Helping Small Practices Navigate Value-Based Reimbursement While Improving Patient Care

Overview

Small clinical practices, or those located in rural or underserved areas, play an important role in the health care landscape and are critical in addressing health disparities. However, these practices are often constrained by limited resources on the path to fulfilling regulatory requirements. In addition to financial strain, they also face significant capacity challenges due to staff turnover and technological limitations. As rural providers tend to serve populations that are older, poorer, and sicker than those in urban areas, they also rely more on Medicare and Medicaid reimbursements. Faced with these capacity constraints, these practices often find it challenging to navigate government payment programs aimed at improving the health of their patients.

Approach

With funding from the Centers for Medicare & Medicaid Services (CMS), Altarum led the creation of a resource and support center to simplify compliance with CMS requirements for such practices. The cornerstone of the Quality Payment Program for Small, Underserved and Rural Support (QPP-SURS) was the Quality Payment Program Resource Center® website. After launching in 2017, this resource center provided clinicians across seven midwestern states (Michigan, Ohio, Minnesota, Wisconsin, Illinois, Indiana, and Kentucky) with free, self-paced tools and resources to help them successfully navigate the Quality Payment Program (QPP) within the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). It also connected clinicians directly with Altarum’s experienced practice facilitators for hands-on, personalized support.

Through QPP, MACRA’s aim is to help transition health care providers from fee-for-service to value-based care. To advance this effort, the Merit-based Incentive Payment System (MIPS) payment track combines legacy-quality reporting programs and an improvement category into a single new composite scoring and reporting system. Under MIPS, clinicians can receive positive, neutral, or negative adjustments to future Medicare payments based on their final score. 

For small, rural practices operating on slim margins, the ability to proactively manage Medicare payments is crucial. To help these practices report information accurately and achieve their highest possible MIPS score, Altarum created MIPScast®, a user-friendly Qualified Registry tool. We provided the tool at no cost to all SURS-eligible clinicians, enabling them to track their MIPS measures and improvement activities, compare their performance to national benchmarks and their peers, and directly submit program data to CMS.