Provider Spotlight: Tina Eide, MD, Matrix Anesthesia

Provider Spotlight: Tina Eide

Tina Eide, a board certified anesthesiologist from Matrix Anesthesia, was one of the winners of our recent Patient Experience Week giveaway. We asked Tina about the best practices she follows to provide exceptional patient care, and we’re excited to share her responses.

Tina studied medicine at the University of Washington and trained at Virginia Mason Medical Center. Her primary areas of work interest include regional anesthesia, neuroanesthesia, lifestyle/behavior, and anti-aging medicine.

What best practices do you and the staff you work with follow that you attribute to your positive scores?

Tina Eide: [The] Overtake Hospital pre-operative setting includes private rooms for each patient, so interviews can be conducted with a closed door, and a quiet environment. This is instrumental in developing patient trust, explaining anesthetic choices, and creating a safe space for patients to voice anxieties or fears. Also, the pre-op nurses are excellent and gather information ahead of the anesthesiologist meeting the patient, so we don’t have to be entirely reiterative.

I always try to ask several specific questions about a patient. By knowing a few personal details, I can often begin talking about a familiar topic that helps put the patient at ease. I’ve even gotten three patients to sing for me recently!

Finally, I always offer my first name after I’ve introduced myself as Doctor Eide. I give my patient the choice of which to call me, and most prefer calling me Dr. Tina or just Tina. I am able to communicate through this that I am a professional but I am also a human.

What is one example of how you improved your relationship with your patients and/or the care you provide?

Tina Eide: When I first began, I was hesitant to explain all the risks that are inherent to anesthesia with patients. I felt this information might burden them or raise their anxiety prior to surgery. As I grew as a doctor and learned from my patients, I realized that patients are entitled to know the specifics of the care they will receive while under anesthesia. Some patients will decline a total explanation, and this is just fine. Other patients want to know each event that will occur and the possible up and downsides.

I learned that if I was upfront and explicit about the risk discussion, patients were extremely appreciative and their trust in me grew as well.

How do you best use your SurveyVitals data for your own personal improvement?

Tina Eide: I look for the specific comments that patients make about their experiences. Often we only hear general feedback like “great job” but when people relay a certain moment that touched them, or a particular action I did that helped them feel at ease, I am able to repeat that going forward.

I also accept any critical feedback with an open mind and heart. As a doctor, I hold myself to an exceptionally high standard to ‘do no harm’ which can sometimes translate in my mind as ‘make no mistakes.’ Clearly, as a human being, I have to accept that I will make a mistake now and again. If I can hear the critical feedback well enough to learn from it, however, I see it as a growth opportunity rather than something negative.

September 16th, 2019 Categories: Anesthesia, Best Practices, Client Spotlight, featured, Patient Experience

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Surveys You Might Not Know SurveyVitals Offers

4 survey types you may not know SurveyVitals offers

SurveyVitals’ digital patient experience surveys help you gain a deeper understanding of your performance with immediate patient feedback. Did you know our solution includes many more surveys at no additional cost to help drive improvement from every angle of your practice?

1. Point of Care

Our Point of Care tool allows you to address patient concerns on the spot before the leave your facility. The survey is sent to patients on their own devices while they’re still onsite, giving you the opportunity to resolve concerns in real-time.

2. Outcomes Surveys
Global Surgical Outcomes Survey (GSOS)

The GSOS survey is sent to surgical patients post-visit to collect feedback about the recovery experience. GSOS works in sync with the Perioperative Surgical Home (PSH) model and ERAS guidelines to identify gaps in care and spot opportunities to improve outcomes.

Emergency Medicine Outcomes Survey (EMOS)

The EMOS survey is sent to patients following an Emergency Department visit. It collects patient feedback related to understanding the recovery plan and accessibility to follow-up care.

3. 360° Surveys

As a part of our 360° solution, we offer a variety of internal and stakeholder surveys to help you better understand the perceptions of employees, peers, surgeons, physicians, and third party groups who work with your organization.

Employee Satisfaction

The Employee Satisfaction survey collects feedback to help increase teamwork, reduce turnover, and keep your teams motivated. The survey assesses individual employee perceptions about the organization, professional interactions, performance, job duties, and more.

