Medical Staff Seated In Circle Talking At Case Meeting.

Less than a year ago, the leadership at Prairie Lakes Healthcare System (Prairie Lakes) in Watertown, SD, realized they needed to take action to begin the transition to the Centers for Medicare & Medicaid Services (CMS) Merit-based Incentive Payment System (MIPS). On March 31, 2018, Prairie Lakes successfully completed the MIPS attestation and received a quality score of 97 out of 100.

“Prairie Lakes is committed to quality care and their leadership recognized the opportunity MIPS provided to highlight their expertise and services,” commented Holly Arends, CHSP, CMQP, program manager for the Great Plains Quality Innovation Network (QIN).

Prairie Lakes Healthcare System, Watertown, SDAs a rural, regional medical center providing healthcare services through an acute-care hospital and eight specialty clinics, Prairie Lakes had a diverse set of physicians and faced a variety of technical obstacles.

“The physicians realized the benefits of MIPS for quality improvement and were actively engaged from the start,” recalled Stacy Reck, MBA, RHIA, director of coding for Prairie Lakes. “The first decision made was to report as a provider group.”

Physicians participating in the Quality Payment Program (QPP) submit quality data and receive payment adjustments based on the performance of the individual or the group. Groups are allowed to choose from six methods for submitting quality data including a web interface, registry, electronic health record and attestation.

“The biggest hurdle was how to do MIPS without a comprehensive electronic health record,” Reck explained. “Holly Arends pulled us together to get the ball rolling. She helped us designate a project champion and walked us through the options to determine the best approach for data submission.”

Prairie Lakes’ hospital and dermatology clinic were able to merge their EHR systems to be used for attestation, but there was still the challenge of processing the remaining specialty clinics’ claims data. Ultimately, a registry approach was chosen allowing for real-time data sharing using a web-based portal.

This real-time data was used to determine high-impact areas and narrow down the lengthy list of MIPS quality measures for review and selection.  Great Plains Quality Innovation Network (QIN) Quality Payment Program Service Center provides technical assistance and resources to aid in this selection process including a MIPS calculator.

“It was important to share the data with the providers; the clarification they offered helped us avoid extra work and allowed us to refine and determine high-impact areas for reporting,” Reck added. “We chose quality measures focused on patient-centered care. We know how important it is to listen to our patients and provide a plan of care, including educating and preparing the patient for any procedure.”

Prairie Lakes will continue to use the registry method to provide real-time quality data for staff and providers.  As they begin a new reporting year, the team will take advantage of the opportunity to fine tune and select the highest value quality measures for tracking and reporting.

The CMS QPP website has additional resources and the Great Plains Quality Innovation Network (QIN) Quality Payment Program Service Center provides online technical assistance and support through phone, email and live chat.