Northeast Indiana primary care applies practice transformation tools to hit MIPS metrics

Dupont Family Medicine (“Dupont”), a primary care practice located in the Fort Wayne, Ind., used the demands of the Quality Payment Program (QPP) as a springboard for effective practice transformation.

To get assistance with the reporting requirements of the QPP’s Merit-based Incentive Payment System (MIPS), Dupont joined the Great Lakes Practice Transformation Network (GLPTN) and started a journey through the five phases of patient-centric practice transformation deemed by the Centers for Medicare and Medicaid Services (CMS) as necessary to effectively participate in value-based payment systems.

Working through the practice assessment and milestones

Although the formula for practice transformation seems straightforward ― create a team, set a vision, develop a plan, implement the plan, and track outcomes ― in reality, the extra burden placed on small- and mid-sized groups may seem insurmountable, according to Derek Kendrick, a PHA quality improvement advisor from Purdue Healthcare Advisors (PHA), which is the entity that manages the network for Indiana.

Since Dupont joined the GLPTN, Kendrick’s job has been to coach the practice through the transformation process. “At the onset, the requirements of practice transformation seem like too much as practice managers are forced to quickly become familiar with jargon associated with assessments, process improvement, metrics tracking, cost savings initiatives, and transitioning to value based contracts,” Kendrick said.

Taking it slow, Kendrick and Dupont Practice Manager Jaimee Cearbaugh began by reviewing quality data and completing a practice assessment. The network’s Practice Assessment Tool (PAT) gave the staff a new perspective on value-based reimbursement and how practice management can impact that revenue. “We were doing well before we joined GLPTN, but that assessment tool really made us think differently about our practice and about meeting its milestones,” Cearbaugh said.

The practice reported its metrics to CMS in 2017, the initial year for MIPS. The next year, the staff started preparing for MIPS earlier in the year to meet the enhanced 2018 MIPS measures, and was able to achieve exceptional performer status per the MIPS criteria.

Taking transformation a step further with Lean Daily Improvement

Later that year, Dupont decided to tackle a gap highlighted by the practice assessment that called for the organization to have a consistent process-improvement methodology. As a GLPTN member, Dupont was eligible for grant-supported lean coaching offered through PHA, and agreed to use PHA’s Lean Daily Improvement approach to correct inefficiencies in their chart-completion process.

We were not necessarily doing anything wrong in the past, but we just didn’t have a clear process. Now we do.

Overcoming initial hesitation due to what they perceived as a lot of work, the staff agreed to measure their performance by charting daily whether they met their goals; detailing corrective actions; and holding daily team huddles. They also placed numerator and denominator statistics for the week in an area where all staff could see the progress. This enhanced visual-management cue instilled the importance of completing every chart, every day.

Initially, the group struggled with the newly developed process, but within 10 weeks the process was hardwired into their operation and sustained for an additional month. “We were not necessarily doing anything wrong in the past, but we just didn’t have a clear process. Now we do,” Cearbaugh said.

Practice staff have applied that process to other pain points, including a project to correct inefficiencies in the practice’s scheduling system as well as efforts to better utilize Transitional Care Management Services (TCM) codes. Monitoring hospital discharges through a direct message portal now allows the practice an opportunity to provide better continuity of care through scheduled post-hospital office visits, to reach a network milestone aimed at providing better care coordination, and to increase MIPS metrics that lead to higher reimbursements.