Peer-to-Peer

The Peer-to-Peer survey aims to increase accountability and awareness of workplace conflict. Employees rate their peers in a number of areas including attitude, communication, competency, responsibility, teamwork, and timeliness.

Physician Satisfaction

Intended to prevent physician burnout, the Physician Satisfaction survey gathers insights from physicians about their quality of life in the workplace. Drive positive change with candid feedback from your physicians in a number of areas.

Referring Physician

Maximize your referral opportunities with the Referring Physician survey. Receive feedback from referring physicians on reports, recommendations, and interpretations they receive.

Anesthesiologist Surgeon Satisfaction

The Anesthesiologist Surgeon Satisfaction Questionnaire gathers important input from surgeons who work alongside anesthesia providers. This survey gives anesthesia providers valuable insights to strengthen relationships and increase safety and efficiency.

Third Party Group Evaluation

Enhance your third party relationships with feedback from your hospital and facility partners about your care, safety, responsiveness, clinical competency, cost efficiency, support, and more.

4. CAHPS

SurveyVitals is certified by CMS to administer nine different CAHPS surveys. The transition to value-based care has made CAHPS surveys mandatory for many facilities. The CAHPS surveys we offer are:

Note: There may be an additional cost to administer CAHPS surveys.

Questions?

Have questions about the SurveyVitals solution or any of the surveys we offer? Reach out to us today at support@surveyvitals.com or contact us using the blue chat icon below.

August 28th, 2019 Categories: Anesthesia, CAHPS Surveys, Emergency Medicine, featured, Outpatient Practice, Patient Experience

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Provider Spotlight: Clint Allred, CRNA, Anesthesia Associates of Boise

Provider Spotlight: Clint Allred

Clint Allred, a full-time CRNA for Anesthesia Associates of Boise, was the grand prize winner of our recent Patient Experience Week giveaway. He is performing in the top 25% of anesthesia providers nationally. We asked Clint about his best practices for providing exceptional patient care, and we’re excited to share his responses.

Clint completed his nursing education at Weber State University in 2006, and then attended the University of Tennessee for CRNA training. He has been practicing in Boise since 2011.

What best practices do you and the staff you work with follow that you attribute to your positive scores?

Clint Allred: There is a huge push in our profession to unite with our surgeon colleagues and work toward “enhanced recovery after surgery ” protocols. We have known that there are a lot of different ways to manage the anesthetic of a patient, and each patient requires a different anesthetic. The downside to this is the fact that everyone does something different so the continuity of care is sometimes lacking.

To correct this discrepancy, we created a quality committee within our group. This committee was tasked with reviewing literature along with some of the bigger medical institutes, and then sitting down with anesthesia providers from within our group and developing some protocols for the surgeries that we provide routinely. This initiative at least put all of us on the same page to start with. These protocols deal not only with the patient during surgery, but also some interventions before surgery to improve their outcomes. Since installing these protocols, it has been incredible to see the patient, surgeon, and nurse satisfaction elevate. Every anesthetic still needs to be tailored just right, but this has really helped us be proactive in our decision prep.

What is one example of how you improved your relationship with your patients and/or the care you provide?

Clint Allred: It has amazed me how a little bit of effort goes a long way in ensuring comfort for our patients. It can be something as simple as a warm blanket in the cold metal OR, or talking with the patient on their level trying to take time to explain things.

One thing that we have instituted is in our pediatric population. The inhalational anesthetics that we use have a pungent smell. Kids really hate inhaling that odorous gas. So, we bought a bunch of Lip Smacker chapsticks and then bring the mask to the kids and let them pick out a flavor. They paint the inside of the mask with the flavor they selected and it negates that bad smell when the mask is on their face. Little things like these efforts don’t really take a cumbersome amount of time or energy. They just require a little effort and can really improve the relationship with patients.

What is one thing you avoid doing in order to provide a better experience for your patients?

Clint Allred: The biggest thing I have had to make a conscious effort to try and avoid is just going through the motions with my patients preoperatively. I have always taken pride in the quality of anesthesia care that I provide, but I realized when my son had surgery, that I really needed to change my approach to patients before they even have anesthesia. The day of surgery for patients is an overwhelming experience. Even before you get to the surgery and recovery phase, so much is thrown at them. I found that because administering anesthesia is a routine part of my life, I was just doing the bare minimum to educate and put my patients at ease. We would then whisk them away and go provide anesthesia. My experience taught me that taking an extra five minutes to sit down and talk with the patients about what they were going to experience, both for them and their family members, went a long way to easing their anxiety.

