Athenahealth will reimburse clients for MIPS-related payment cuts in new guarantee

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A new program from athenahealth underscores the idea that providers alone shouldn't be responsible for risk-based care — vendors have a role to play, too. The company announced Monday it will reimburse clients who face a downward payment adjustment under the Merit-based Incentive Payment System, which is part of the proposed Medicare reimbursement rule.

The MIPS Guarantee program essentially promises that clients using the athenaOne services suite will perform at or above the national performance threshold set by CMS, therefore avoiding any payment penalties on their Medicare Part B fee schedule.

"Because of our national network, our quality management and payer rules engine, our team of experts, and our track record of client success as part of other government-run programs, we believe we can free the industry of reimbursement cuts associated with MIPS," Jonathan Bush, athenahealth co-founder, president and CEO, said in a statement. "And if we can't, we'll put our money where our mouth is and reimburse clients up to the penalty amount."

There is some fine print to the guarantee, such as it is only available to new athenaOne clients that are live on the athenaNet network by June 30, 2017. Additionally, reimbursement can't exceed athenahealth service fees.

Allison LaValley, athenahealth's executive director of quality performance and value-based care, says the guarantee follows the company's push to align and partner with clients to help solve business problems. She says they are looking at areas where athenahealth can reduce work for practices or better structure workflows to make it as easy as possible for practices to be successful in these government programs.

"We really want to understand what are the requirements of these programs? ... What things do we feel like are truly opportunities for athena to take work on from our practices or reduce work?" Ms. LaValley says. "There's a lot of time and energy [which] translates into dollars that practices have to spend in order to just get data out of their system and report it to CMS."

This isn't the first guarantee program offered by athenahealth — the company also offers similar guarantees for clients attesting to meaningful use and participating in the Physician Quality Reporting System. Clients appear to be succeeding in these government reporting programs: In calendar year 2015, athenahealth users had a 97.6 percent meaningful use attestation rate, and in 2016, 98.9 percent avoided PQRS and value modifier reimbursement penalties.

Ms. LaValley attributes much of this success to athenahealth's data capabilities and partnering with clients to understand challenges. Athenahealth's network gathers data from more than 72,000 providers and processes 1.2 billion data transactions each year. This type of information helps the company glean insight into challenges providers and practices faces and how to help them. This, coupled with success in the other guarantee programs, gave athenahealth the confidence to roll out the MIPS Guarantee, according to Ms. LaValley.

What's more, Ms. LaValley says athenahealth is introducing these guarantee programs now because the industry will have to eventually solve issues related to reimbursement and workflows.

"Solving for these problems is going to have to happen for our clients regardless. This is a great way for us to pave the future and help provide more tools that are going to enable practices to really thrive under these different payment models," Ms. LaValley says.

Currently, practices and providers are left with figuring out the algorithms or sorting through the calculations required to report to CMS on their own, according to Ms. LaValley. It's up to vendors to design solutions and support with these types of challenges in mind, she says, offering the example of how athenahealth submits necessary data to CMS on clients' behalf so they don't have to worry about it and can focus on patient care.

All vendors can play a role in alleviating these types of tasks to help providers be successful, Ms. LaValley says.

"At the end of the day, our clients [and] providers across the country really just want to take care of their patients and deliver the highest quality care they can. But they also need to get paid," Ms. LaValley says. "How do we help the industry get more vendors accountable for truly making that the focus rather than leaving it to practices to recreate really complicated algorithms and calculations?"

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