For radiologists, MIPS preparation analogous to 'colonoscopy prep'

December 07, 2016
by John W. Mitchell, Senior Correspondent
In a RSNA session last week in Chicago titled "Will MACRA and MIPS Kill Your Practice?", three radiologists presented viewpoints that became more optimistic as the session progressed. While there are legitimate quality and cost control reasons for the new payment models, the panel acknowledged the change is unnecessarily confusing and the final rules were only adopted at the last minute in October.

"It would be nice if I could say you're going to learn a lot and leave feeling good. But that's not the case," Dr. David Levin, Emeritus Professor and Chairman of the Department of Radiology at Thomas Jefferson University Hospital deadpanned about Merit-Based Incentive Payment System (MIPS) preparation.

"It's like a colonoscopy prep — it's something you have to do," he added.

Given the late finalization, CMS has lightened the 2017 reporting demands by only requiring 90 days of 2016 data be reported, and has pushed the commencement date off until spring, according to Levin.

Confusing language and acronyms defining MIPS payments that change from one CMS and federal document to another have not made things easier.

For example, Levin noted some federal sources termed the reform "pillars" as "components" or "performance categories" in different sources. The six clinical MIPS quality measures — clinical care, patient safety, care coordination, patient and caregiver experience, prevention and population health — were also at times referred to in other terms, depending upon the federal source. He also presented a list of 10 acronyms in the rule language, such as QPP, QCDR and OPDR that are confusing.

"We don't know what all these things mean yet," said Levin.

On the positive side, he said the MIPS payment system — which was passed under the Medicare Access and CHIP Reauthorization Act in April 2015 — does get rid of the hated sustainable growth rate (SGR) payment system that required Congress to pass a "doc fix" every year, a nerve-wracking political process widely despised by physicians.

The second presenter, Dr. Ezequiel Silva III, a San Antonio-based radiologist, made the case for the need for a quality-based payment system. He noted that physicians have been through payment reforms in the 1980's with the prospective payment formula on the inpatient side.

"We've been here," Silva told HCB News after the session. "The stakes are higher this time, but it is possible to just do a little in the first two years and not get penalized."

He also noted that while the U.S. political landscape has changed with a Republican President and Senate, he does not think that necessarily portends a repeal of MIPS. According to Silva, MACRA — which required the MIPS payment reform — had bipartisan support when it was passed two years ago.

Silva added that although Dr. Tom Price, the incumbent Secretary of the Department of Health and Human Services, may not be a fan of these reforms, it is unlikely that he would interfere with them.

"Price doesn't like meaningful use rules (for electronic health records) but that doesn’t mean he will cancel current MIPS requirements," said Silva. "MIPS is doable, if onerous."

Silva made a case for the need for quality versus quantity, the principle behind MIPS. He noted that the 1999 Institute of Medicine report "To Err is Human" and subsequent studies indicated that as many as 100,000 patients die every year due to poor quality controls in medicine and care.

Dr. J. Raymond Geis, FACR, a radiologist from Ft. Collins, Colorado, the third and final presenter in the session, talked about the need for radiologists to become masters of data in order to succeed under MIPS.

"Whoever has the best data, wins," he told the audience. "We're figuring out how to pay for another type of system ... and we're getting paid for value (not volume). We may not know what that is yet but we do know it's linked to our ability to transmit data."

Geis demonstrated Triad, a reporting platform he helped develop for radiologists through his work on the Commission of Informatics at the ACR, and advised his colleagues to start implementing a system right away if they haven't already.

"Every specialty is working to get 100 percent of payments under MIPS and they are all descending on hospital IT departments to get their platform live," said Geis.

He predicted that in a few years, once MIPS is fully implemented, most doctors will see marginal compensation increases or decreases. He also advised that new data and business models may be necessary for radiologists to prove their value.

"The MIPS rollout might dent, but it will not wreck, radiologists practices," he said.