How do you best use your SurveyVitals data for your own personal improvement?

Clint Allred: SurveyVitals definitely serves as a reminder to keep those goals and changes, instituted in my own personal practice, in the forefront of my mind daily. Obviously, I won’t make everyone happy all the time. I used to just shrug my shoulders and act like it didn’t matter. However, what I did find is that when I changed my attitudes and practice – all of a sudden the SurveyVitals data meant something to me. It is a way to drive and improve my practice. I still won’t make every patient happy all the time, but I can take pride in my work and raise the bar for my patients.

August 6th, 2019 Categories: Anesthesia, Best Practices, Client Spotlight, featured, Patient Experience

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Patient Experience Week Winners!

Patient Experience Week Giveaway

April 22-26 was Patient Experience Week and to celebrate, we asked our clients to share what drives them to provide memorable patient care. Those who responded were eligible to win an Amazon gift card. We’re excited to announce the winners of the giveaway and to share what motivates and inspires them to provide an exceptional patient experience!

We asked: It's Patient Experience Week! Tell us what inspires you to work every day to provide amazing care to your patients.

Grand Prize Winner: Clint Allred, CRNA, Anesthesia Associates of Boise

Clint Allred Patient Experience Week

“I work at a fairly average sized hospital with ten operating rooms in which we do all kinds of surgeries and care for all types of patients. It is a job that is always moving and often requires stretching of one’s abilities clinically and also professionally within our anesthesia group. Sometimes amidst the day to day providing of anesthesia, combined with the complexity of hospital bureaucracy, the patient and their experience can sometimes be forgotten. At some point in all of our careers, we got into the medical field because of our desire to care for other people. For some that motivation is fast forgotten and never found again. For me growing up, it was my younger brother who instilled this desire in me. He had serious handicaps and spent a lot of his life in and out of hospitals. Our experience was so dependent on those caring for him, for better or worse, those providers served as the rudder for our interactions with healthcare. I wanted to have a strong and helpful influence so that others could have their burden lightened.

Recently, my eight year old son had his tonsils removed. This is a very routine case, millions are done each year, and I provide the anesthesia for 6-8 of these types of cases at least once a week in our practice. The anesthetic for this case has become routine and mundane for me personally. All of a sudden I was thrust onto the other side of the experience. There my son laid on the gurney getting prepped for surgery. I saw him run the gamut of emotions; fear, anxiety, apprehension, concern...etc. All of a sudden those emotions of why I went into medicine came flooding back. I realized that the way I interacted with patients would leave a lasting impact on them. Clinically I have always provided my best care and effort, but I saw through my boy's eyes that I could do more and be more as a clinician. My son received incredible care and has since healed from his physical incisions, but the experience he had prior to surgery has had a far greater impact.

It is this message that inspires me to provide amazing care to my patients. No matter how routine or regular a procedure is to me, I remember that experience and hold strong to the fact that it is not routine for the patient on the stretcher.”


Alexis Haney, RN, USAP

“To be a caring voice to a person who didn't wake up wanting to be sick or have surgery. Everyday, I partner with SurveyVitals because in the background, almost every patient is given a chance to have a voice. I am that individual that gets to read their thoughts, their frustrations, their fears. I am able to offer them a chance to make a difference when they are in a position where they feel they have little control. When a patient requests to be called back... I can be the caring voice on the other end and I can convey to them I really do care, perhaps that will make them feel a little better and perhaps I can make a change or help their concern because USAP cares and wants to be better and that why I am inspired to provide amazing care and support to patients.”


Tina Eide, MD, Matrix Anesthesia

“Anesthesia is a tricky job, because everything is fine until it’s really not fine. It requires constant vigilance and care, even when I show up feeling less than 100%. On these days, I look to my patients for energy and strength, because I know they are relying on me for the same. I love learning about their careers, seeing pictures of their children and pets, hearing their songs they belt out (people love singing to me!), and listening to their stories that brought them to surgery. I’ve met musicians, politicians, hospital administrators, teachers, circus performers, professional athletes, prima ballerinas, and so very many people who have interesting stories. Because we often cannot share details of our patients with our families or friends, I hold these private encounters with special regard.”


