Newsroom

April 21, 2017

Summary
Most anesthesia practitioners participating in the Quality Payment Program in 2017 will participate in the Merit-Based Incentive Payment System (MIPS). This eAlert offers a guide for eligible clinicians on how the MIPS composite score will be calculated, including an explanation of the scoring system’s four thresholds, a description of the four categories in which clinicians can earn points and suggestions for optimizing your scoring potential.

The Medicare Access & Chip Reauthorization Act of 2015 (MACRA) marked the end of Medicare payment’s fee-for-service model and the beginning of a performance-based payment system, the Quality Payment Program (QPP).  Understanding how participation in the QPP will impact your payments begins with understanding the scoring system.

Scoring in the QPP is impacted by the eligible clinician’s (ECs) choice of one of two tracks: the Advanced Alternative Payment Models (APMs) or the Merit-Based Incentive Payment System (MIPS).  

This eAlert explains the scoring system for MIPS from a high level, including the following:

  • The scoring system’s performance thresholds, laying out the points needed for positive payment adjustments
  • The categories in which clinicians can score points, including an explanation of the benchmark scoring for Quality that is 60% of the clinician’s score
  • Suggestions for how to plan your MIPS strategy within CMS’s new “pay for performance” model

MIPS’ scoring system is on a scale of 0-100.  The score will impact how the Centers for Medicare and Medicaid Services (CMS) calculates payments, trailing two years. A good score in 2017 means a positive payment adjustment in 2019, and so on.  The MIPS score will be used to calculate payment adjustments on a sliding scale from a 4% positive or 4% negative payment adjustment based on 2017 scores (paid in 2019) ramped up to +/- 9% scored in 2020 and paid in 2022.  Payment adjustments will be on a linear scale, so every point earned will mean a larger reimbursement.

Four Scoring Thresholds

The MIPS scoring system has four distinct thresholds.  As 2017 is the transition year for clinicians to join the new program, CMS has tried to make the scoring system as friendly as possible to those just beginning to participate in MIPS.  Not participating at all means a score of zero points, but even modest participation will translate to a score above the positive payment threshold of three points, thereby reaching the neutral payment adjustment.

  • 0 Points: Clinicians who do not participate in MIPS at all will receive zero points and a negative 4% payment adjustment.
  • 3 Points: Even modest participation in MIPS, commonly called the “test pace” option, will earn three points and qualify for a neutral payment adjustment (neither a positive nor negative change in payment).
  • 4–69 Points: This is the range where clinicians can begin to see modest payment adjustments.  Positive payment adjustments will be assigned on a linear sliding scale, with higher scores bringing clinicians closer to the maximum 4% positive payment adjustment.
  • 70–100 points: This group is eligible for the exceptional performance bonus, which will use additional funds to boost positive payment adjustments for top performers.

These thresholds will change in subsequent years, but during the 2017 transition year, the QPP provides a large range of positive payment adjustments for enrollees who earn between 4 and 100 points.

The sliding scale for payment adjustments will depend on several factors, ranging from the available money retained in negative payment adjustments to the scores of participating clinicians.  CMS will take scores in the 4-100 range and apply an adjustment factor that takes these factors into account.  For those scoring in the exceptional performance range of 70-100 points, additional funds are available for a minimum 0.5% performance bonus, possibly scaling as high as a 10% bonus.

Four Performance Categories

In order to earn points, ECs can choose to participate in MIPS' four performance categories: Quality, Improvement Activities, Advancing Care Information and Cost.  The amount that each category contributes to the MIPS final score will change over time, but in 2017, Quality comprises 60% of the MIPS score, Improvement Activities 15%, Advancing Care Information 25% and Cost 0% (to ease the transition to MIPS).  The methods to earn points in each category are unique:

