Orthopedic practice maximizes MIPS performance with athenaOne tools

“Where does it hurt?”

That’s the question posed to prospective patients when they visit the website of Carolina Regional Orthopaedics (CRO). Shoulder or spine? Elbow or hip? The knee or the foot, the ankle or wrist? The practice is ready wherever the pain is, and not only with orthopedic surgical services but pain management, wound care, and physical therapy as well.

For patients within range of either of its two offices in Rocky Mount and Tarboro, North Carolina, CRO is known as the largest and best respected multispecialty practice in the region. Founded in 1986, the organization is owned and operated by four managing partners, all of whom are board-certified physicians. A total of 10 clinicians work at the practice, including five physicians and five physician assistants.

Like many of its peers in the healthcare world, CRO first turned to electronic medical records to qualify for incentive payments through the Centers for Medicare & Medicaid Services’ (CMS) Meaningful Use program. In 2013, says Blair Walker, the administrative assistant at the practice, they started their partnership with athenahealth.

“Many of our providers had been in medicine for 20-plus years, so they were used to doing everything on paper,” Walker recalls. “We went with athena because it’s so user-friendly. It made that transition to electronic records easy.” 

Good timing

Coincidentally, CRO’s move to athenahealth came just before CMS began pushing providers to embrace value-based care. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established the agency’s Quality Payment Program (QPP), and soon the practice had set its sights on participating in the QPP’s Merit-based Incentive Payment System (MIPS).

Walker says they enrolled in MIPS the first year they were eligible to do so, in 2017. The program provides Medicare payment adjustments reflecting how well practices and clinicians do across four key performance categories: quality, promoting interoperability, clinical improvement activities, and cost. Participants collect quality-measure data over 12-month performance periods and submit their results to CMS, usually directly from their EMR systems.

“We’d done our research and realized that we’d essentially be penalized if we didn’t participate,” Walker recalls. With that being the case, they turned to athenahealth “to figure out how to optimize our performance and receive the positive incentives that were available.”

MIPS rules allow organizations to report measures of their own choosing, but they must be appropriate for their specialty or specialties. Practices that perform best in the program tend to be good at picking measures that they’re good at and avoiding those measures that could give them trouble.

Their first year in MIPS, Walker remembers, she and the team at CRO quickly realized that strong performance could drive payment adjustments that would have a real impact on their bottom line. However, the practice had gone through a merger, she explains, and their scores were surprisingly low. “It was a real learning experience with a lot of trial and error, and a lot of watching the numbers,” she says. 

Eventually, with help from their athena customer success manager (CSM), the practice learned how to navigate the program, Walker recalls. “Thankfully, with her, and all the resources right in athena, I had everything that I personally needed and to teach my staff.” They made the best use of the measures they excelled in, and soon they were among its “exceptional” performers, or those who achieve the highest MIPS scores.

Visibility key to success

Today, CRO continues to leverage athenahealth for all things MIPS-related. With athenaOne as their EMR, providers can easily see the measures the organization is reporting and track their performance in real time. Anyone at the practice can access educational information through the platform if scores seem low, for example, and the athena CSM is just an email or call away when problems come up they can’t resolve on their own.

“We’re able to see which providers are doing well in certain measures, and which may do better in other measures,” Walker explains. That visibility allows them to focus their resources and “narrow down what each clinic needs to work on,” she says.

Walker adds that she’s taken advantage of one-on-one training sessions with the athena quality team, and notes that they helped her get accustomed to important resources like the QPP website and the CMS identity management portal HARP. These meetings have helped her determine when it makes sense to stop reporting a measure or to enroll in a new measure for the following year. athena also helped CRO maximize their performance through two proactive optimization services: Quality Measure optimization, which identifies higher-performing quality measures the practice is not already enrolled in; and Promoting Interoperability optimization, which identifies reporting periods for customers that yield optimal scores in this category.

Similarly, Walker often turns to athenaOne to make decisions on her own simply by going to the “quality” tab on her dashboard. The system works like “Google in an EMR,” she notes. “Everything is right there, and all our stats for each measure are a click away, even for the ones we’re not enrolled in.” She also takes part in “every athena specialty group that’s offered,” including those dedicated to orthopedics, wound care, and pain management.

By participating in those user groups, Walker says she’s been able to see what other practices are doing differently and, in many cases, apply their experience to CRO. “Anytime I’m having an issue, there’s always someone willing to lend a hand and share what worked or didn’t work for them.”

Last year, Walker says, CRO had four providers who exceeded the MIPS “exceptional performance” threshold and earned final scores of 100 or greater. For the practice, that’s meant better Medicare payments today, but it’s also helped their confidence as they look to succeed in value-based care in the future.