#10: How To Navigate MACRA And MIPS (And Why It Matters In Health IT) with Joy Rios and Robin Roberts
With each new year bringing a new government playbook for clinicians and providers, it’s hard to navigate the regulation. That’s why Joy Rios and Robin Roberts joined me on the show.
Joy is a three-time author, subject matter expert in MIPS, and health IT consultant and co-founder of Chirpy Bird Health IT, focusing on the Merit-based Incentive Payment Systemn (MIPS). She holds an MBA and is a Certified Healthcare Technology Specialist with a specialty in Workflow Redesign.
Robin’s experience in health IT goes back fifteen years. She currently is the co-founder and Director of Operations for Chirpy Bird Health IT. She and Joy co -host HIT Like a Girl Podcast, a podcast that interviews women in health IT. Constantly innovating and educating, Robin is very active in the health IT space.
Joy and Robin work together to help clinicians understand and meet the measures of the Merit Based Incentive Payment System (MIPS). They serve clinicians, saving them time and money, by helping them meet government regulations so they meet the qualifications for reimbursements.
Joy didn’t always know what she wanted to be. Along the way to her current career, she gained many skill sets. Her first exposure to health IT was in the 1980s when her dad and uncle started a company that specialized in turning medical records into microfilm.
Her bachelor’s is in English (yay for English majors!). But while completing her grad work, she took a “part time” job for a solar technology company. In the first year she enabled the company to grow from five employees to over eighty.
While these years were grueling, she learned first hand how to grow a business from the ground up.
After finishing grad school, she was burnt out and ready for something different. After a conversation with her uncle, she learned of his plans to expand medical records to electronic health records, and she decided to join him.
Then 2010 hit and the government funded EMR implementation for all of healthcare. She threw herself into researching the ins and outs of health tech.
Eventually, she saw a growing need for someone to help clinicians navigate the ever-changing government policies. She built a consulting team and began educating clinicians about their role.
Robin didn’t always work in health IT. Initially she worked in human resources and billing for healthcare. She got her first introduction to health IT threw happenstance. Her CEO needed help with a project that was in peril so she joined in.
She helped implement EMR for her company and that began her journey into health IT. Along the way she created software for value-based care. But this journey really began to change about a year ago during a conference call with the leaders of the company where she and Joy both worked.
It all began that fateful day when 22 people gathered for a conference call. Joy and Robin both worked in a private laboratory that recently changed ownership. They worked in the consulting arm of the company, and they learned on the call that the ownership was shutting down their department.
They seized the day. Instead of sinking in defeat at losing their jobs, they took the opportunity to start their own venture - Chirpy Bird Health IT Consulting.
They’d been throwing around the idea of Chirpy Bird for a while. And as luck would have it, a company had already contacted them about working on a value-based care project. No longer tied down, they immediately contracted with this company.
Fired on Friday. Hired on Tuesday. Chirpy Bird was on its way into existence.
Though it may seem like they had a smooth transition, it wasn’t all easy. Robin was in the middle of personal life challenges right when she lost her job.
Dealing with personal problems and not having a documented plan for work was definitely overwhelming. But she said that it forced them to work even harder, and be okay with making decisions on the fly.
Joy said that having a business partner was a big commitment. Almost as big as marriage. But both Robin and Joy agree that co-founding has been wonderful. You become each other’s cheerleader.
Joy has loved not having to ask permission to implement new ideas. You can get creative. The challenge is choosing which ideas to implement and where to spend your resources. The opportunities are endless.
Chirpy Bird deals deal with CMS reimbursements - otherwise known as Medicaid and Medicare. They also help clinicians navigate MACRA (Medicare Access and CHIP Reauthorization Act of 2015)- a bill that changes how doctors who treat Medicare patients are reimbursed.
To really grasp what’s going on, you need to understand the history of how CMS reimbursed providers.
In the past, clinicians were paid based on the sustainable growth rate. In other words, the government offered more compensation each year to compensate for more patients, inflation, etc.
But as of 2015 MACRA introduced value-based care.
It repealed the way physicians used to be paid and now required physicians to prove that they were implementing value-based care or they would be penalized. Sounds easy enough right? Wrong, in part because the government keeps changing the rules every year.
Keeping up with all the changes in regulations is a full-time job. And if you don’t keep up, your revenues will take a hit.
Here’s how MACRA works. Each year clinicians accepting CMS that meet any one of these three criteria could be losing government compensation.
Making more than $90,000 a year in revenue
Seeing more than 200 patients
Delivering more than 200 medical services
If clinicians accepting CMS fall into one of these categories, they are required to meet certain criteria. Otherwise, they forfeit a percentage of revenue.
In order to maximize revenue, physicians are subject to a sort of grading system. They receive a score from 0 - 100 based on what they report in these four categories.
Promoting interoperability in EMR
Reporting on half a dozen quality measures
Clinical practice improvement activities
In this new system, clinicians can be audited for up to seven years across multiple practices. And revenue losses can range anywhere from the $10,000s to the millions. This is a big deal for clinical practices.
Simplifying the process
Chirpy Bird helps clinicians stay up to date with new CMS requirements. And they help them improve their rating so they can receive better compensation.
Doctors didn’t go to college to deal with fine print. They went through years of school so they can help people. And that’s what Joy and Robin want to enable doctors to do. Eliminate distractions so they can help more people.
If you’re curious if you could be saving revenue, check out their calculator on their website. All you need is your NPI (National Provider Identity) number.
By helping clinicians optimize their scores, Chirpy Bird aims to give them more reimbursements and useful fodder for marketing.
Staying up to date
There are a lot of great resources out there for people who want to keep track of the regulations for themselves. You can access cliff notes online. But make sure you are seeing the most up to date material.
You can also participate in online workshops. In these workshops Joy and Robin break down the program and provide certification for those who take the course. Courses are available live or on demand.
You can access these courses at 4MedOnline. Get an extra 20% off by using the code CHIRPYBIRD20
Robin shared that when starting a new business, you need to choose your tools carefully. Don’t go with the cheapest options just to cut costs. Look at the full picture.
How much time will the cheaper tools cost you? Would you save more than revenue by investing in a more pricey option? Set up long term solutions so you don’t have to shift systems while you grow.
Joy invites everyone to listen to HIT Like a Girl. It keeps you in the know about the newest innovations made by women.
The most recent book Joy has been reading is Michelle Obama’s book entitled Becoming. It’s full of encouragement and inspiration.
She also recommends Dreamland, a book about the opioid epidemic in the U.S. It tracks the historical involvement of the healthcare industry in the epidemic we face today. This book is less uplifting but puts current trends in perspective.
Robin’s most recent read has been Girl, Wash Your Face. It encourages women that they can accomplish the goals and dreams they aspire to.
Want to connect with Joy and Robin? Find them here:
Robin on Twitter - @RRobertseHealth
Joy on Twitter - @askjoyrios
Like what you hear?
And, as always, if you need help with your marketing…
Let’s talk. You can book your free consulting session with me today.