- The first component for success is perhaps the most important, and that's having a culture of provider support. A willingness to explore new options. This component is free, so if you don't have that culture in place today, before going and investing in analytics products, performance improvement or new staffing, you've got to put this culture in place. We have seen organizations do this successfully, and make the journey into accountable care organizations (ACOs) or value-based programs by working on this piece first.
- Second is strategic planning. Set measurable goals. That's important. Look ahead one year, two years, three years. Set goals that have timelines, and goals that are reasonably achievable.
- The next piece is strong leadership. If you don't have a quality committee or a Merit-Based Incentive Payment System (MIPS) committee, consider establishing one, and establishing a position lead in that program. It should be a multidisciplinary effort. Pull physicians, mid-levels, nursing leadership, IT and program management into that program. You should have tailored reporting strategies that align with your planning efforts.
I've experienced teams that didn't work well. In working with large systems, even with the support of clinical leadership and with the right analytical skills, efforts, I have witnessed efforts that were slower than they should have been until they brought in the right team member. This team member possessed in-depth knowledge of clinical workflows, had clout within the organization, knew personnel across IT, could talk to providers, and was a good communicator. When that person was on the team, the efforts began to move forward much faster. You've got to find the right people to be involved.
- Next, data analytics is key. This starts with an individual with the right skills. It doesn't mean you have to buy the most expensive solution for this. Sometimes ad hoc solutions work just fine for certain organizations. However, you need the right individual who knows the data, who knows how to respond to requests from leadership, and who can really own it.
- Lastly, clinical documentation is essential. Doing that well will improve your position in this program.
Physician MACRA-Readiness: Mining QRUR and Other CMS Data to Maximize MIPS Performance describes the wealth of data analytics available from the CMS Enterprise Portal—Quality Resource Use Reports (QRURs) and other analyses providing a window into practice performance under the Merit-Based Incentive Payment System (MIPS). MIPS is one of two MACRA reimbursement paths and the one where most physician practices are expected to align.