Rhina Romera, Envision Healthcare

“Working in healthcare makes a difference in people's lives. Caring for people and helping others lead healthy lives is satisfying and important. I love humankind and it is gratifying to me to make a positive impact not just on patients but everyone involved. No one likes to be ill, so it is very important to me that patients feel that they are treated with compassion and respect.”


Sarah Russell, FNP, Wellspring Health Services

“The one thing that inspires me the most to provide excellent care is when patients follow up and start feeling so much better! I have also had patients tell me that for the first time they felt like a provider actually listened to them and cared about their story and their health. Oftentimes a patient's story will give the clues to their disease processes and struggles and be the beginning of the answer in leading them back to health. Without listening to the patient, it is often a matter of just cold medicine treatment that can leave the patient sicker rather than better.”


Anne LeBlanc, USAP

“For us providers, our days can often seem routine. Remembering that for our patients, surgery is often a very scary and powerless position to be in. Connecting with the patient and family in the preoperative area and forming a trustworthy bond is one of the most inspiring and valuable parts of our job. Being able to relieve some of that anxiety and comfort them in their time of fear is incredibly rewarding and inspiring for me.”


Thank you to all of our clients who took the time to share their stories! We admire your dedication to the patient experience.

May 23rd, 2019 Categories: Anesthesia, Best Practices, Client Spotlight, Outpatient Practice, Patient Experience

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Introducing the SurveyVitals Improvement Center!

Introducing SurveyVitals Improvement Center

SurveyVitals is excited to announce the launch of the Improvement Center in our client portal!

Our reporting, alerts, and dashboards have given our clients the real-time data needed to identify trends and work toward improving the patient experience. The Improvement Center takes the solution to the next level with a wealth of educational videos and articles to aid providers in targeting improvement where it is needed most.

To get started using the Improvement Center, login to your portal and click ‘Improvement Center’ in the left navigation. Browse general resources on the Improvement Center homepage, or view resources by survey. Survey-specific content is broken down by question group.

Not sure where to start? Use the Report Builder to analyze your data and comments and identify improvement opportunities. Then utilize the resources in the Improvement Center to gain a better understanding of what may help your patients in those areas.

SurveyVitals created the Improvement Center using input from top performers combined with extensive scientific-based research into the patient experience. Check back often for new content as our improvement resources evolve and grow with your solution.

Learn More!

May 6th, 2019 Categories: Anesthesia, featured, Outpatient Practice, Patient Experience, Product Features

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MACRA Quality Payment Program: MIPS 2020

The Quality Payment Program (QPP) falls under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). It is a value-based program that determines reimbursement for clinicians treating Medicare patients.

The Centers for Medicare and Medicaid Services (CMS) recently released the final rule outlining the Quality Payment Program (QPP) for 2020. Keep reading to learn how the changes could affect you, and how SurveyVitals can help your organization meet reporting requirements.

Who Participates?

If you bill Medicare Part B more than $90,000 in allowed charges per year and provide over 200 covered professional services under the Physician Fee Schedule for more than 200 unique Medicare patients a year, then you are part of the QPP. If you do not meet all three criteria, you could be exempt from participating in the program in 2020 under the the low-volume threshold exemption. Clinicians who meet the low-volume threshold may still opt in to MIPS if they meet at least one criterion.

Eligible clinicians under the program include:
  • Physicians
  • Physician assistants
  • Nurse practitioners
  • Clinical nurse specialists
  • Certified registered nurse anesthetists
  • Physical therapists
  • Occupational therapists
  • Qualified speech-language pathologists
  • Qualified audiologists
  • Clinical psychologists
  • Registered dietitian or nutrition professionals

If you are unsure if you are required to participate in MIPS, CMS has provided a resource to check your status by entering your NPI into an eligibility “calculator.” Additionally, the agency plans to send letters to clinicians notifying them of their eligibility in 2020.

MIPS Eligibility

Two Tracks: Which is right for you?

