Patient Experience QCDR for MIPS

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CMS has approved Bivarus to participate in the Merit-Based Incentive Payment System (MIPS) for 2018 as a Qualified Clinical Data Registry (QCDR).

Under MIPS, there are several data submission methods, one of which is a Qualified Clinical Data Registry (QCDR). A Centers for Medicare & Medicaid Services (CMS)-approved QCDR is an entity that collects clinical data from MIPS eligible clinicians (both individual and groups) and submits it to CMS on their behalf for purposes of MIPS.

Structured Assessment of the Patient Experience (SAPE) QCDR

Our Structured Assessment of the Patient Experience (SAPE) QCDR is a unique patient experience survey platform that enables your practice to both comply with MIPS and gather meaningful patient-generated insights about their experience with your practice and team. With SAPE QCDR, patient-reported insights are gathered via email or text message following their encounter or visit. This provides greater potential to capture a better picture of the overall quality of care as well as implement data-driven continuous quality improvement (CQI) initiatives. As a cloud-based platform, an easy-to-implement EHR data feed is all that is required to get started.

Key Benefits

The Bivarus-powered QCDR platform satisfies MIPS requirements by recording performance based on patient feedback completed in near-real time. In addition, the SAPE QCDR has three distinct advantages over other reporting mechanisms:

The Bivarus QCDR is not clinically specific. Most registries are designed for specific clinical specialties – but what if your group practice encompasses multiple specialties? Our QCDR is flexible enough to be used for all clinical subspecialties and has the ability to report outcomes by provider, department, specialty, or organization. The specificity of the data available allows you to identify mentors within your practice and develop interventions to address specific performance issues that may be found. Our reporting platform also provides “top box” performance scores, mean scores, and scores for comparisons within practices.

Our approach truly captures the voice of the patient. Our QCDR surveys patients directly via email or text message within hours of an encounter. The data collected provides a comprehensive view of overall quality of care and benchmarks for future comparisons. Our QCDR is also designed to focus on the most critical aspects of care observable from the patient perspective including patient safety, communication and care coordination, and quality of care.

The Bivarus QCDR is easy to implement. Our QCDR is a cloud-based platform that requires a minimal data feed from your electronic health records system – and that’s it! No data or chart reviews are required from providers. Patient insights are accessible 24/7. And, finally, we deliver all required MIPS data to CMS on your behalf.

Core Measures

To meet the needs of MIPS, eligible professionals and/or practices have to report on 6 measures which must include one outcome measure. The QCDR reporting option is different from a qualified registry because it is not limited to measures within the Quality Payment Program.

Our QCDR meets the MIPS reporting criteria with the following measures:

MEASURE 1: Patient Reported Comprehensive Assessment of Safety (BIVARUS27)

  • Bivarus 1: Hand Sanitation Performed By My Provider
  • Bivarus 2: Medication Reconciliation Performed At My Visit
  • Bivarus 3: Practice Asked Me About Allergies
  • Bivarus 5: Practice Explained Medications Before Giving Them
  • Bivarus 10: Overall Assessment Of Safety

 MEASURE 2: Patient Reported Experience and Care Coordination (BIVARUS28)

  • Bivarus 16: My Doctor Listened To Me
  • Bivarus 17: My Doctor Made Me Feel Comfortable Asking Questions
  • Bivarus 19: My Doctor Explained My Final Diagnosis
  • Bivarus 22: My Doctor Informed Me of My Treatment Options
  • Bivarus 23: My Doctor Told Me How Longs Things Would Take
  • Bivarus 24: My Doctor Did Not Seem Rushed With Me
  • Bivarus 25: While In My Room, My Doctor Was Focused On My Issues
  • Bivarus 26: How Likely Are You to Recommend This Physician To Your Family

MEASURE 3: Patient Reported Care Team Communication (BIVARUS32)

  • Bivarus 7: Coordination of Care Among Physicians And Nurses
  • Bivarus 9: I Was Told How to Arrange an Appointment for Follow-Up Care
  • Bivarus 11: The Doctor Provided Follow-Up Care Instructions in A Way I Could Understand
  • Bivarus 12: I Was Involved In Developing My Care or Follow-Up Plan

MEASURE 4: Patient Reported Procedure Readiness and Care (BIVARUS33)

