Partnering for QPP Submissions

Physician MIPS Participation Determines Smiles or Haircuts: Part 2

Outpatient Physicians Benefit from Partnering for QPP Submissions

As Medicare recently closed reporting for their Year I of their Quality Payment Program (QPP) (See Physician MIPS Participation Determines Smiles or Haircuts), it is too soon to say how many physicians and other ambulatory providers will post 2019 wins (bonuses) or losses (penalties) on their efforts. Many physicians should consider partnering for QPP submissions in 2018.

It is disappointing how many physicians decided to not participate in the 2017 transition year of QPP.  Some of the reasons they share are:

Photo of a young smiling physician looking over a boy cutting off the long hair of a young girl. This signifies the outcome of physician MIPS participation - some will receive 2019 bonuses at the expense of those who will take a haircut or reduction to their payments. All practices should consider partnering for QPP submissions in 2018.
It is too soon to know the 2017 physician MIPS participation. While many physicians will enjoy their 2019 bonuses, many remain unaware of the Medicare haircut they will see in 2019. Consider partnering for QPP submissions.

  • It doesn’t affect me? (Though they failed to confirm their status at
  • The cost of reporting will exceed the benefits. (See Article).
  • Congress will appeal it. (though it passed in a bi-partisan manner)

Unfortunately many physicians will learn later this year (2018) how their 2017 QPP decisions will impact their 2019 Medicare payments.  Their 2020 Medicare are contingent on physicians’ performance during 2018. Physicians may set themselves up for significant Medicare reductions as the penalties go to 5% in 2020, 7% in 2021, and 9% in 2022.

Bar graph showing MIPS reimbursement models 2016-20122
Figure 1. Graph shows growth in Medicare payments ($10K baseline) over next few years based on full MIPS bonuses (green line), full MIPS penalties (red bars) or neutral (black hashes in center of clear histogram bars). Note: 18% differences between winners & losers.

Case Studies Yield Some Encouraging Results


MSN Healthcare Solutions provides comprehensive medical billing services and practice management solutions. They shared a case study from their work with a radiology group (provided by Barbara Rubel, Senior Vice President of Marketing & Client Services). The group is exempt from the Advancing Care Information (replacing the Meaningful Use EHR measure). This allowed them to weigh their 2017 quality score to 75% of their MIPS calculation, rather than 60%.

According the MSN Healthcare Solution, the group would earn a total MIPS score of 67.5 points to only meet the minimal threshold. This would permit them to avoid a QPP penalty to their 2019 Medicare payments.

However, MSN Healthcare Solutions MIPS team was able to optimize the group’s performance through the following interventions:

  • "Provided the group with feedback about their quality performance by calculating their baseline quality score of 42 points.
  • Provided education and materials to the radiologists about the quality measures and the documentation that is needed to optimize performance under the chosen measures.  Interventions included webinars and individual sessions.
  • Analyzed the group’s billing data to assist with Quality Measure selection by querying the billing database for measures where the group had the required denominators.   The purpose of this analysis was to identify "new," non-topped out measures for future reporting which would allow the group to earn the maximum points per measure of 10 and not be subject to the point reductions assigned to ‘topped-out’ measures.
  • Provided specific measure details on how to meet all of the Quality Measures (the group) selected to report on.
  • Provided guidance on Improvement Activities selection.
  • Assisted the group with assessments of their workflows for each measure to increase their quality performance scores.  Workflows that were analyzed included use of macros, templates, and structured reporting and how to effectively obtain support from hospital technicians when the required data was not available electronically, e.g. the information needed for reporting Fluoro Exposure Indices (Measure 145).
  • MIPS team members held monthly meetings with (the group’s)  representatives to discuss and review their quality performance and to identify trends.Quality performance reports were produced and reviewed monthly and group members participated in identifying strategies for improving performance”* (*reported by vendor as a case study).

Winning the Numbers Game Through Partnering for QPP Submissions...

Through this intervention, the radiology group increased their total MIPS score from 67.5 to 85 point.  This “exceeds the exceptional performance threshold of 70 points and will earn the group an exceptional performance bonus.”

Since Medicare determines these bonuses in a “budget-neutral” manner, it is too soon to say how the economic impact of earning this designation.  Of course, the group will receive at least 4% more than providers who did not submit data. Their exceptional performance bonus could add up to an additional 4% to their 2019 Medicare payments.

Mining Data Beyond the Electronic Health Record (EHR)

SPH Analytics uses a somewhat different approach through their Population Care: Quality Measures Medicare solution. They helped several physician groups dramatically improve their total MIPS points by leveraging campaigns and data beyond that provided through their EHR vendor** (**Case Studies provided by Susan Stallings, Regional Vice President).

One example was a 203% increase in influenza vaccinations documentations. They included an email campaign in December 2017 to capture those patients who received the Flu vaccine elsewhere. As a result, they were able to report scores 78% higher than reflected from their EHR alone.

The group also reported improvement in other populations, including diabetes, hypertension and pneumonia vaccination.

SPH Analytics shared additional case studies.  Their clients included payer-sponsored networks with multiple specialties and EHR providers. In addition to improved QPP reporting, a network of 500 physicians across 165 practices were able to demonstrate an 80% improvement in staff efficiency.

Consider Boards and Professional Societies

The American Board of Family Medicine’s (ABFM’s) PRIME Registry allows Board Certified Family Physicians to submit quality data electronically. Through grants, they have been able to provide three years of this service to their Diplomates. Physicians and their staff should check with their Boards and professional organizations for similar opportunities. Partnering for QPP submissions with your Board may be an economic opportunity for many practices.

Take Homes on the QPP, MIPS and APM Programs...

Though some physicians have been reluctant to participate with QPP, others have worked with their Boards and business partners to achieve and report significant improvements in 2017.  Many will discover that they can achieve net bonuses over the cost of these programs. Most physicians have opportunities to improve patient care while avoiding Medicare penalties. By properly partnering for QPP submissions, you may even earn significant Medicare bonuses for future years.

Physicians can learn more by visiting the website. Please search the numerous free QPP articles on the website or the MACRA QPP Glossary of Terms.

Visit our Glossary of MACRA QPP Terms


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