There are two participation tracks in the Quality Payment Program. Most Medicare Part B clinicians and groups will fall under the Merit Incentive Payment System (MIPS) track, while a smaller percentage will qualify to participate in the Advanced Alternative Payment Models (APM) track if considered an “advanced APM.” It is important to note that those APM models which are not considered “advanced” by CMS will still participate in the MIPS track.

Learn more about APMs here.

The MIPS Track

You will receive a performance-based adjustment to your Medicare fee schedule in 2022 based on your performance in 2020. The amount of the adjustment, either positive, negative, or neutral, is based on an eligible clinician or group’s Composite Performance Score (CPS). The CPS is calculated using data across four categories of measurement:

  1. Quality
  2. Promoting Interoperability
  3. Improvement Activities
  4. Cost

MIPS Category Weights

How do I avoid a negative payment adjustment?

For the 2020 performance year, CMS extended a portion of the “pick your pace” program, allowing clinicians to submit just 90 consecutive days of performance data for the required measures in the Improvement Activities and Promoting Interoperability categories. However, clinicians will need to report data on all required measures in the Quality category for the full performance year (12 months).

CMS will also score and measure the Cost category for the full 12 month period as well. Since CMS gathers the Cost category information through Medicare claims data, no additional submission mechanism is required. If you do not participate in MIPS in 2020 you could be faced with a 9% penalty.

MIPS Performance Periods

Individual vs. Group Reporting

Eligible clinicians have the option to report as an individual, within a group, or within a virtual group.

An individual is a single National Provider Identifier, or NPI, tied to a single Taxpayer Identification Number, or TIN.

A group is a single TIN with two or more eligible clinicians (including at least one MIPS eligible clinician), as identified by their NPIs, who have reassigned their Medicare billing rights to the TIN. Participants are scored as a group and receive one payment adjustment based on aggregate performance.

A virtual group is a combination of two or more TINs assigned to one or more solo practitioners or one or more groups consisting of ten or fewer eligible clinicians that elect to form a virtual group for a performance period for a year. There is currently no limit on the number of TINs that can participate in a virtual group. Virtual Groups bring additional flexibility to the program, allowing clinicians to participate in MIPS with their peers, regardless of their geographical proximity or specialty. Those wishing to participate in a MIPS Virtual Group must make a formal election with CMS by December 31, 2020.

MIPS Individual and Group Reporting

Data for participants can be reported by various submission types by an individual or group as applicable. Alternatively, data may be reported by a Third Party Intermediary that submits data on measures and activities on behalf of a MIPS eligible clinician or group.

Selecting and Reporting Measures

The aim of the MIPS program is to provide clinicians and groups with the flexibility to select measures that best suit their practice. For the Quality category, participants can choose from several types of measures, which vary based on whether they are reporting as individuals or as part of a group. Submission methods are dependent on the types of measures chosen.

MIPS Data Collection

For the Improvement Activities and Promoting Interoperability categories, participants choose their measures from the QPP website. There are three submission methods for these measures.

  1. Direct: Users transmit data through a computer-to-computer interaction such as an API.
  2. Log-in and upload: Users log in with a set of authenticated credentials and upload and submit data in a CMS-specified format.
  3. Log-in and attest: Users log in with a set of authenticated credentials and manually attest that certain measures and activities were performed.

MIPS Requirements

Quality Category

Eligible clinicians are required to report six measures of their choosing for the Quality category. One of those measures must be an outcome measure. If no outcome measure is available, a ‘high priority’ measure must be reported in its place. High priority measures are contained in the following domains: outcome, appropriate use, patient safety, efficiency, patient experience, efficiency, and care coordination.

What are specialty measurement sets?

CMS developed specialty measure sets as a part of the available MIPS measures in the Quality Category. Participating clinicians must choose six measures to report within their specialty set. If there are fewer than six Quality measures to choose from in a specialty set, the clinician or group must complete all available measures contained in the set.

For anesthesia clients

SurveyVitals can help anesthesia clients who utilize a Qualified Clinical Data Registry (QCDR) meet a measure–AQI 48 (anesthesia patient experience)–in the Quality performance category. Learn more here.

Improvement Activities

The IA category requires clinicians to participate in a combination of measures totaling 40 points to fully satisfy reporting requirements. Activities weighted “high” are worth 20 points, while “medium” weighted activities are valued at ten points. Clinicians and groups considered non-patient facing, and practices with 15 or fewer eligible providers and/or clinicians practicing in rural and health professional shortage areas, may face reduced reporting requirements. Learn more about these special exemption statuses here.

