Year one MIPS is behind us: Experience of San Juan Health Partners (SJHP), a division of San Juan Regional Medical Center (SJRMC)

• In April 2015, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) became law.
• Sustainable Growth Rate (SGR) was repealed, which governed updates to the Medicare PFS and replaced it with fixed, annual payment updates for all future years.
• MACRA retained the Medicare PFS as the basis for Part B payments to healthcare professionals. It establishes two separate payment tracks that will more closely align reimbursement with new quality and outcomes measures.
• The Physician Quality Reporting System (PQRS) and the Value Modifier programs will continue through 2018 and then sunset.
• MACRA created the Merit-based Incentive Payment System (MIPS), which merges several quality programs, including MU and PQRS (for eligible providers).

The goal of MACRA (see picture below) is to provide better care, spend healthcare dollars wisely and create healthier people and healthier communities. While none of us can deny the goals are principled, the question remains—will MACRA get us there?



San Juan Health Partners (SJHP), a division of San Juan Regional Medical Center (SJRMC)

MIPS Experience

San Juan Health Partners (SJHP) in New Mexico is a single tax ID, multispecialty health system with roughly 130 clinicians, 250 support staff, 15 unique ambulatory locations and three hospital-based groups covering one acute care hospital servicing a patient base with roughly 249,078 claims in 2017.

The challenge for San Juan Health Partners: a lack of integrated, aggregated data across the multiple systems. In 2017 SJHP noted over 80 different EHR systems/vendors.

As a health system, SJHP embraced the goal of better care, spending healthcare dollars wisely and promoting healthier people and healthier communities. SJHP is taking steps in 2018 to aggregate and integrate their data with a single EHR for improved reporting and outcomes of care and costs; however, for 2017 the challenge was reporting MIPS as a group. Leaders reported that the MACRA/MIPS reporting seemed confusing and extremely difficult to interpret. The already demanding day-to-day operations left little time to sort through options and methods for accurately understanding and effectively reporting MIPS. Leaders felt it was impossible to gain the expertise needed from their own staff. They didn’t want to resort to “test” options, as they knew they had to gain an understanding of the transformation at hand and ahead.

San Juan Health Partners engaged MGMA Consulting to guide them in interpreting and administering the MIPS rules, applying them to the SJHP system in a way that provided successful reporting and set SJHP up for future value-based models. When additional information from CMS about the MIPS program was expanded and clarified, SJHP felt the need for an outside subject matter expert to interpret and keep them on task for reporting and awareness of impacts to their health system.  

For the 130-plus clinicians at San Juan Health Partners, the task of reporting posed minimal intrusion. The system’s “SJHP physician-led Governance Council and leadership team,” already involved in improving outcomes, worked with the clinicians to understand the quality measures at hand and document strategies for capturing data for reporting through a CMS-certified registry. At this stage, the clinicians felt like MIPS was a “game”—how do we report and where, to gain the points? The sense of improving quality was not realized. Leadership did not believe Year One of MACRA/MIPS did anything to change the providers—they were passive in the process.

For the MACRA outcomes to be realized, clinicians will need to have a broad awareness of total cost of care and how quality measures improvement activities and technology (i.e., EHR) play a role in measure outcomes. SJHP leadership agrees that clinician involvement is key, and that the integrated EHR, as well as an understanding of total cost of care data as displayed in its QRUR, will further engage the clinicians in value, outcomes and cost conversations. For a multi-specialty group, the challenge will be how to engage the clinicians to understand the collective impact they have on meeting the goals of better care, spending healthcare dollars wisely, and providing healthier people and healthier communities.

Summary

San Juan Health Partners’ leadership solidly confirms that the engagement with MGMA provided value to their organization. Successful reporting at 99.5 points with opportunity for upward adjustment in 2019 is one positive. The real success is the foundation laid for future ongoing transformation. San Juan Health System’s move in 2018 to a single EHR across the continuum will be a huge step toward meeting the MACRA goals of better care and wiser spending of healthcare dollars, resulting in healthier people and healthier communities. In 2018, MGMA will continue to work with San Juan Health Partners to understand their robust QRUR report. Seeing the total cost of care impact with the Medicare patients they serve will further enhance SJHP’s cultural and operational shift to value-based models.


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