  • Quality (60%): the Quality category is scored by reporting on six quality measures for the full reporting period.  For at least half of the episodes in the reporting period, ECs need to record their performance. (In future years, this reporting rate will increase.) Those of you who have participated in past CMS programs will recognize this as the successor to the Physician Quality Reporting System (PQRS).
  • Improvement Activities (15%): Reporting Improvement Activities requires selecting activities from CMS’s list, which contains over 90 options.  Each activity is either a high or medium "weight," and ECs will need to attest to CMS some combination of four mediums, two highs or a high and two mediums.  Some groups can earn double points, reducing the number of activities they need to attest to for full credit.
  • Advancing Care Information (ACI) (25%): To participate in this category, ECs or groups must complete four or five base requirements with a 2014 or 2015 Certified Electronic Health Record (EHR), respectively.  ECs may then score additional performance and bonus points.  ACI’s component measures will be familiar to those who have participated in the Meaningful Use or EHR incentive programs, but ACI's modular scoring and greater flexibility are different from those programs.
  • Cost (0%): The Cost category measures resource use, and is the only category that does not require ECs to report anything.  In 2017, CMS will calculate Cost scores from submitted claims. CMS will give ECs feedback through the Quality and Resource Use Reports (QRURs), which were previously used as individualized feedback for the Value Based Modifier.

CMS intends to adjust the score weights and nature of these categories every year to adapt to providers’ changing performance.  In 2017, the transition year, CMS has tried to make scoring points as achievable as possible by weighting the categories toward familiar activities (such as quality reporting).  CMS has also tried to provide accommodations for non-patient facing and hospital-based providers and providers in rural or small settings.  Finally, for 2017 only, providers only need to participate for 90 days to be eligible to score in the 4-100 point range.  Earning a positive payment adjustment for 2019 is achievable, with the right registry, EHR and management approach and as long as you are registered and begin collecting data by October 1, 2017.

Most category scoring has a direct relationship between a provider or group's performance and the score earned.  For instance, Improvement Activity scoring is based on a simple attestation: if you perform the activity, you have earned the points.  However, the Cost category (in future years) and the Quality category both have competitive or relative scoring methods.  In 2017, the Quality category's performance scoring method is important to fully understand, since Quality makes up fully 60% of the final MIPS score.  The category's performance scoring system is based on benchmarks derived from previous years' performance data.

In the Quality category, the scale for scoring points varies by measure because each measure has its own benchmark.  An individual quality measure has a scoring potential of 0-10 points.  To assign points, CMS looks at historical performance on that quality measure to establish benchmarks.  The top 10% of a benchmark will earn 9-10 points, the next 10% will earn 8-9 points and so on.  This decile scoring system means that it is possible to perform 95% on a quality measure, but if that is only "average" for the measure (the middle 50% of people reporting that measure had 95% performance), then CMS will award only five points for a 95% score.  Think of this as the equivalent of "grading on a curve."  For measures with very high historical performance, performance rates are so high that only perfect performance can earn the full points, and even 99% performance may only equate to four or five points (CMS refers to these as "topped out" measures).

Optimize Your Scoring Potential

While the Quality category has high standards for benchmarked measures, nearly half of all quality measures do not have benchmarks.  For quality measures without a benchmark, CMS has established a "floor" of three points (out of 10) for measure scores.  This means that, in 2017, it is possible that anesthesia providers selecting measures applicable to their practice may have no applicable measures with benchmarks.  If no submitted measures have benchmarks, a provider's Quality category score will be 18 out 60 points.  CMS will be working to benchmark measures for future years, but in this transition year, many quality measures will only have a three point (out of 10) scoring potential.  To review this year's benchmarks, visit the QPP site's Education page to download the Quality Benchmarks.

QPP Education Page: https://qpp.cms.gov/resources/education  
Quality Benchmarks: https://qpp.cms.gov/docs/QPP_Quality_Benchmarks_Overview.zip

Anesthesia providers wishing to maximize their Quality performance score have some options to increase their Quality category scoring potential.  First, they should work with a specialty registry to help select measures applicable to their practice and take care to consider measures with benchmarks (there are some anesthesia-specific measures with benchmarks).  Secondly, providers should consider submitting as many outcome and patient experience measures as possible.  There are many outcome measures in anesthesia, and each measure submitted past the first required measure is worth two bonus points.  Although capped at 10%, ECs can even submit additional measures past the required six measures to earn the bonus points for supporting high priority measures.

The Quality category reveals CMS's general MIPS strategy.  The MIPS scoring system is designed to reward ECs who are deliberate in strategizing about how to improve patient care over time.  Providers who seek high priority measures focused on patient outcomes and experience will earn higher scores.  By incentivizing these activities, CMS hopes to help providers improve their care.

