By David Truncer, Dräger

Many of our customers are spending an increasing proportion of their time dealing with healthcare regulations. One recent example carries significant impact for anesthesia providers: On October 14, 2016, the Department of Health and Human Services published the final rule implementing the Quality Payment Program (QPP) as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

As of January 1, 2017, certain clinicians reimbursed by the Centers for Medicare and Medicaid Services (CMS) are required to participate in the QPP, which replaced the Sustainable Growth Rate formula.

There are now two pathways for CMS reimbursement: the Merit based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APM). Most anesthesia providers will likely follow MIPS. Under MIPS, Medicare reimbursement is determined by clinician reported performance data in specific categories: 1) Quality; 2) Advancing Care Information; 3) Clinical Practice Improvement Activities; and, 4) Resource Use (Cost). In order to be eligible for the maximum reimbursement, clinicians need to submit at least 90 days of performance data for these four categories.
The common factor of these four categories is the need to collect, collate, format, and submit required data. Because manual data collection is expensive and time consuming, clinicians often outsource the task to third-party vendors.

The Electronic Health Record and an Anesthesia Information System (AIMS) can be used to capture data for certain anesthesia-related quality measures because they contain most of the necessary data elements. You can work with your IT department to establish multiple collection processes. Defining and standardizing your data collection and submission process is critical to the success of your MIPS data submission. Ideally, you should take these steps and consider the following factors: