Not long ago, Joseph Aloise, D.O., a family practice physician based in North Myers, Fla., was struggling to keep his practice afloat financially due to inefficient technology, leaving practice staff overwhelmed with billing, eligibility checking and quality reporting, as well as clinicians bogged down by paperwork.
With government-mandated quality reporting programs like meaningful use and eventually MIPS (the Merit-Based Incentive Payment System) requiring the use of better IT systems, Dr. Aloise was struggling to comply with the technology he had. Tia Merlot, office manager/practice administrator at the practice, recalls that when the meaningful use (MU) program first kicked off, her practice missed the Stage 1 attestation by a single measure—giving patients access to their health data within three days of the visit.
But as Merlot, who has been with the practice for 12 years, contends, it wasn’t really the practice’s fault for missing the measure since it actually had the patient summary ready at the end of each visit, assuming the doctor finished the note. “But at the end of the visit, the patient just ‘checked out’ of the option if he or she didn’t want to see the record. There was no option [in our system] to say that the record was available but the patient declined seeing the summary. It was something so simple that the system couldn’t handle. That was a limitation and it caused us to miss that one measure,” she says. What’s more, the practice had to wait 24 to 48 hours to see reports after requesting them, meaning it took time to see how clinicians in the practice were progressing in regards to meeting MU measures. “I used to have weekly meetings with a consultant to get through meaningful use; each one took hours,” she recalls.
About three years ago, Aloise decided to implement a cloud-based EHR (electronic health record) platform from Watertown, Mass.-based vendor athenahealth. Now, with the new system, Merlot and others can see minute-by-minute updates on where the practice is with its measures, as everything is quantified in real time. “So for us, MU used to be a trial-and-error headache in the past, but now having been on the athenahealth [system] for three years, these [regulations] don’t feel like a big deal anymore.”
Indeed, this year for the practice, meaningful use has turned into MIPS, one of the payment tracks for eligible clinicians under MACRA’s Quality Payment Program that rolls MU and other programs together. But Merlot says not much has changed from a quality reporting standpoint since it’s mostly the same concept. “What we were doing for MU we are now doing for MIPS. The name has just changed,” she says. “In the athenahealth platform, I go to my MIPS dashboard and it has all of the clinicians, their performance, every single measure, the category, the percentage satisfied and how many points we will get.” For example, she continues, “We just got our influenza vaccines here, and the system is showing that right now we are at 16 percent satisfied since we just got them and started giving them out. If I look tomorrow at the percentage, that number will change since we will see more patients. All of the information is right there in front of us.”
Merlot attests that the new system is making the process “foolproof.” As the patients are being triaged and their vitals are taken, there is a "quality" tab in which the clinician can see if the patient is due for a flu vaccine or a colorectal screening or a pneumonia vaccine. "It’s almost impossible to get something wrong since they are spoon-feeding us the information. And it’s very easy to be engaged in MIPS, which takes the stress away,” she says.
For the first year of MIPS, participating clinicians have the option to report only a minimum amount of data to CMS (the Centers for Medicare & Medicaid Services). The feeling is that most folks will opt for this route since it eases them into a complex reporting program. However, Merlot contends that the goal for her practice is to submit a full year’s worth of data. “Go big or go home,” she says, half-facetiously. “But really, athenahealth does all of it for us. Our goal is to [report] for the entire year, but the system takes our data and quantifies it for us, telling us how we’re progressing and what our choices will be. And then Dr. Aloise signs off at the end. I don’t have to do the attestation process for us; there is an attestation person at athenahealth who does it.”
Before implementing this platform, Merlot notes that the practice would receive small incentive payments from Medicare replacement HMO plans that they were contracted with and which would give bonuses based on star scores, quality performance, HEDIS (Healthcare Effectiveness Data and Information Set) measures, and more. The bonuses, says Merlot, would be $1,000 here or there, perhaps in the range of $10,000 to $12,000 per year between all of the insurers for their incentive programs. But now, she adds, the bonuses are quite bigger. The practice recently received a single $14,000 check as an incentive payment from one of the insurance companies, spanning the period of one or two quarters of the year. Merlot says that it was the biggest single incentive payment the practice has ever received, and year-to-date it has gotten $53,000 in bonuses, while in the three years since deploying the athenahealth platform, the incentive money received stands at $137,000.
In the end, Merlot greatly credits switching IT platforms as the biggest single contributor to the improved results. She also points to other ways in which the system is helping such as an increase in patient collections by 30 percent; a decrease in patients’ no-show rate to less than 1 percent; and a reduced DAR (days after receipt) from 45 to 19 days.
While some smaller practices are in fear of MACRA/MIPS and foresee a future of sacrificing their independence due to not being able to meet these government regulations, this organization has not had those concerns. “I am friends with a couple local office managers and they have frantically been trying to join an ACO [accountable care organization] or get bought out by a bigger entity. They are trying to play the numbers game and think that it will be easier if they were part of a bigger group or ACO, rather than be graded individually and get a negative payment adjustment,” says Merlot. “But for us, that wasn’t an option. Dr. Aloise likes being his own boss and likes not being owned by anyone else. And we don’t have the fear of a negative payment adjustment since we use [this platform]. We’re not at all afraid.”