My dear departed Mother was a spiritualist. While the kids next door were playing Monopoly my siblings and I were being tutored in the finer aspects of the Ouija board. When I was a teenager she would strap on her “aura goggles” and give me a once over to make sure negative vibrations were not upsetting my adolescent development. I don’t know where those goggles are now but I remember the day she suddenly forbid us to touch the Ouija board. It was banned from our house for reasons unknown. The only thing she every said about it was that “if you open the door, you might not be able to close it”. The one thing she never abandoned was her crystal ball. I still possess that orb and from time to time it finds itself before me. Permit me a quick peak into the future so I may report on unexpected aspects of the MACRA/MIPS program.
Last month I wrote a post entitled, MIPS: The Tyranny of the Composite Score. The majority of Medicare Part B providers (those not in the Advanced Alternative Payment Model (APM) bubble) will have reimbursement directly and deeply impacted by the Merit-based Incentive Payment System (MIPS). A provider’s annual score (0-100) will be the holy grail in this new game of “pay for value” competition. For the most part those that will be affected have no idea that the reimbursement landscape has changed. They will know soon enough.
Now for the images appearing in the crystal ball. It reveals the composite score will not only have the effect of nudging providers into the “pay for quality” universe but also bring unexpected collateral effects. Here are a few:
Electronic Health Records:
Each provider’s composite score, and their EHR vendor, will be public information. Very quickly EHRs will be compared based on the average composite score of their users.
When a medical practice is hiring a Part B provider the value of that provider is directly related to their existing composite score. Likewise, if a hospital or some other entity is considering the purchase of an existing practice, you can bet the average composite score of that practice will come into play as value is assigned.
Right or wrong, distilling a provider down to a single “quality score” will make it easy to compare healthcare providers. Just as hospitals proudly boast of their national accolades and awards, this will be played out on the provider’s level.
The crystal ball has now grown cloudy and the images have become obscured. Back into the silk pouch it goes. Until next time.