Unless Congress intervenes, the smallest and most rural health care providers will soon be unable to get help to switch to value-based care.

In the past five years, rural providers with fewer than 15 clinicians have been increasingly encouraged to participate Performance-based reward payment system Value-based payment plans that provide financial bonuses or fines. Participating providers must submit data on costs, results, quality, and interoperability, otherwise they may be affected by cuts in medical insurance payments. This year, due to not participating in the program, this is equivalent to a reduction of 9%.

When Congress created MIPS in 2015, legislators also provided Medicare and Medicaid Services $100 million create Small, underserved and rural support Plans to help these providers gain insight into the measures to report and how to keep up with the latest changes in MIPS. But starting from February 15th, the money will be used up.

CMS notified providers this week that small, underserved, and rural support programs will soon be discontinued.Technical assistance contractor Vendors have been warned for months that once the funds disappear, they will have to manage the transition to MIPS to a large extent on their own.

“In these smaller practices, this is just another hat worn by someone in the organization, usually an office manager or billing person. This is very different from a larger organization, because when you have time to focus 100% on this During the project, said Candy Hanson, project manager of your SURS subcontractor and quality improvement non-profit organization Stratis Health.

Megan Housley, a SURS subcontractor and assistant managing director of the University of Kentucky Regional Outreach Center, said: “We have some practices that we might want them to let us double-check their work.” “Then we have other people themselves. A little ignorant, I am really worried. They are our heavy users every year.”

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Small practice seen most MIPS penalties. Among the 1 million clinicians who participated in the 2019 performance year, about 95% received bonuses. Almost 99% of groups with more than 99 suppliers received bonuses. In contrast, among groups with 2 to 15 suppliers, nearly 90% and nearly 64% of individual suppliers received bonuses.

Under MIPS, suppliers choose from a wide range of measures in each category based on their strengths. But sifting through the data and figuring out what exactly should be reported is complicated. This is where the SURS contractor comes in. According to data from the Government Accountability Office, out of the 136,448 small suppliers in the MIPS program in 2019, approximately 99,000 received technical assistance.

This kind of consultation can range from guiding providers on how to collect relevant data and choosing measures that best reflect practice to basic education about the purpose of value-based care itself.

Hanson recalled an optometrist who was initially prepared to accept the Medicare cut because he did not participate in the MIPS practice. “He didn’t think it would have any value, but we not only convinced him to report, but they have been one of the best performers ever since,” Hansen said. “We also trained all his employees to understand the workflow of collecting data and reporting, because MIPS really needs, especially in small organizations, to let everyone understand the workflow in order to be successful.”

A coalition including the American Medical Association, American College of Physicians, Medical Group Management Association, and the National Partnership for Women and Families requested Congress to extend the plan at the end of November.

Claire Ernst, head of government affairs at MGMA, said that early next year, the extension of a small, underserved and rural support program may be included in the expenditure bill.

“Large practices face the frustration of the MIPS program, and I think the same is true for smaller practices, even more,” Ernst said. “Any assistance that can help them comply with this extremely complex and constantly changing plan is critical to their success.”

However, the effectiveness of SURS in helping small rural suppliers adapt to MIPS is unclear, and there is no research on how contractors perform. Makra, The laws that created MIPS and SURS did not instruct CMS to evaluate the results of financial support or its impact on MIPS. A CMS spokesperson wrote in an email that, based on an average of 19,281 responses, the average annual clinician of SURS contractors was 99% satisfied with technical assistance.

“The broader question is: How useful is this program?” said Peter Mendel, a senior sociologist at RAND. When RAND researched MIPS in 2018, the consulting firm collected feedback from participating suppliers, indicating that they thought the plan was onerous. “The plan still requires a lot of work from doctors, and even this kind of support will not reduce the burden of participation,” he said.

Suppliers must submit data for this year before March, and the results will be reflected in the 2023 payment rate. The agency stated in its announcement on the expiration of SURS funds that in March 2023, the CMS Quality Payment Plan Service Center will be able to answer basic questions and solve more complex situations.