MIPS Improvement Activities

In order for a group or virtual group to attest to an improvement activity, at least 50% of the clinicians in the group or virtual group must perform the same activity during any continuous 90-day period in the performance year.

Your SurveyVitals solution can help you satisfy measures in the IA category. Download our “Roadmap to Improvement Activities” or contact us at info@surveyvitals.com to learn more.

Promoting Interoperability

The Promoting Interoperability category places an emphasis on interoperability and patient engagement with certified EHR technology. Eligible clinicians must report on certain measures from four ‘objectives,’ or claims exclusions if applicable. Scoring is performance-based at the individual measure level, for a total of up to 100 points. In 2020, organizations must use the 2015 Edition CEHRT.

Special Status

Clinicians and groups considered non-patient facing, and practices with 15 or fewer eligible providers and/or clinicians practicing in rural and health professional shortage areas, may face reduced reporting requirements. Watch the video below to learn more.

Anesthesia QCDR Reporting

SurveyVitals can help anesthesia clients who utilize a Qualified Clinical Data Registry (QCDR) meet a measure–AQI 48 (anesthesia patient experience)–in the Quality performance category. We currently support NACOR (Anesthesia Quality Institute), Anesthesia Business Group, Anesthesia Quality Registry (ePreop), and Medaxion. Learn more here.

What are the current MIPS dates and deadlines?

January 1, 2020

2020 performance year begins

January 2, 2020

Data submission period for the 2019 performance year begins

March 31, 2020

Data submission for the 2019 performance year closes

October 3, 2020

Last day to begin the continuous 90-day performance period for Improvement Activities

December 31, 2020

Last day to make a virtual group election for the 2021 performance year

December 31, 2020

2020 performance year ends

How is MIPS different in 2020?

To learn about the changes from year 3 (2019) to year 4 (2020) of the MIPS program, see our article on the 2020 updates.

Does SurveyVitals administer CAHPS for MIPS?

Yes! SurveyVitals is a CMS-approved vendor ready to administer CAHPS for MIPS on behalf of your organization in 2020. The CAHPS for MIPS survey can be used to satisfy one Quality measure or one Improvement Activity.

Contact us at info@surveyvitals.com to learn more about our CAHPS program.

Interested in meeting measures with SurveyVitals?

Want to learn how SurveyVitals can help you prepare for MIPS? Subscribe to our MIPS update list below or email us at support@surveyvitals.com. You can also send us a message using the blue chat icon below to speak to a member of our support team.

*Note: Information and program details are based solely upon SurveyVitals’ experience with MACRA and our interpretation of CMS rule-making and policy statements. The information presented does not reflect the views or policies of CMS or any other governmental agency and is not to be construed as practice management advice.

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March 13th, 2019 Categories: Ambulatory and Outpatient Surgery, Anesthesia, CAHPS Surveys, Emergency Medicine, featured, MIPS Information, Neonatology, Outpatient Practice, Radiology, Urgent Care

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2018 Year in Review

SurveyVitals 2018 Year in Review

SurveyVitals 2018 Year Stats

The patient experience is improving because of your dedication. Here are some remarkable metrics you were a part of in 2018.

Over 2 million surveys were completed last year, providing feedback on more than 31 million questions and bringing in over 2 million comments. Patient comments were overwhelmingly positive–there were 57 positive words for every one negative word!

Patients aged 64-75 years old were the best respondents, with the highest response rates for email, SMS, and overall. The most satisfied patients were males 25-34 years old for APSQ, and females 65-74 years old for SPSQ.

Our clients logged in over 124,000 times last year and received 138,000 low score alerts and 18,000 contact requests. This helped drive improvement in every area of care, but the most improved areas were Privacy Respected for APSQ and Communication for SPSQ.

Thank you for working with SurveyVitals to help your patients and your organization. We look forward to helping you continue to meet your patient experience goals in 2019!

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January 8th, 2019 Categories: Anesthesia, featured, Outpatient Practice, Patient Experience

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MIPS 101 for Anesthesia Providers

MIPS anesthesiologist
***Updated January 2020***

Are you an anesthesia provider participating in the Merit-Based Incentive Payment System (MIPS)? Let us tell you how the SurveyVitals solution might help you fulfill certain reporting requirements.

