PracticalDermatology

Watch it Now

Watch as Heidi Waldorf, MD discusses the relative merits of EHRs in a dermatology practice in the original series Heideas from ModernAesthetics.tv.

Watch at modernaesthetics.com/series/heideas-for- aesthetic-practices/video.asp?f=heideas-pt-2-assess- ing-ehrs-and-the-practice-of-medicine

When Centers for Medicare and Medicaid Services (CMS) Acting Administrator Andy Slavitt announced that 2016 would likely see the end of the Meaningful Use (MU) altogether, Acting Assistant Secretary for Health in the U.S. Department of Health and Human Services, Karen DeSalvo quickly piped in with some damage control. DeSalvo said that reports of the death of MU have been greatly exaggerated. Instead, she said, we would see a new and improved MU.

Exactly what this means is not yet fully understood, but that doesn’t mean we should stand by as MU gets a makeover (or make under, as the case may be). Here are five things that dermatologists can, and should, do today to protect their practices and patients tomorrow.

Apply for the Hardship Exemption

If you didn’t meet the EHR MU rreporting requirements in 2015 or don’t know if you did, apply for hardship exemption STAT. The deadline is July 1, 2016 and physicians will be granted a reprieve from the 3 percent penalty in 2017. This will not prevent an incentive payment. Of note, CMS has stated that it will broadly accept hardship exemptions because of the delayed publication of the program requirements last year. Apply at https://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/paymentadj_hardship.html.

Save the Dates

Although it’s something of moving target, keep up to date on pertinent attestation deadlines and other news by following CMS on Twitter (@CMSGov) and by subscribing to the EHR Listserv: https://public.govdelivery.com/accounts/USCMS/subscriber/new?topic_id=USCMS_627.

Get Schooled on MIPS

In April 2015, Congress enacted the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which ties payment to value of care. MACRA ended the Sustainable Growth Rate (SGR) formula in favor of two tracks: 1) the Merit-Based Incentive Pay System (MIPS) and 2) Alternative Payment Models, or APMs. For now, only MIPS is relevant for dermatologists. MIPS streamlines the different penalty/payment systems into one including Physician Quality Reporting System (PQRS), Value Modifier (VM or Value-based Payment Modifier), and the Medicare Electronic Health Record (EHR) incentive program. These payments start Jan. 1, 2019 and are based on care delivered in 2017.

Do the MIPS Math

The PQRS quality score account for 30% of your MIPS composite score. Meaningful use of an EHR counts for 25% of the MIPS composite score and the VM is 30% of your MIPS composite score. What’s more, MIPS will also unveil a bonus incentive payment system of up to 10 percent for users who display exceptional performance.

Chart Your Course

Are you in or are you outside looking in? You have to decide whether to take the hit or be “all in” with whatever comes next. In some practices, opting out of the regulatory brouhaha may be akin to taking on two more Medicare patients to make up for the penalty cost. Regardless, keep your eye on the prize. Remember why you choose this specialty, and why you still love the practice of dermatology. Patient care comes first, and doing your job and doing it well will always count for something. n

Mark Kaufmann, MD is an associate clinical professor of dermatology at Mount Sinai Medical Center in New York City.