Every day I receive all kinds of emails and other ads telling me about services offering me help to meet MIPS quality metrics. While they may be helpful, most doctors don’t see the need for such a program. It drives up costs in administering and time in needless metrics reporting. Yet, give us a new regulation and a whole industry is going to pop up to profit off of our work.
It assumes doctors were not already providing quality medical care. Most of the metrics are things we’ve already been doing in practice. However, there are people being paid to make sure we are checking off metrics to prove it to them. Perhaps an analysis of these costs would be a great eye-opener.
Doctors are expected to follow there is evidence. There is no real evidence to show that forcing doctors to spend more time in useless record keeping tasks instead of direct patient care improves clinical outcomes.
Small practices don’t have IT departments to dedicate to the task. I have my staff and if I ask them to work on MIP related tasks, who’s going to answer the phone or take the patients’ blood pressures? Most medical staff are already doing too many tasks these days.
As a doctor, my focus is on the patient in front of them and helping them to be the healthiest they can be. Not every patient is willing to give up their ice cream habit to get their HbA1C below 6.5. However, they may be able to get it down from 11.0 to 7.8. There is evidence to show that reduction improves clinical outcomes. However, it is not good enough to satisfy certain quality metrics. Doctors and patients can only do so much. Doctors realize we are working with very human patients. MIPS looks at patients as data metrics.
Medicare intends to use MIPS to decide how much to pay doctors. It neglects the fact that more complicated patients having more severe diseases require much more of our time and effort. Those are the patients who are going to have the worse outcomes, and those are the very ones we will be paid less for. We will be incentivized to take care of only healthier patients. Who needs doctors more, the healthy or sick?
Time spent recording metrics must come from somewhere. There are only 24 hours in a day, and one person can only do so much. If I must spend more time charting based on federal mandates, that leaves less time to spend face-to-face with patients. I think it is also pretty intuitive that the more time I spend with my patient, the better off they will be.
Do I participate in MIPS? According to the regulations, I am exempt from reporting because I don’t have a large volume of Medicare patients. While I will not be financially penalized for not meeting MIPS metrics, it also means I will not receive any bonuses for providing quality care. My Medicare reimbursement is hence stalled at its present level despite changes in the cost of living and inflation. Will I participate in MIPS? I don’t plan on it because I don’t have the staff or time. If it comes to the point that I can’t afford to see those patients anymore, then I will likely opt out. Will where those patients go as well as many others who are struggling to find access to a doctor who listens to them? Perhaps, that is the better question that should be addressed to improve quality outcomes rather than force training the next generation of doctor data entry specialists.
Linda Girgis is a family physician who blogs at Dr. Linda.
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