What is MIPS?

The Merit Incentive Payment System (MIPS) is one of two tracks in the QPP, the quality payment incentive program implemented by CMS. A small percentage of clinicians will qualify to participate in the Alternative Payment Models (APM) track, but most anesthesiologists will fall under the MIPS track.

You will receive a performance-based adjustment to your Medicare fee schedule in 2022 based on your MIPS performance in 2020. The amount of the adjustment, either positive, negative, or neutral, is based on an eligible clinician or group’s Composite Performance Score (CPS). The CPS is calculated using data across four categories of measurement.

Who participates?

If you bill Medicare Part B more than $90,000 in allowed charges per year and provide over 200 covered professional services under the Physician Fee Schedule for more than 200 unique Medicare patients a year, then you are part of the QPP. If you do not meet all three criteria, you could be exempt from participating in the program in 2020 under the the low-volume threshold exemption. Clinicians who meet the low-volume threshold may still opt in to MIPS if they meet at least one criterion.

To determine if you are required to participate in MIPS, CMS has provided a resource to check your status by entering your NPI into an eligibility “calculator.”

How are measures reported?

Anesthesiologists have the option to report as an individual, within a group, or within a virtual group.

Individual Single NPI tied to a single Tax Identification Number (TIN)
Group Single TIN with two or more eligible clinicians, including at least one MIPS-eligible clinician, as identified by their National Provider Identifiers (NPIs), who have reassigned their Medicare billing rights to the TIN
Virtual Group Combination of two or more TINs assigned to one or more solo practitioners or one or more groups consisting of ten or fewer eligible clinicians

Reporting mechanisms vary based on reporting type and measure category. You can find more information on reporting mechanisms here.

How are measures selected?

Anesthesia providers and groups can select measures from the list of CMS-approved MIPS measures at the QPP website. Alternatively, they may select to report on Quality performance using specialized measures developed by a Qualified Clinical Data Registry (QCDR) of their choosing. QCDR measures must be approved each year by CMS.

Quality Category

Anesthesiologists are required to report on six measures of their choosing for the quality category. One of those measures must be an outcome measure.

SurveyVitals is equipped to help anesthesia clients utilizing a QCDR to meet an outcome measure (AQI 48 – Patient-Reported Experience with Anesthesia) in the Quality category. You must sign a disclaimer in order to report your patient experience data to a QCDR. View the reporting checklist, quick facts, and important deadlines here.

Improvement Activities (IA) Category

Anesthesia providers are required to participate in a combination of IA measures totaling 40 points. “High-weighted” activities are worth 20 points, while “medium-weighted” activities are valued at ten points. Your SurveyVitals solution can help you satisfy measures in the IA category. Download our “Road-Map to Improvement Activities” or contact us at info@surveyvitals.com to learn more.

In order for a group or virtual group to attest to an improvement activity, at least 50% of the clinicians in the group or virtual group must perform the same activity during any continuous 90-day period in the performance year.

Reporting requirements for Improvement Activities are reduced for non-patient facing clinicians, which are defined as either:

  • An individual clinician that bills 100 or fewer patient-facing encounters (including Medicare telehealth services), or
  • A group that provided more than 75 percent of the clinician’s billing under the group’s TIN

Those considered non-patient facing must participate in one high-weighted activity or two medium-weighted activities to satisfy the Improvement Activities category (for a total of 20 points rather than 40).

Always remember to check the eligibility calculator on the QPP website to confirm you are considered non-patient facing.

Promoting Interoperability Category

The Promoting Interoperability category places an emphasis on interoperability and patient engagement with certified EHR technology. Eligible clinicians must report on certain measures from four ‘objectives,’ or claims exclusions if applicable. Scoring is performance-based at the individual measure level, for a total of up to 100 points. In 2020, organizations must use the 2015 Edition CEHRT.

Cost Category

The score for the Cost category is calculated using administrative claims data. No data submission is required.

How can SurveyVitals help you succeed with MIPS?

SurveyVitals can help you meet one Quality measure and fulfill the entire Improvement Activities category. Reference the table below to see which measures we can help you meet.

