Practice managers and physicians say they have had to work hard at MIPS, but ACI is the least of their headaches.
“The move from MU to ACI has not been a huge deal for us,” Abha Batta, billing manager for Ashim Arora, MD, who has a pulmonology practice in Simi Valley, Calif., with two physician assistants. “When we saw MIPS coming, we decided to join an accountable care organization to be part of a bigger entity,” she says. “They are submitting the improvement activities and quality information on our behalf, and we are submitting the ACI information ourselves." Batta’s practice is using the 2014-certified version EHR from drchrono, which includes a MIPS scorecard she says lets them proactively see progress on quality metrics to ensure success.
Ogechika Alozie, MD, has seen the transition from MU to ACI from two different perspectives. He has a private practice focusing on infectious diseases and he also serves as chief health information officer at Texas Tech University Health Science Center in El Paso. The transition from MU to ACI wasn’t difficult in his private practice, he says.
Alozie credits his EHR vendor, athenahealth, for providing the tools to help with the shift from one data-based program to another.
“They would send e-mails and a monthly scorecard so you could see if your numbers were not where you wanted them to be on some measures and you could take steps to improve them," he says
In his role at Texas Tech, one challenge he sees is that some providers have been in the Medicaid MU program and others in MIPS, yet they're using the same health IT platform. Although MIPS has fewer burdensome requirements than MU, “you always have some providers who do not want to engage and see this as a burden,” Alozie says. “They are digital immigrants, not digital natives, and they see this only as boxes to be checked.”
Practices tend to have the most trouble with view, download and transmit requirements and sending summaries of care, Alozie says. Providers of all sizes still having problems with transitions of care, he adds, saying that the industry as a whole needs to work on interoperability. “I have patients with HIV and hepatitis and I still have trouble getting consistent transition-of-care summaries from hospitals.”
MSOC’s Chamberlin says many providers in rural areas refer to other small practices rather than to large hospital-based clinics. Many of these referral partners haven’t done MU or MIPS and don’t have secure e-mail accounts set up to receive the summary of care document. “The exclusion finalized in the 2018 Final MIPS rule is really helpful for these folks, but it will continue to be a problem when the reporting period for ACI eventually moves from a 90-day period to the full calendar year,” she says.
A Focus on Care Coordination
ACI can be seen as a stripped-down version of MU focused on improving care coordination, says David H. Smith, assistant director of HIT and outpatient services manager for HealthInsight, a nonprofit quality improvement organization for a four-state region serving Nevada, New Mexico, Oregon and Utah.
“I think CMS has really focused on retaining the care coordination aspects of MU. In Oregon, we have been encouraging practices to do more management of their electronic inbox."