One Alabama Physician’s Quality Payment Program Journey from Penalties to a More Productive Path

Dr. Adetokunbo Ladipo, an internist, is the sole medical doctor and owner of LHM Clinic PC in Anniston, Alabama. Not only does she practice medicine, but she also fulfills administrative obligations – spending countless hours treating patients and maintaining her practice. It is not unusual for a doctor to function as both the clinician and office manager in a small practice; however, it can be overwhelming to meet the demands of the CMS Quality Payment Program (QPP).

To successfully participate in the QPP and avoid Medicare penalties, physicians often transform their practices by using electronic medical record (EMR) systems. EMRs should be certified for quality reporting and meet the meaningful use criteria. Although Ladipo is self-sufficient and wants the best for her patients, her EMR lacked the functionality necessary to participate in the QPP. And because she did not participate in prior years, she was receiving negative adjustments on Medicare reimbursement.

She received a call from April Richardson, a Quality Improvement Advisor with the Alabama Quality Assurance Foundation, an Qsource partner. Richardson is part of the Small, Underserved, and Rural Support initiative to provide free assistance to clinicians in small practices and offered to help the practice in its quality reporting efforts.

Richardson scheduled several on-site meetings. Her goal was to help Ladipo better understand the QPP, prevent additional penalties, reduce physician burden, and improve care for patients.

She explained each element of the QPP program and helped pull data reports. Richardson saw that the practice’s EMR structure was poorly-designed and unable to capture and aggregate quality data in the correct format. Ladipo agreed that her system was cumbersome and she attempted contacting technical support several times for assistance. A consultant declined to work with her due to EMR challenges.

After carefully accessing the practice’s quality reporting status for 2017, Richardson encouraged Ladipo to submit a test claim (only 3 points), the minimum requirement to avoid a downward payment adjustment for that year.

Richardson also asked to review the Security Risk Analysis (SRA), which had not been updated. She encouraged Ladipo to update and perform an SRA annually to protect health information. In order to meet the SRA criteria for 2017, Richardson used the free SRA Audit tool developed by Qsource to conduct the assessment. She discovered some opportunities for improvement that the practice’s IT team addressed immediately.

In preparation of the 2018 QPP year, Richardson continued helping Ladipo, who wanted to change EMRs. Richardson assisted in this research process; she told Ladipo what to look for and what types of questions she should ask the various vendors. Ladipo invested in a new, more intuitive EMR that is highly-rated by CMS.

One of the benefits of the new EMR is the Clinical Practice Guidelines. The EMR system now captures all components of QPP and is a 2015 CEHRT-licensed software. With this new capability, Richardson was in a better position to recommend measure selections, monitor quality performance, and assist with a more comprehensive submission for 2018. Currently, Ladipo’s preliminary score is 30 points, pending the finalized score that will be available mid-2019.

With a higher QPP score than the previous year, Ladipo is now on a more productive path to quality reporting. The new EMR has transformed her practice. There are fewer templates and less clicking in the EMR. She feels that she can take better care of her patients and meet the requirements of QPP.

Ladipo is no longer overwhelmed or being penalized. Richardson has been a valuable resource and will continue to help ensure this practice’s success in QPP.

We look forward to helping your practice. Sign up at Providers.Exchange, our QPP resource center for individualized support, events and resources, email [email protected], or call us toll-free Monday to Friday at 1-844-205-5540 from 8:30 a.m. to 5 p.m. CT, to connect to the technical assistance you need regardless of practice size or location.