MIPS Category Measures We Support More Information
Quality AQI 48 (Outcome) Anesthesia QCDR Reporting
Improvement Activities High-weighted:
  • IA_BE_6
  • IA_PSPA_11
Medium-weighted:
  • IA_BE_13
  • IA_PSPA_4
  • IA_PSPA_18
  • IA_PSPA_19
  • IA_PSPA_20
Improvement Activities Roadmap

Want to learn how SurveyVitals can help you prepare for MIPS? Email us at support@surveyvitals.com. You can also send us a message using the blue chat icon below to speak to a member of our support team.

Learn More!

*Note: Information and program details are based solely upon SurveyVitals’ experience with MACRA and our interpretation of CMS rule-making and policy statements. The information presented does not reflect the views or policies of CMS or any other governmental agency and is not to be construed as practice management advice.

June 3rd, 2018 Categories: Anesthesia, MIPS Information

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Working MOCA 2.0? SurveyVitals Can Help

MOCA 2.0 anesthesia

The redesigned MOCA 2.0 (Maintenance of Certification in Anesthesiology) allows anesthesia diplomates to complete a variety of new activities to meet the Part 4 Quality Improvement requirement. Diplomates are required to earn a minimum of 50 points during their ten-year MOCA 2.0 cycle by choosing and completing quality improvement activities most relevant to their practice.

Where does SurveyVitals come in?

You may be able to use the SurveyVitals solution to fulfill the requirement by completing an improvement plan based on A) 360 professional reviews, or B) patient experience of care surveys. The point value for this activity is 1 point per hour spent on the activity, for a total of up to 25 points.

SurveyVitals’ Anesthesia 360° solution offers surveys for patients, practitioners, administrators, surgeons, and peers to give you a comprehensive look at patient and professional satisfaction.

Don’t know where to start? Your survey dashboard provides a detailed visual of areas scoring the lowest and receiving the most low-score alerts, allowing for quick identification of improvement opportunities. SurveyVitals’ robust reporting options allow you to easily track and measure improvement in these areas over time based on near real-time patient feedback.

How can I attest to meeting this requirement?

Diplomates must attest to the activity on the American Board of Anesthesiology (ABA) website using the ABA-approved template found here. Your SurveyVitals data can be used to summarize both the Data Summary and the Change in Practice.

More information about the MOCA 2.0 Part 4 requirement can be found on the ABA website.

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June 1st, 2018 Categories: Anesthesia, Product Features

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New Data Submission Interface for Quality Payment Program

New Data Submission Interface

On January 2, the Centers for Medicare and Medicaid (CMS) launched a new data submission system for groups and clinicians participating in the Quality Payment Program.

Here are some key points:

Clinicians now submit all their 2017 performance data in the same place.

Previously, under the various CMS legacy programs, clinicians had to use multiple mechanisms to submit performance data. CMS has now consolidated the data submission process to a single access point via an online portal, making it easier for clinicians and vendors to submit data.

The submission period for the 2017 QPP performance year runs from January 2, 2018, to March 31, 2018.

For groups using the CMS Web Interface, the submission period runs from January 22, 2018 to March 16, 2018.

How to submit performance data?

To submit performance data, clinicians must visit the QPP website. Once on the QPP website, users can login by entering their EIDM User ID and password. Users may have used this ID and password in the past to login to the CMS Enterprise Portal.

If you don’t have an EIDM User ID and password, you can create an account on the CMS Enterprise website.

In the portal, clinicians have the option to choose between multiple data submission options, including Qualified Clinical Data Registries (QCDRs), qualified registries, attestation, or the CMS Web Interface.

Data can be uploaded incrementally throughout the submission period. Groups and clinicians are not required to upload all of their data at once. However, all performance data must be uploaded before the submission period deadline.

For Merit-based Incentive Payment System (MIPS) participants, real-time initial scoring updates will appear as performance data is tallied on the site. This scoring may change as new data is uploaded, or if new benchmarks take effect. Note that special status, Alternative Payment Model (APM) status, and Qualifying APM Participant status (QP), will not initially appear in each category score.

Final scores will appear after the submission period closes.

For more information about the Quality Payment Program, see our guide.

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January 3rd, 2018 Categories: Anesthesia, featured, MIPS Information, Outpatient Practice

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