The patient referral system is in for a shake-up as the implementation of the Medicare Merit Based Incentive Payment System (MIPS) draws closer. It’s not just a matter of following the new legislation (which will be implemented in 2019). Many physicians will need to redesign their entire surgical practice to work with and maintain referral-provider relationships under the new system.
MIPS operates on a point-scoring system, and the scores of your referring practice could be affected by their ability to collaborate with your practice. If you already have a digital system in place, there’s little need to worry. But if your practice is still relying on pen and paper, there’s work to be done.
If referrals can’t be tracked and managed (a crucial part of MIPS), referral physicians may cut you loose, choosing to work with practitioners who are already fully electronic. The reason is simple. Without comprehensive tracking, referring physicians risk losing out on the additional Medicare payments to which they are entitled.
Take the Steps to Make Sure Your System is MIPS-Worthy
So, rather than risking your relationship with your referring practice – which could severely affect your practice – make sure your system is MIPS-worthy.
As already mentioned, the best way to do so is to embrace the 21st Century and process all care information electronically. Referral sources want to ensure patients are properly passed off to your surgical practice and seen quickly to reduce (and hopefully prevent) the chance of more serious and expensive problems arising.
Referral sources may also want to collaborate more formally and effectively on patient issues within your practice. This will enhance their patient service scores and ensure cost-effective patient treatment (another MIPS scoring category).
For example, hassle-free coordination of post-surgery services with other practices could mean the difference between an expensive readmission and a cost-effective recovery process.
Similarly, lapses in therapy or delayed follow-up could be the difference between a speedy return to work or a permanent disability.
How to Maintain Your Relationships
Your relationship with the referring practice may also affect your participation in alternative payment models such as shared savings, care management, and capitation arrangements.
For example, a shared savings plan may require that referred patients be contacted within a set time limit about their condition and surgical options. In other situations, evidence-based pre-operative therapy and counseling may be required for patients served under an Accountable Care Organization.
Failure to see referred patients in good time or properly share the patient’s status with the referring practice could result in lower incentive payments or even limitations on the primary care provider network’s ability to refer patients to your practice. This means that surgical practices with high costs and/or less effective results may be excluded from the Accountable Care Organization provider network.
MIPS Requirements
MIPS includes several requirements that affect how practices interact with their referral base (and vice versa).
Transition of Care
MIPS includes an electronic method for facilitating and tracking a patient’s transition from one care setting to your surgical practice. If you can’t handle electronic referrals (or transition patients to other care settings), it may complicate the patient hand-off from your referral base to your practice.
In addition, the transition of care record from your surgical practice may include important information needed by the primary care practice and/or other parties to which you may refer the patient.
Reconciliation of Clinical Information
Under MIPS, physicians must reconcile patient medications, allergies, and problems for new patients. The transition of care record includes this information.
With the addition of any other information gathered by your practice, an updated transition of care record allows all relevant providers to easily and efficiently keep up with important patient information.
Access to Patient Information
MIPS quality measures encourage more patient engagement and communication. Under MIPS, patients can access their information and have greater opportunities to interact with practices through the patient portal.
Surgical practices that fail to support patient service opportunities and use MIPS-driven strategies to engage patients may be at a disadvantage to monitor patient wellness and adequately respond to patient issues.
The Advancing Care Information aspect of MIPS includes a measure involving the acquisition of patient information from outside the clinical setting and the opportunity to use secure messages to monitor patient wellness.
For example, a post-surgery health assessment questionnaire can monitor a recovering patient’s pain levels. In other situations, patients may use their smartphones to send a picture of their surgical site to monitor patient recovery more closely and frequently.
These patient service strategies are relevant for relationships with referring providers since surgical patients who are not properly informed or served may have a higher risk of post-surgical issues and delayed surgeries that can lead to serious conditions and expensive treatment.
More expensive patient treatment could negatively impact scores and the referring provider’s chance of qualifying for additional MIPS payments.
You Snooze, You Lose
Whether they want to or not, surgical practices are being called upon to manage referred patients more effectively and ensure proper communication on clinical issues and treatment strategies with referral sources and patients.
As the healthcare system continues to advance treatment and collaboration strategies to improve care and save money, practices lacking a reliable process to accept the electronic transition of care records and follow-up with referred patients will be severely disadvantaged.
