October 5, 2022 | Jessica Zeff

3 Minute Read

Are You a Wound Care Provider at a SNF, LTC or Private Practice? Don’t be Left in the Dark about MACRA, MIPS and More

At night, do you dream about PDPM, MACRA, MIPS and all the regulations that must be met in today’s heavily regulated health care environment? Does the jumble of acronyms and abbreviations have you confused? If so, you are certainly not alone and the confusion is understandable.  But knowledge can provide peace of mind, and knowledge combined with resources, technology and support can equate to a little less stress and hopefully a few more well-rested nights.

First, it’s important to note that these regulatory requirements apply to all wound care providers – whether you are in a hospital system, clinic, SNF, LTC or private practice.

So, let’s start with the basics of how MACRA and MIPS impact wound care. Our colleagues at Net Health FOTO recently ran a blog on this topic. Here’s how they explained MIPS and MACRA:

MIPS stands for Merit-Based Incentive Payment System, a program that determines future Medicare payment adjustments.

What is MIPS? 

Unlike the Sustainable Growth Rate (SGR) law that previously outlined a straight fee-for-service payment program, MIPS pays out based on the composite performance scores of eligible clinicians (ECs). From these scores, ECs may receive positive payment adjustments, bonuses, or negative payment adjustments.

In other words, [clinicians] who participate in MIPS receive Medicare payment adjustments based on the quality of services they provide and the steps they take to improve their clinical practice, also known as “improvement activities.”.

Why does MIPS exist?

MIPS was born from an ongoing effort to provide affordable, high-quality healthcare to Medicare recipients. The program was established with the passing of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

In place of the SGR model, MACRA tied payments to quality and cost-efficient care. Its goal was to drive improvement in care and outcomes, increase the use of healthcare data and information, and ultimately reduce the cost of care.

Rather than a straight pay-for-service program, MIPS is part of an effort by CMS to transition to value-based reimbursement, fostering a system in which providers are accountable for quality and costs of care.  One of the key obstacles to success under this model is adequate documentation, a perennial bug bear for virtually all health care providers.

Now, Let’s Tackle PDPM

The Patient-Driven Payment Model (PDPM) is the Medicare payment rule for skilled nursing facilities. It replaced the former RUG-IV system with a completely new way of calculating reimbursement. Assessment and coding accuracy are critical here, starting with the Minimum Data Set (MDS), which has become more complex under PDPM. For busy wound care providers as well as SNF and long-term care providers, it’s critical to streamline MDS reporting, which captures patients’ clinical characteristics and services rendered, so that the organization can deliver the best patient outcomes and receive appropriate reimbursement.  

So what do these programs have in common?  Documentation.  Documentation is essential to avoid over- or under-reimbursement, whether in private practice, a long-term care facility, or a large hospital system. 

But how to minimize time spent on documentation and maximize time spent with patients and patient care?

Your New Best Friend:  A Certified Wound Care EHR

A good EHR is one of the most critical pieces of technology for wound care providers to invest in. Your EHR drives everything, from registration to getting paid to meeting regulatory requirements. More specifically, EHR systems built specifically to meet the needs of wound care providers can easily and seamlessly support the collection of data for MIPS reporting and quality monitoring.

Be sure to look for Certified EHRs. According to CMS: “In order to efficiently capture and share patient data, health care providers need certified electronic health record (EHR) technology (CEHRT) that stores data in a structured format. Structured data allows health care providers to easily retrieve and transfer patient information and use the EHR in ways that can aid patient care.” You can find more information here.

As part of the 21st Century Cures Act, EHRs will need to be able to share data electronically with patients, other providers, organizations, etc., by October of this year.1  Wound care providers, including those at SNFs and LTCs, are included in this new mandate.

Look for a Trusted Partner

There is no such thing as one-size-fits-all regarding wound care EHRs. With all this on your plate already, look not just for great technology but also for a trusted partner who can provide personalized support from people who understand the industry. Net Health offers a range of consultative services from some of the top wound care specialists in the nation.

Wound care today is complex, challenging and heavily regulated and navigating the wound care landscape may keep you up at night. Learn how Net Health can help. Schedule a free demo.

1The 21st Century Cures Act Part Two: Information Blocking and Interoperability. HIMSS. Available at https://www.himss.org/resources/21st-century-cures-act-part-two-information-blocking-and-interoperability

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