Rural value-based care initiative faces funding gap

The smallest and most rural health care providers will soon lose access to help transitioning to value-based care unless Congress intervenes.

Over the past five years, rural health providers with fewer than 15 doctors have increasingly been encouraged to participate in Merit-based incentive payment system a cost-based payment program with financial bonuses or penalties. Participating providers must provide cost, benefit, quality, and interoperability data, or there may be risks associated with reduced Medicare payments. This year, for refusal to participate in the program, this is 9%.

When Congress created MIPS in 2015, lawmakers also provided Medicare and Medicaid services to the Centers. $ 100 million create Small, underserved and rural support A program to help these vendors figure out what action to report and how to keep abreast of MIPS changes. But starting from February 15, the money will run out.

CMS notified vendors this week that the Small, Low-income and Rural Support Program will close soon. Technical assistance contractors warned providers for months that they would have to largely manage the MIPS migration on their own once funding disappeared.

“In these small organizations, it’s just another hat that someone in the organization wears, usually an office manager or an account manager. And it’s very different from larger organizations because when you have time to be at Being 100% dedicated to the program makes it much easier to keep up to date with all the details, ”said Candy Hanson, program manager for the nonprofit quality improvement organization Stratis Health, a subcontractor of SURS.

“We have practitioners who would probably want us to double-check their work,” said Megan Houseley, assistant managing director of the University of Kentucky Regional Advisory Center, a subcontractor for SURS. “Then we have others who are themselves ignorant, which I am really worried about. Every year they actively use us ”.

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The largest number of MIPS penalties falls on small practitioners. Of the 1 million doctors who participated in the reporting year 2019, about 95% received bonuses. Almost 99% of groups with more than 99 providers received bonuses. For comparison, almost 90% of groups with 2-15 providers and almost 64% of individual providers received bonuses.

According to MIPS, providers choose from a wide range of measures in each category based on their strengths. But analyzing the data and figuring out exactly what to report is difficult. This is where SURS contractors come in. Of the 136,448 small suppliers that participated in the MIPS 2019 program, about 99,000 received technical assistance, according to the Government Accountability Office.

This consultation can range from giving instructions to providers on how to collect relevant data and select interventions that best reflect practice, to basic education about the purpose of values-based assistance itself.

Hanson remembered an optometrist who originally intended to simply enroll in Medicare for his non-MIPS practice. “He didn’t think there would be any value in it, but we not only convinced him to report, but they have been some of the best ever since,” Hanson said. “We also trained all of its employees to understand the data collection and reporting workflow because MIPS requires, especially in smaller organizations, that everyone understands the workflow in order to be successful.”

A coalition of the American Medical Association, the American College of Physicians, the Medical Group Management Association and the National Partnership for Women and Families petitioned Congress in late November to request an extension of the program.

Clare Ernst, MGMA’s director of government relations, said the expansion of the small, low-income and rural support program could be included in the expense accounts early next year.

“The frustration that big practitioners have with the MIPS program, I think smaller practitioners feel it the same way, if not more,” Ernst said. “Any help that can help them complete this incredibly complex and ever-changing program is truly critical to their success.”

However, the effectiveness of SURS in helping small rural service providers adapt to MIPS is unclear, and there is no research on how well contractors perform. MACRA, the law that created both MIPS and SURS, did not instruct CMS to assess the results of financial support or its impact on MIPS. SURS contractors achieved a 99% average annual clinician satisfaction rate with technical assistance based on an average of 19,281 responses, a CMS spokesperson wrote in an email.

“The broader question is, how useful is this program?” said Peter Mendel, senior sociologist at RAND Corp. When RAND studied MIPS in 2018, the consulting firm gathered feedback from participating vendors indicating that they considered the initiative onerous. “The program still required so much work on the part of doctors that even having this kind of support did not ease the burden of participation,” he said.

Suppliers must submit data for that year by March, the results of which will be reflected in their payment rates for 2023. In March 2023, a service center for the CMS quality payments program will be available to answer basic questions and consider more complex scenarios, the agency said on the expiration of the SURS funding.

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