Impact of Quality Metrics Requirements on Daily Practice of Advanced Practice Clinicians

Background: The Medicare Access and CHIP Reauthorization Act was designed to shift compensation from fee-for-service to pay-for-performance. Under the new Quality Payment Program, providers can choose between a Merit-based Incentive Payment System (MIPS) and an Advanced Alternative Payment Model (APM). In the MIPS, practitioners receive a composite score based on quality, meaningful use of certified electronic health record (EHR) technology, practice-based improvements, and cost. Providers will receive positive, negative or neutral payments based on their MIPS score. Practitioners participating in an APM will receive incentive payments for taking more risk related to patient outcomes. 

Objectives: To outline the new reporting requirements and timelines set by the ruling, and obtain the perspectives and needs of advanced practice clinicians (APCs) on the upcoming changes.

Methods: In a virtual advisory board, a group of 11 APCs from across the US reviewed the new requirements and discussed how they will impact practice and patient care in MS. Advisors responded and interacted virtually in an online forum over a period of 2 weeks. 

Results: Providers should begin recording quality metric data between January 1, 2017 and October 2, 2017 and must submit data by March 31, 2018, to potentially earn a positive payment adjustment and avoid a negative adjustment in 2019. APCs can document quality metrics through personal interactions and open communication with patients. These interactions can capture cognitive and bowel/bladder issues, fatigue, gait problems, falls, patient-perceived improvement, and employment, and may provide insights into early signs of deterioration, prompting timely intervention. However, entering this information into the EHR is time-consuming and could actually reduce one-on-one time spent with patients, which may adversely affect their satisfaction. Different measures to evaluate MS patients at the various stages of their disease are needed to document quality of care and practice-based improvements in care, and to ensure practitioners are not negatively assessed due to progressive disease. The effect of different treatment regimens on reimbursement also needs to be assessed.

Conclusions: Time constraints and current assessments limit the ability of APCs to document their value and ultimately improve patient outcomes. Longer, more frequent visits and updated assessments may improve patients’ impression of patient care and overall satisfaction.