Physician/CMSS Teams can Help With MACRA’s Improvement Activities Category

Since the Medicare Access and CHIP Reauthorization Act (MACRA) Quality Payment Program went into effect at the beginning of this year, the American College of Medical Scribe Specialists (ACMSS) has been helping clinicians and practices work through compliance issues during the first reporting period, which began on Jan. 1, 2017 and closes Dec. 31, 2017.

To avoid penalties, eligible clinicians should be planning to report some data to the Centers for Medicare and Medicaid Services (CMS) in 2017.  Whether they choose to report only 90 days of data or the entire year, eligible clinicians need to do some planning.

In this article we will point out some of the ways that Certified Medical Scribe Specialists (CMSS) and ACMSS can help providers report one of the key categories—Improvement Activities—which is weighted at 15% of QPP consideration.

In this category, to potentially earn a positive payment adjustment of 4% beginning on Jan. 1, 2019 under the Merit-based Incentive Program (MIPS), clinicians must send in data to MIPS about their clinical quality improvement activities in 2017 by the deadline of March 31, 2018. (Those who are using an Advanced Alternative Payment Model, or APM, will report through that model by the same date and may earn a 5% incentive payment in 2019.) There may be some crossover in reporting on this category for the Advancing Care Information category (see our previous article at https://theacmss.org/macra-aci/), and bonus credit may be available for reporting in both.

For full participation in the Improvement Activities performance category, most MIPS-eligible clinicians must attest that they have completed up to four improvement activities of their choosing for a minimum of 90 days. Groups with fewer than 15 participants or that are in a rural or health professional shortage area must attest that they have completed up to two activities for a minimum of 90 days.

Eligible clinicians can choose four improvement activities that best fit their practices from among 92 different activities. For the full list of improvement activities and to choose and download a CSV file with your chosen measures, go to https://qpp.cms.gov/measures/ia

We have provided examples below of some of these improvement activities that relate to preventive care and wellness plans, because ACMSS actively advocates for patient-centric improvement activities with a wellness focus. ACMSS also highlighted these because Physician/CMSS teams are well-suited to these particular activities and many more.

The following are some examples of measures that practices may choose from, and how ACMSS and Physician/CMSS teams may help:

·       Engage patients, family and caregivers in developing a plan of care (IA_BE_15): Engage patients, family and caregivers in developing a plan of care and prioritizing their goals for action, documented in the certified EHR technology.

How we can help: Certified Medical Scribe Specialists can help with many tasks, including assisting with insurance documentation, research, patient education, and ensuring an effectively documented CEHRT. They are also able to provide valuable input into improving documentation within the EHR and using that information effectively in care coordination.

·       Evidence-based techniques to promote self-management into usual care (IA_BE_16): Incorporate evidence-based techniques to promote self-management into usual care, using techniques such as goal setting with structured follow-up, Teach Back, action planning or motivational interviewing.

How we can help:  Certified Medical Scribe Specialists have deep knowledge of EHR documentation and structure.  Clinical outcomes are produced through alignment of richly embedded narrative that extends beyond pick lists and minimum data detail to produce patient-centered advanced care and outcomes.

·       Implementation of documentation improvements for practice/process improvements (IA_CC_8): Implementation of practices/processes that document care coordination activities (e.g., a documented care coordination encounter that tracks all clinical staff involved and communications from date patient is scheduled for outpatient procedure through day of procedure).

How we can help: Certified Medical Scribe Specialists meet certified electronic health record technology (CEHRT) requirements through CMS-recognized attested CEHRT personnel. Clinical information is captured in helping to write the patient’s narratives toward wellness, providing rich detail. In this way, care coordination can be based much more on outcomes that matter to patients in providing value-based care. The ACMSS CMS-approved credential crosswalk includes full advanced clinical and non-clinical skill sets that include workflow enhancements and which now go far beyond documentation into clinical/non-clinical workflows, meeting CMS compliance.

·       Participation in population health research (IA_BE_16): Participation in research that identifies interventions, tools or processes that can improve a targeted patient population.

How we can help: Physician/CMSS teams may assist with research, patient education and information dissemination, in addition to workflow and highly advanced clinical/non-clinical skill sets and roles found in these hybrid teams, allowing physicians to innovate care and create new holistic integrative models of care with the assistance of ACMSS.

Additional Measures

Other QPP Improvement Activity measures that Physician/CMSS teams are well suited to include:

·       Care transition documentation practice improvements (IA_CC_10)

·       Collection of patient experience and satisfaction data on access to care (IA_EPA_3)

·       Implementation of analytic capabilities to manage total cost of care for practice population (IA_PSPA_17)

·       Electronic Health Record enhancements for behavioral health data capture (IA_BMH_8)

·       Engage patients and families to guide improvement in the system of care (IA_BE_14)

·       Implementation of formal quality improvement methods, practice changes or other practice improvement processes (IA_PSPA_19)

·       Implementation of practices/processes to develop regularly updated individual care plans (IA_CC_9)

A Certified Medical Scribe Specialist serves as an assistant to the physician and/or mid-level provider, and can help to maximize the efficiency and productivity of clinical care. Physician/CMSS teams operate under the physician license to enhance workflow, patient efficiencies, patient-centered care, and focus on holistic wellness-driven care. Traditional duties include real time transcribing of physician notes, organizing objective health care data, and enhancing the electronic health record, point-of-service collections, and patient tracking. However, the role of a Certified Medical Scribe Specialist is now going far beyond those traditional duties.

The new Medical Scribe Specialist Curriculum, approved in January, has greatly expanded the role of the Certified Medical Scribe Specialist, focusing them on clinical and non-clinical roles related to wellness, preventive integrative medicine, disease reversal, integrative care, and complementary and alternative medicine, in addition to their traditional documentation roles. This includes delving into national standards such as MACRA, MIPS, and the Health Information Technology for Economic and Clinical Health (HITECH) Act, and enhanced training that makes them more valuable healthcare team members in care coordination and improvement.

The ACMSS certification program meets current and proposed CMS certification requirements toward meaningful use of electronic health records. ACMSS is independent from all scribe companies and organizations and works in compliance with the Centers for Medicare and Medicaid Services to meet national goals and initiatives of MIPS, MACRA, and Meaningful Use of computerized provider order entry.  Certified medical scribes also meet the “qualified people” standard in CEHRT.

The American College of Medical Scribe Specialists offers several pathways for Certified Medical Scribe Specialists and a growing list of customized, one-on-one consulting solutions. Please contact ACMSS directly at info@theacmss.org or 657-888-2158 if you have any questions regarding the ACMSS program and consulting services.

For a wealth of information on how to prepare for success with the Quality Payment Program, visit the Quality Payment Program Educational Resource library.