The Impact of QPP on Cardio-Oncology Care

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The Impact of QPP on Cardio-Oncology Care

Many professionals or experts working in the
healthcare IT industry, policy specialists and
new industry stakeholders continue to investigate
into the 1,473-page proposed rule released by
the CMS or Centers for Medicare and Medicaid
Services in July 2018 that provides updates on
the OPP or Quality Payment Program and Physician
Fee Schedule. This new update also summarizes the
Medicare Incentive-based Payment Program (MIPS)
and Advanced Payment Models. Where we Stand on
Healthcare Spending? An investigation comparing
health care spending, prices, utilization, and
healthcare results across 13 high-income nations
shows that in 2013 to 2016, the United States
spent far more on healthcare than the mentioned
high net worth countries, Despite this, Americans
had poor health care outcomes, which also
includes shorter life expectancy along with high
rate of chronic conditions. As an assessment,
the US spends 17.1 of the gross national product
on healthcare, but the United Kingdom spends 8.5
with the same healthcare outcomes. This model of
higher spending with bad outcomes is not
justifiable. Each year, the federal government
relies on the Sustainable Growth Rate to keep
costs low. Every passing year as the spending
increased, resulting in the formation of the
Medicare Access and CHIP Reauthorization Act of
2015 (MACRA) that stirred the focus from
fee-for-service to value-based payments.
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The Impact of QPP on Cardio-Oncology Care

• However, this transformation has both proponents
  and detractors. But most importantly, it makes
  sense that to be the best guardian of healthcare
  dollars, physicians and healthcare units must
  focus on providing the best care to our patients
  at the lowest cost. The value of your work is
  publicly reported and appreciated by patients as
  well as payers.
• One important thing to remember here is that for
  participation in advanced alternative payment
  models, the Merit-Based Incentive Payment System
  (MIPS) for financial and quality reporting data
  collection was started in 2017 and will be used
  for payment adjustments or incentives in 2019.
• The Impact of QPP on Cardio-Oncology Care and
  Medical Billing
• Identifying opportunities to rectify the
  cardio-oncology care delivery along with billing
  and coding should be a win-win. The Cardiologist
  should know that taking full advantage of the QPP
  program will be vital to maintain and improve
  their reimbursement cycle. Utilizing the parts of
  the program which directly measure
  cardio-oncology processes and results will also
  ensure suitable therapy for the patients.
• One of the main objectives of the QPP is to give
  cardiology healthcare facilities the flexibility
  to choose the procedures and measures which are
  meaningful to their practice.

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The Impact of QPP on Cardio-Oncology Care

• Of the four categories defined, two of the areas
  Quality and Improvement Activities - provide the
  opening to optimize clinical care specifically
  for cardio-oncology physicians. For the program,
  clinicians must pick six out of (about) 300
  quality measures one of them should be an
  outcome or high-priority measure. This Quality
  category has a 50 weight for 2018 data year that
  aligns with MIPS.
• Quality Measures for increased Reimbursement
• For a physician who wants to directly impact
  cardio-oncology care and take advantage of MIPS
  QPP via medical billing and coding, the following
  list has some worthy choices for Quality
  measures.
• Have shared decision making and discuss/provide a
  care plan
• Communicate through reports and coordination of
  care
• As you deal in the cardio-oncology screen for
  tobacco use and provide cessation to manage
  comorbidities
• The Centers for Medicare and Medicaid Services
  has an informational online tool that allows
  cardiologists to explore the various measures
  that may best suit their practice.

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The Impact of QPP on Cardio-Oncology Care

What next? As the QPP is pushed further in the
next couple of years, the penalties and
incentives will rise. There is no real option for
not participating. Therefore, participating in
the program is a clinician's best option for
success. For those healthcare units who manage a
large number of cardio-oncology patients, keeping
patient care and claims reimbursement on the same
track is not possible. In such, aligning your
priorities with experts in the cardiology medical
billing and coding like us will help ensure that
the quality measures are in check and the claims
submitted via us aid is pacing your revenue
cycle. As far as the patient population in
cardio-oncology increases, your ability to
provide high-quality care in a lucrative manner
will continue to grow in importance.