For the overall MIPS score, CMS has set the performance threshold at only three points for the QPP’s transition year.  They will raise the minimum next year (increasing the number of ECs who will receive a negative payment).  In subsequent years—2019 and beyond—the performance threshold will be the mean or median score, as required by MACRA.  Ultimately, a higher minimum performance threshold will mean larger rewards for good performance and deeper negative payment adjustments in the coming years.  The best way to prepare is to start participating now, and to develop a meaningful strategy to ensure the highest quality care.

Questions?  Contact This email address is being protected from spambots. You need JavaScript enabled to view it. or the MACRA MadeEasy hotline at (517) 962-7301.

 

Rotaplast InternationalJackson, Mich.,— Rotaplast International Inc., a humanitarian non-profit organization, announces the successful addition of the Plexus Technology Group, LLC (Plexus TG) anesthesia EMR, Anesthesia Touch™, in their mission work performed all around the world. Rotaplast anesthesia teams began electronically charting anesthesia records during their mission trips to Faridabad, India and Chittagong, Bangladesh and will continue beginning with their mission trip to Guatemala City, Guatemala in February 2017.

Rotaplast recognized that traditional anesthesia EMR solutions, such as those that dominate at large universities, were not practical for their mission trips, nevertheless they understood electronic recordkeeping should be part of their humanitarian vision. They sought out a state-of-the-art mobile cloud-hosted solution with the flexibility to succeed in the various environments encountered on global missions. Rotaplast volunteer anesthesiologists were pleased to find such a solution in Anesthesia Touch Plexus TG, a company willing to support their humanitarian vision.

“The anesthetic record was developed as a tool for improving care, but the classic written record does little to help us as the provider or those we are teaching at our host hospitals. Anesthesia Touch provides all the things we need and want from an electronic record, such as legibility and accuracy. In addition, its platform provides a searchable database making it easy to study and analyze past cases, enhancing our ability to learn and improve future experiences,” says Neal Fleming, MD, PhD, Chief Anesthesiologist and Board of Directors' Vice Chair at Rotaplast International; and Professor of Anesthesiology and Pain Medicine, Vice Chair for Education, and Director of Cardiovascular and Thoracic Anesthesia at UC Davis Medical Center.

Rotaplast has been providing free cleft lip and palate reconstructive surgery to children and families around the world for 25 years. The organization partners with local medical professionals and Rotary clubs to send 30-person multidisciplinary medical teams to developing countries. Not only do these teams provide comprehensive surgery and treatment free of charge, but they also educate and train the local medical staff. Plexus TG is proud to have Anesthesia Touch featured as a best practice tool for anesthetic care. A team usually runs three operating rooms with each requiring a plastic surgeon, an anesthesiologist and an operating room nurse, as well as other support volunteers. Rotaplast volunteers treat approximately 100 children per mission and have performed reconstructive surgery for over 18,000 children in 26 countries on five continents.

 “It’s a privilege for Plexus Technology Group to support the compassionate work provided by Rotaplast and to assist the more than forty anesthesiologists who volunteer on twelve to fifteen missions each year. We are very pleased to share our AIMS technology and cloud hosting services with Rotaplast. Anesthesia Touch delivers greater efficiency allowing the anesthesia team to spend even more time with the children they treat all around the world,” explains Tony Mira, CEO of Plexus TG.

About Rotaplast International Inc.
Rotaplast International, Inc., a non-profit organization, was founded in 1992. In 1996, Rotaplast became a separate non-profit corporation and has since consistently expanded its number of annual missions. In February 2015, Rotaplast sent its 200th mission and to date has served over 18,000 children. Rotaplast is committed to helping children and families worldwide by eliminating the burden of cleft lip and/or palate, burn scarring, and other deformities. Working with local professionals, Rotarians, and other organizations, Rotaplast sends multidisciplinary medical teams to provide free reconstructive surgery, ancillary treatment, and training for the comprehensive care of these children. Rotaplast supports education and research towards prevention of cleft lip and/or palate. Their aim is to help local professionals build sustainable models for the care of these children, improving their lives and those of their families. Rotaplast Chief Executive Officer Donna-Lee Young Rubin adds that Rotaplast is a participating organization with Rotary International Districts as part of Vocational Training Teams. Vocational Training Grants are centered around groups of professionals traveling abroad to teach local professionals to be independent or around projects designed to be sustainable. Rotaplast is part of a VTT Pediatric Craniofacial Reconstructive Unit in Iasi, Romania for surgical/ anesthesia training. Some of the scheduled Rotaplast missions for 2017 include Guatemala, Romania, Peru, Tanzania, Myanmar, Colombia, Venezuela, Bangladesh and India.  For more information, please visit rotaplast.org

About Plexus Technology Group, LLC
Plexus Technology Group, a subsidiary of MiraMed Global Services, is a leading provider of anesthesia information management and medication management systems.  Anesthesia Touch is a full-featured AIMS for both Windows and iOS platforms that supports concurrent charting and automatically records physiological data. It is easy to use, enhances patient safety, provides comprehensive anesthesia documentation and is certified as a full EHR for meaningful use.  Pharmacy Touch™, a modular add-on to Anesthesia Touch, automates controlled substance reconciliation, eliminates duplicate documentation, reduces drug errors and delivers charge capture and decision support at the point of care. 

Contact Info:
Jennifer Dixon, Director of Communications
781.915.0221
This email address is being protected from spambots. You need JavaScript enabled to view it.

Jackson, Mich.,—Plexus Technology Group, LLC (Plexus TG), a market-leading, best-of-breed anesthesia information management systems (AIMS) provider, is pleased to announce they will be exhibiting their anesthesia EMR and medication management system at the 2017 Healthcare Information and Management Systems Society (HIMSS) Annual Conference and Exhibition, held February 19th through 23rd at the Orange County Convention Center in Orlando, Florida. This five-day event includes exceptional education, world-class speakers, cutting-edge health IT products and government sessions that focus on public policy initiatives like Medicare, Medicaid and MACRA. HIMSS brings together more than 40,000 health IT professionals, clinicians, executives and vendors from around the world.

Plexus TG will be demonstrating its easy-to-use, scalable AIMS solution, Anesthesia Touch™, for both iPad iOS and Windows platforms.  Plexus TG recognizes the value and importance of offering seamless integration with existing hospital systems to achieve smooth workflows before, during and after surgery. By integrating Anesthesia Touch with facility’s electronic health records (EHR), clinicians can quickly access surgery schedules, patient demographics, physiologic data, lab results and patient preoperative information.

In addition, Plexus TG will be showcasing Pharmacy Touch™, an add-on module that makes medication management simple with its intuitive, easy-to-use system that delivers to anesthesia providers and their pharmacies an integrated solution with controlled-access cabinets, barcode syringe labeling, closed-loop reconciliation and automated charging.

“We are excited to present our state-of-the-art anesthesia EMR and medication management system, as well as offering one-on-one demonstrations to conference attendees this year at HIMSS17,” said Tony Mira, CEO at Plexus Technology Group. “This is a great venue for demonstrating how our medication management solution bridges the gap between pharmacy and anesthesiology, offering the easiest way to satisfy the necessary control and tracking of anesthesia drugs.”

As an iPad-based anesthesia documentation solution, Anesthesia Touch's full KLAS rating demonstrates Plexus TG’s commitment to providing complete AIMS functionality for their clients. For more information, visit www.klasresearch.com.

To learn more about the solutions offered by Plexus Technology Group, please visit booth #3393 at the Orange County Convention Center.
 

About Plexus Technology Group, LLC
Plexus Technology Group, a subsidiary of MiraMed Global Services, is a leading provider of anesthesia information management and medication management systems.  Anesthesia Touch™ is a full-featured AIMS for both Windows and iOS platforms that supports concurrent charting and automatically records physiological data. It is easy to use, enhances patient safety, provides comprehensive anesthesia documentation and is certified as a full EHR for meaningful use.  Pharmacy Touch™, a modular add-on to Anesthesia Touch, automates controlled substance reconciliation, eliminates duplicate documentation, reduces drug errors and delivers charge capture and decision support at the point of care. 

Contact Info:
Jennifer Dixon, Director of Communications
781.915.0221
This email address is being protected from spambots. You need JavaScript enabled to view it.

Plexus TG’s Anesthesia Touch™ earns high performance scores and is recognized for improving clinician workflows, delivering greater functionality and overall better user experience.

