Many professionals or experts working in the healthcare IT industry, policy specialists, and new industry stakeholders continue to investigate into the 1,473-page proposed “rule” released by the CMS or Centers for Medicare and Medicaid Services in July 2018 that provides updates on the OPP or Quality Payment Program and Physician Fee Schedule. This new update also summarizes the Medicare Incentive-based Payment Program (MIPS) and Advanced Payment Models.
Where did we stand on Healthcare Spending?
An investigation comparing health care spending, prices, utilization, and healthcare results across 13 high-income nations shows that in 2013 to 2016, the United States spent far more on healthcare than the mentioned high net worth countries, Despite this, Americans had poor health care outcomes, which also includes shorter life expectancy along with the high rate of chronic conditions.
As an assessment, the US spends 17.1% of the gross national product on healthcare, but the United Kingdom spends 8.5% with the same healthcare outcomes. This model of higher spending with bad outcomes is not justifiable.
Each year, the federal government relies on the Sustainable Growth Rate to keep costs low. Every passing year as the spending increased, resulting in the formation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that stirred the focus from ‘fee-for-service’ to ‘value-based payments.’
However, this transformation has both proponents and detractors. But most importantly, it makes sense that to be the best guardian of healthcare dollars, physicians and healthcare units must focus on providing the best care to our patients at the lowest cost. The ‘value’ of your work is publicly reported and appreciated by patients as well as payers.
- One important thing to remember here is that for participation in advanced alternative payment models, the Merit-Based Incentive Payment System (MIPS) for financial and quality reporting data collection was started in 2017 and will be used for payment adjustments or incentives in 2019.
Impact of QPP on Cardio-Oncology Care and Medical Billing
Identifying opportunities to rectify the cardio-oncology care delivery along with billing and coding should be a win-win. The Cardiologist should know that taking full advantage of the QPP program will be vital to maintain and improve their reimbursement cycle. Utilizing the parts of the program which directly measure cardio-oncology processes and results will also ensure suitable therapy for the patients.
One of the main objectives of the QPP is to give cardiology healthcare facilities the flexibility to choose the procedures and measures which are meaningful to their practice.
Of the four categories defined, two of the areas; Quality and Improvement Activities – provide the opening to optimize clinical care specifically for cardio-oncology physicians. For the program, clinicians must pick six out of (about) 300 quality measures; one of them should be an outcome or high-priority measure. This Quality category has a 50% weight for the 2018 data year that aligns with MIPS.
Quality Measures for increased Reimbursement
For a physician who wants to directly impact cardio-oncology care and take advantage of MIPS QPP via medical billing and coding, the following list has some worthy choices for Quality measures.
- Have shared decision making and discuss/provide a care plan
- Communicate through reports and coordination of care
- As you deal in the cardio-oncology screen for tobacco use and provide cessation to manage comorbidities
The Centers for Medicare and Medicaid Services has an informational online tool that allows cardiologists to explore the various measures that may best suit their practice.
What next?
As the QPP is pushed further in the next couple of years, the penalties and incentives will rise. There is no real option for not participating. Therefore, participating in the program is a clinician’s best option for success. For those healthcare units who manage a large number of cardio-oncology patients, keeping patient care and claims reimbursement on the same track is not possible.
In such, aligning your priorities with experts in the cardiology medical billing and coding like us will help ensure that the quality measures are in check, and the claims submitted via us aid is pacing your revenue cycle.
As far as the patient population in cardio-oncology increases, your ability to provide high-quality care in a lucrative manner will continue to grow in importance.
FAQs
1. What is the QPP and how does it impact healthcare providers?
The Quality Payment Program (QPP), introduced by CMS, focuses on shifting healthcare from fee-for-service to value-based payments, encouraging providers to improve care quality while lowering costs. It includes the Merit-Based Incentive Payment System (MIPS), which adjusts payments based on quality data reporting.
2. How does healthcare spending in the US compare to other high-income nations?
The US spends significantly more on healthcare (17.1% of GDP) compared to other high-income countries like the UK (8.5%), but despite higher spending, the US experiences poorer health outcomes, including shorter life expectancy and higher chronic conditions.
3. What role does MIPS play in the QPP?
MIPS is part of the QPP and requires physicians to report data on quality, cost, improvement activities, and use of electronic health records (EHR). Physicians’ scores in these areas determine their reimbursement rates for Medicare services.
4. How can cardio-oncology care benefit from the QPP?
Cardio-oncology care can benefit from the QPP by allowing cardiology practices to select relevant quality measures, such as shared decision-making, tobacco cessation, and care coordination, to improve patient outcomes and maximize reimbursements under MIPS.
5. Why is it important for cardio-oncology practices to participate in the QPP?
Participating in the QPP is crucial as it directly affects reimbursement rates. As penalties and incentives increase over time, cardio-oncology practices must focus on quality care and proper billing to ensure continued financial success and improve patient outcomes.
