer screenings, ensure safety in cataract surgery and control high blood pressure in people with hypertension. "There is a whole list of quality measures and the scoring takes the top six measures. The closer you are to the 99th percentile, the more points you get. We scored very high to have lost only one point in this area,” Sullivan explained.
UCPC excels at ensuring children are up-to-date on their vaccines. "Our primary care practices contact patients’ caregivers when a child needs to catch up on immunizations. Proactive outreach was critical to the high performance and score on this measure,” says Kristina Kew, data analyst at the UC College of Medicine, who oversees the submission and implementation of the MIPS program at UCPC.
Other sections where UCPC excelled includes how it uses Epic electronic medical records and various quality improvement processes UCPC has conducted during 2017.
"For example, we worked hard to get patients to use My UC Health as a patient portal. CMS is leaning toward patients interacting more electronically with physicians. We improved in how we connect the Epic system to other health care facilities. We improved how we screen for depression and fall risks,” Sullivan says.
"What Medicare is trying to do with these additional payments is encourage improved quality, outcomes and patient experience. It’s not about the number of patients you see, but the experience they have,” Sullivan says. "Our score is considered exceptional performance.”