  • Bivarus (S-1): My surgeon’s office adequately prepared me for my experience at [Insert Name] Surgery Center.
  • Bivarus (S-2): My doctor or care team explained the procedure before it was performed in a way I could understand.
  • Bivarus (S-3): Before my procedure, possible risks and side effects of the procedure were explained in a way I could understand
  • Bivarus (S-4): The anesthesia team explained the side effects of the medications I was to receive during my procedure.
  • Bivarus (S-5): Prior to starting, my care team confirmed the procedure to be performed with me in a way I could understand.
  • Bivarus (D-1): Discharge and home care instructions were clearly explained in a way I could understand.
  • Bivarus (D-2): I was alerted to problems for which I should seek immediate medical attention should they occur after my procedure.
  • Bivarus (D-3): My care team explained how to manage any pain I felt after my procedure
  • Bivarus (D-4): My care team communicated with me about my care throughout my stay
  • Bivarus (D-5): My follow-up care was scheduled and explained in a way I could understand before discharge.

Frequently Asked Questions:

Q: How does MIPS scoring work?

A: MIPS scoring considers four weighted performance categories:

  • Quality (50%).
  • Advancing care information (25%).
  • Improvement activities (15%).
  • Cost (10%) (calculated from adjudicated claims, no data submission required).
Q: Who is eligible to participate in MIPS?

A: To be eligible for MIPS, you must bill Medicare more than $30,000 in Part B allowed charges a year and provide care for more than 100 Medicare patients a year. You must also be a:

  • Physician
  • Physician assistant
  • Nurse practitioner
  • Clinical nurse specialist
  • Certified registered nurse anesthetist

If 2018 is your first year participating in Medicare, you are not in the MIPS track of the Quality Payment Program.

Q: How much will the Bivarus SAPE QCDR cost my practice?

A: There is a nominal fee of $100 per provider per year for your practice to participate in the SAPE QCDR. In addition to the annual reporting fee, practices must also pay for an annual subscription to our Patient Insights platform. Our QCDR is essentially a module of our Patient Insights platform. For more information about our tiered pricing model (based on total number of providers in the practice), please contact us.

Q: How do I know if SAPE QCDR is the right reporting mechanism for me?

A: We would be happy to provide you with a demo of SAPE QCDR and answer any questions. We think that once you see how painless it can be to meet MIPS requirements with SAPE QCDR, you will determine that it’s the platform for you. Contact us to schedule a demo.

Q: What is the Quality Payment Program?

A: In October 2016, the Department of Health and Human Services issued its final rule implementing the Quality Payment Program, part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA ended the Sustainable Growth Rate formula, which threatened clinicians participating in Medicare with potential payment cliffs for 13 years.

The Quality Payment Program policy is designed to reform Medicare payments for more than 600,000 clinicians across the country. Clinicians can choose how they want to participate in the Quality Payment Program based on practice size, specialty, location, or patient population. One participation option (also referred to as a “track”) is the Merit-Based Incentive Payment System (MIPS).

Q: What is the Merit-Based Incentive Payment System (MIPS)?

A: MIPS is a track of the Quality Payment Program designed for clinicians who are choosing to participate in traditional Medicare where they earn a performance-based payment adjustment to their Medicare payment. MACRA replaced three Medicare reporting programs with MIPS (Medicare Meaningful Use, the Physician Quality Reporting System, and the Value-Based Payment Modifier). MIPS also adds a new performance category called “improvement activities.”

In MIPS, clinicians earn a payment adjustment based on evidence-based and practice-specific quality data.

Q: How does participation in MIPS work?

A: The MIPS performance period for 2018 began January 1 and closes December 31, 2018. During this first year of MIPS, eligible clinicians must submit at least 90 days worth of data to avoid a downward payment adjustment. Clinicians who aren’t yet collecting data have until October 2, 2018 to get started. All clinicians reporting for 2018 will have until March 31, 2019 to deliver performance data in order to avoid the downward adjustment. Clinicians will be able to submit as an individuals or as part of a group.

The MIPS payment adjustment is based on the data submitted. Based on your performance in 2018, you will see a positive, neutral, or negative adjustment of up to 5% to your Medicare payments for covered professional services furnished in 2020. This adjustment percentage grows to a potential of 9% in 2023 and beyond. In addition, during the first six payment years of the program (2019-2024), MACRA allows for up to $500 million each year in additional positive adjustments for exceptional performance.

In total, MACRA provides for up to $3 billion in additional positive adjustments to successful clinicians over six years.

Q: How can I determine if I’m included in MIPS?

A: Just have your National Provider Identifier (NPI) number nearby and visit the CMS Quality Payment Program website.

Have more questions about QCDR for MIPS?