Jackson, Mich.,—Plexus Technology Group, LLC (Plexus TG), a fully KLAS rated, market-leading, best-of-breed anesthesia information management systems (AIMS) provider announces high performance results in the recent KLAS performance report, Anesthesia 2016: A Clinician Take on Anesthesia Information Management Systems.1 KLAS studied the differences among AIMS vendors to learn which vendors are meeting clinicians’ needs and are committed to their success in anesthesia. Based on responses from hundreds of active customers, KLAS reported best-of-breed vendors deliver better clinician workflows, greater functionality, better user experience and customers feel they are more invested in their success.

KLAS cites Plexus TG as consistently adapting its system to fit clinician workflow at the point of care.  Customers commend the integration, proactive support, technology and customizable workflows that all help drive clinician satisfaction with Plexus Technology Group.2

Recent KLAS research reveals that despite the market success of many enterprise vendors, best-of-breed vendors, like Plexus TG, continue to exceed their enterprise counterparts in efficiency, functionality and support.3 Clear differences are reported between enterprise and best-of-breed vendors, with best-of-breed vendors leading in overall provider satisfaction due mainly to their willingness to go beyond contractual obligations and work with their customers to improve usability and reliability.4

Below are a few comments provided by Plexus TG’s customers in the Anesthesia 2016 performance report:1

“When I work in the system, as opposed to on paper, I feel like I am actually doing my job, not just taking care of patients and then doing paperwork. I don't feel like I have to pay any attention to the record keeping, but I get very legible, detailed records at the end of my cases. The simplicity is the best thing about Anesthesia Touch.”

“We improve patient outcomes with Anesthesia Touch because of the system's quality measures, due to the collection of post-op outcomes, and because the system helps us with complications associated with our cases. Anesthesia Touch gives us the ability to manage the case and deliver safe anesthesia.”

“This system is user friendly. We can access data easily and stream vital signs. It is pretty much effortless for us to do these things.”

As an iPad-based anesthesia documentation solution, Anesthesia Touch's full KLAS rating and high performance scores in the anesthesia specialty report demonstrate Plexus TG’s commitment to providing complete integrated AIMS functionality.

“The reports KLAS produces are valuable to us, as a software vendor, because they offer an impartial assessment of how our customers perceive our products and services. Not only that, but receiving this information from KLAS on a regular basis allows us to continually strive to be the best in the industry and to challenge ourselves,” explained Tony Mira, CEO of Plexus Technology Group. “It’s clear from A Clinician Take on Anesthesia Information Management Systems that our clients recognize Plexus TG as a trusted partner to both the anesthesia practice and the facilities where they work.”

About Plexus Technology Group, LLC
Plexus Technology Group, a subsidiary of MiraMed Global Services, is a leading provider of anesthesia information management and medication management systems.  Anesthesia Touch™ is a full-featured AIMS for both Windows and iOS platforms that supports concurrent charting and physiological data streaming.  It is easy to use, enhances patient safety, provides comprehensive anesthesia documentation and is meaningful use certified as a full EHR.  Pharmacy Touch™, a modular add-on to Anesthesia Touch, automates controlled substance reconciliation, eliminates duplicate documentation, reduces drug errors and delivers charge capture and decision support at the point of care. 
 

1Anesthesia 2016: A Clinician Take on Anesthesia Information Management Systems” December, 2016.  © 2017 KLAS Enterprises, LLC. All rights reserved. www.KLASresearch.com.

2Anesthesia 2016: A Clinician Take on Anesthesia Information Management Systems” December, 2016. Page 4.  © 2017 KLAS Enterprises, LLC. All rights reserved. www.KLASresearch.com.

3Anesthesia 2016: A Clinician Take on Anesthesia Information Management Systems” December, 2016. Page 9. © 2017 KLAS Enterprises, LLC. All rights reserved. www.KLASresearch.com.

4Anesthesia 2016: A Clinician Take on Anesthesia Information Management Systems” December, 2016. Page 10. © 2017 KLAS Enterprises, LLC. All rights reserved. www.KLASresearch.com.

Contact Info:
Jennifer Dixon, Director of Communications
781.915.0221
This email address is being protected from spambots. You need JavaScript enabled to view it.

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