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Learning to Navigate Quality Measurement

Board of Governors Hot Topics: Practical Solutions to Conquer the Quality Quagmire
7:30 – 9:30 am
Tuesday
Room N231

In addition to learning about treatment advances, otolaryngologists must learn about the quality measures that took effect in 2017 as part of health system reform. These measures are key components of physician ratings and can affect inclusion in provider panels, ultimately influencing reimbursement and patient access.

Ken Yanagisawa, MD

Tuesday’s “Board of Governors Hot Topics” Miniseminar will provide tips on how physicians can improve patient satisfaction scores, navigate the Merit-based Incentive Payment System (MIPS), get support at the local level, and appeal reimbursement denials. All four topics are key elements of quality measurement.

“For our Academy membership, the goal is to share this valuable information for individual practice success. The pathway to quality success is complicated and, seemingly at times, convoluted, but it is vital to our livelihood. Our aim is to give the provider real and practical solutions they can take home to their practices and succeed,” said session moderator Ken Yanagisawa, MD, BOG secretary.

A fact of life in the digital age is that patients shop for healthcare online, where patients rate the performance of physicians. It can be a frustrating process, but otolaryngologists must learn how to improve their satisfaction scores, he said.

“We, as providers, can respond to negative as well as positive feedback and reviews,” Dr. Yanagisawa said. “We need to know how this impacts us at the level of insurers and CMS in terms of our reimbursement, our value ratings, and on provider panels.”

A second challenge is filing information with CMS as required by MIPS. The AAO-HNSF Reg-entSM Qualified Clinical Data Registry can help.

“This has become a huge challenge for many providers,” Dr. Yanagisawa said. “The presentation will talk about how to attack this problem and how CMS is measuring a provider’s quality. It also will touch on options for those who do not obtain satisfactory MIPS scores.”

Another key to navigating the path of quality management is support. The Connecticut State Medical Society has introduced a statewide health information exchange, offering support of regional chapters of specialty societies in the state, including otolaryngology.

“There is a wide spectrum of how closely otolaryngology societies and the state societies work together,” Dr. Yanagisawa said. “The beauty of the BOG is to share what has worked and what hasn’t and use it to help improve your own state society. The trick is to help everyone see and hopefully attain a common goal.”

If those quality improvement efforts fail, the result can be a denial of claims and a need to appeal negative decisions. Tips and pointers in working through the appeal process will be presented.

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