Arthritis Health Associates Excels in Annual MIPS Performance

As part of her role as IT Implementation Specialist at Arthritis Health Associates, Carol Glies, is tasked with managing the practice’s Merit-Based Incentive Payment System (MIPS) reporting. Despite having some knowledge of MIPS when she began her position, she felt overwhelmed by the complexity of measuring the four key performance categories: cost, quality, promoting interoperability, and improvement activities.

“I don’t know how many of the participants have time to spend a hundred percent of their time on MIPS regulation and changes. I couldn’t even begin to fathom how to go into all the regulatory workflows involved,” said Glies.

One major challenge of MIPS is keeping up with the constant changes and ensuring credit for tracked measures. Reviewing and planning each year is critical for determining practice focus. Fortunately, Arthritis Health Associates subscribed to NextGen Healthcare Quality Programs (QP) Services.

QP Services provides tailored assistance to help practices find the most efficient solutions for regulatory reporting and achieving measurable success. The team provides guidance on all four categories of traditional MIPS, the new MIPS Value Pathways (MVPs), and APM Performance Pathway (APP) via monthly check-in calls.

Moreover, QP Services runs custom reports, including treatment opportunity reports, and teaches practices exactly how to measure performance with workflow reviews.

“At the beginning of each year, Jeannelle Allen [QP Specialist at NextGen Healthcare] and I review any changes to the measures, new benchmarks, measures that have been capped at seven points, or any removed by CMS,” said Glies.

QP specialists support practices through the entire submission process including preparation for submission and making sure the audit binder is complete. They provide feedback reviews, cost data analysis, audit assistance, regulatory updates, monthly newsletters, and more.

The QP team also checks eligibility twice a year and provides screenshots from CMS’s Participation Lookup Tool, ensuring practices know which providers are required to report, eligible to opt-in, or not eligible for MIPS reporting.

In addition, the Monthly QP Checklist provides a structured and comprehensive tool to streamline Glies’s workflow. This checklist includes:

Monthly Focus Areas – Each month highlights different aspects such as Promoting Interoperability (PI), improvement activities, quality, and cost, with goals clearly listed at the top.

Administrative Section – Upcoming deadlines, audit binder details, and reporting periods are clearly outlined

Quality Measure Review – Highlights treatment opportunities and concerns, with a dedicated action items section for easy tracking.

Education and Alerts – Consolidates links to pertinent education, webinars, news, and changes in one place

“The quality measure review section highlights the treatment opportunity reports that I should focus on. It also lists any concerns about measures I have brought up. At the bottom is a section labeled action items so I can easily see what I need to do before our next call,” said Glies. 

Glies finds the checklist invaluable for recalling details from past calls and staying organized. The structured format allows for easy reference and ensures that all necessary actions are completed on time. Additionally, recap emails from Jeannelle, including the QP checklist and quality benchmarking tool, reinforce Glies’s to-do items and facilitates ongoing improvements.

HEALTH QUALITY MEASURE (HQM) REPORTING 

NextGen® HQM provides reports at the group, provider, and patient level. From these reports, a QP specialist tracks performance on a month-to-month basis and provides helpful recommendations for improving workflows and MIPS performance.

“Jeannelle configures and creates customized reports and makes them favorites, so all I have to do is run them,” said Glies.

Reports and tools include:

Practice Summary Reports – Both Electronic Clinical Quality Measure (eCQM) and Clinical Quality Measure (CQM) reports offer an overview of performance, highlighting areas needing improvement.

Treatment Opportunity Reports – These reports identify training opportunities for the clinical supervisor and help Carol track patient follow-ups and correct missed documentation.

Referral Loop Measure – The treatment opportunity list is used to identify outstanding referrals, ensuring thorough follow-up and patient care.

QUALITY BENCHMARK TOOL 

This tool consolidates measures from highest to lowest performing, incorporating data from the RISE rheumatology registry. Color coding highlighted measures to focus on, and monthly projected quality scores help Carol stay on track.

The structured approach provided by NextGen HQM significantly improves AHA’s MIPS performance. Carol can efficiently manage reporting, track progress, and implement necessary changes, leading to better overall performance and patient care.

The TPCC dashboard provides a detailed overview of Carol’s practice, including scores, patient attribution, spending per category, and risk scores. It compares current data with previous years to identify trends, despite changes in attribution. The dashboard helps identify which providers are ordering more or different services compared to last year. The final report includes a comprehensive written summary with screenshots, which is preferred for presenting to executives or managers interested in cost data.

“I appreciate the insight provided regarding our expenditure and how our costs align with the national average. This analysis enables us to identify our most costly patients and offers valuable perspectives on our spending across various categories,” said Glies.

Stats

AT AHA, the positive results are adding up. Most notably, they:

Earned a positive adjustment of over $35K and avoided more than $170K in penalties (2023)

Achieved a positive adjustment of more than $130K (2022)

Successful MIPS reporting involves careful planning and strategic implementation. NextGen Healthcare has demonstrated success with over six million dollars in incentives earned and over twenty million dollars in penalties avoided in a single year. Our clients consistently score 2–4% higher than the national average, with one-third achieving a perfect score of 100%. The Quality Programs Team at NextGen Healthcare provides essential tools and resources to help practices navigate MIPS and achieve measurable success.