Anesthesia quality reporting was a hot topic when it was first introduced. Many experts predicted that every anesthesiologist group would need to quickly adopt quality reporting for clinical and financial reasons.
However, the implementation methods by various agencies, including CMS, have been flawed.
Anesthesia quality reporting was initially intended to measure a variety of metrics to help with clinical improvement but the actual standards have anesthesiologists doubting their usefulness for clinical outcomes. On the flip side, many groups still feel like they should implement quality reporting for financial reasons.
So, should your practice be investing in quality reporting?
Quick Review: How EHR, APM, and PQRS Play into MIPS
EHR + APM + PQRS = MIPS
- Medicare EHR Incentive Program (EHR) for eligible professionals: A payment incentive program for eligible professionals and hospitals that demonstrate the adoption, implementation, meaningful use, and upgrades of certified EHR systems and technology.
- Alternative Payment Model (APM): Payment systems that provide incentives to doctors who provide high-quality care. Anesthesiologists must participate in the advanced program to avoid penalties (if substituting APMs over MIPS).
- Physician Quality Reporting System (PQRS): A program that uses financial incentives to encourage individual eligible professionals and groups to report information on the patient’s quality of care.
Merit-based Incentive Payment System (MIPS): The combination of these three programs to report on quality, cost, improvement activities, and the promotion of interoperability.
Your score determines the bonus you could receive on your Medicare Part B payments.
Should You Adopt Anesthesia Quality Reporting Measures?
Many anesthesiologist groups feel like they need to implement anesthesia quality reporting for financial reasons but most anesthesia groups don’t need to. In many cases, it will just result in a losing financial bet for the foreseeable future. Here’s why:
Medicare: It’s a Wash
Medicare is the primary payer that requires anesthesia quality reporting. You may feel pressure to implement reporting for your Medicare payments – but be realistic about how much Medicare services you actually bill and determine if that is worth your financial investment.
Be realistic about how much Medicare you actually bill to determine if your MIPS investment is worth it.
The magic number is $90,000 a year in Medicare billing per doctor. For most doctors billing Medicare $90,000 a year, it makes financial sense to participate in MIPS or an APM, if for no other reason than to avoid a 7% penalty for not participating in 2019.
If you’re billing between $50,000 – $90,000 in Medicare annually, participating in MIPS is likely to be a wash in terms of direct costs/bonuses. Anesthesiologists billing less than $90,000 are not subject to penalties and the bonuses they might make are likely to be offset by the direct costs of participating.
If you’re billing less than $50,000 a year in Medicare, you almost certainly will not break even on your direct investment in setting up and reporting on MIPS. You may still want to implement quality reporting, but it shouldn’t be in expectation of direct financial payback.
Private Contracts: Not a Big Driver
There are some private payers who are basing their payment on MIPS-style scores – but this is extremely uncommon. If you have a major payer implementing these rules, then you will obviously want to reconsider whether you want to start doing it based on your own unique situation.
Hospital Relations: Long-Term Relationships
Although the direct financial implications of MIPS reporting may be marginal or negative for most anesthesiologists, some practices may want to invest simply to improve hospital relations.
Having a good relationship with the hospital you work for will help you when it is time to renegotiate your contract.
Many hospitals want their providers to participate in these programs, so even if it costs you some money now, having that positive long-term relationship with your hospital is probably worth it. When it comes to contract renegotiation, being on the good side of your hospital administration makes all the difference.
Another Option: Perioperative Surgical Home
The American Society of Anesthesiologists Perioperative Surgical Home (PSH) model of care provides a more patient-centric approach to surgery. It guides patients through the entire surgical experience from the decision to undergo surgery all the way through post-discharge and beyond. It has gained great enthusiasm amongst many anesthesiologists for opportunities in streamlining care and improving patient outcomes.
If you’re looking to implement a true quality initiative, rather than just checking boxes, PSH may well be a great model for your practice.
Fusion Anesthesia Can Be Your Secret Weapon
Many of our clients believe that spending their time seeking clinical improvements is better spent with their own initiatives rather than with MIPS reporting. Ultimately that decision is up to you and your practice’s specific situation. However, Fusion Anesthesia can be the secret reporting weapon for small anesthesia practices.
Right now, most anesthesiologists are looking for ways to improve their clinical outcomes through their own initiatives rather than anesthesia quality reporting.
Many large national anesthesia groups have used anesthesia quality reporting and software as a competitive weapon against smaller practices in order to poach their contracts. Fusion Anesthesia includes quality reporting consulting as part of our comprehensive service offerings. We are platform-agnostic and work with groups to set up their own customized reporting to help them best measure and accomplish their unique practice goals.
In conclusion, although anesthesia quality reporting may help in the long-term, there is probably no reason to rush into it unless you have a very large percentage of Medicare billing.
Questions? Feel free to contact us to discuss your quality reporting options.