Merry Medisolving featuring St. Anthony Regional Hospital

A veteran nurse and quality leader, Sandi Cook has witnessed a lot of ups and downs in the decade-long journey from meaningful use to MIPS. We chatted with her over Zoom to discuss the latest bump in the road (ahem...COVID!), the tried-and-true lessons she’s learned over the years, and how your MIPS data can help you uncover some surprising truths about your patient population.

Name: Sandi Cook, RN
Job Title: Clinical Application Analyst
Hospital: St. Anthony Regional Hospital

Let’s start with the basics. Tell us about St. Anthony’s ambulatory practice.

We have 9 family practice providers, as well as specialty practices that cover OB/GYN, pediatrics, urology, orthopedics, internal medicine, and behavioral health. Our main clinic is inside the hospital, with 6 additional clinics in the community. We were growing pretty rapidly, but then COVID happened. That brought on all the typical shake-ups, including a lack of providers, so we had to back off a bit.

How has your MIPS performance fared through the COVID upheaval?

That is something I am most proud of: that our numbers have continued to trend upwards despite everything, including clinic closures and provider turnover. Right now, we’re tracking to be around 90.1%, and we’re pretty excited about that.

What’s been the secret to your success? Provider incentives?

No, we don’t incentivize our providers and nurses, and yet our numbers are still climbing. I think education has a lot to do with it.

What does MIPS education look like at St. Anthony?

We sit our clinical teams down and show them the ‘who, what, when, where, why, and how’ of the process: here is the new section, this is why it’s here, here are the rules, and this is how you’ll know when it fires. Each month, we also look at the group data together as a group, and we’re soon going to begin sharing individual provider reports with the group as well. Through it all, we emphasize the recurring theme is that this is essential to providing quality preventive care.

Right, it’s not just about meeting regulatory requirements. MIPS can add a lot of value to your organization.

Yes. MIPS gives you a very discrete way of tracking things. A lot of the measures let you know what your gaps are and force you—in a good way—to better understand your patient population and what their needs are.

Can you give us an example of how MIPS has helped you better understand your patients?

Yes, we actually had an issue with A1C that could have gone undetected without MIPS. All of the sudden, that measure started plummeting. The Medisolv dashboard really helped, because I could immediately tell in two clicks that it was all attributed to one particular clinic that we had just opened. So, of course I’m wondering: what’s going on there? I did a site visit to get to the bottom of it.

Sounds like a good mystery. What did you discover?

The answer was pretty surprising! This clinic was dealing with a population of patients with a wide variety of chief complaints, so the providers were doing a lot of A1C testing on the spot, but the patients weren’t coming back for any follow-up care. What we uncovered was that, in this community, there is a large processing plant that requires workers to have a doctor’s excuse to get out of work. So, what many of these patients really needed was just time off work. And they didn’t have any sort of relationship with a provider, before or after these appointments, that would clue us into that.

That is a wild discovery! How did you remedy the issue?

Our providers really focused on getting more in tune with the patient population, establishing patient relationships, and changing how they interacted with the patients. Soon, they could begin to weed out who was in diabetic crisis and who hadn’t been off work in a while and just needed a break. It added another layer to the provider’s investigative process.

Our providers also started doing a lot more follow-up. The focus of the follow-up would typically be preventive care, so that these patients really understood the importance of staying healthy both physically and mentally. I’m not sure we would have had any of these insights without MIPS.

I’m so glad to hear that Medisolv played a small role in helping you solve the mystery.

The Medisolv dashboard is so user-friendly. You can drill down to each clinic, or provider, or even each patient and see where they met the measure or didn’t. It makes it easy to figure out if you have a global issue or a one-person issue. And if you just spend 30 minutes with that one person, you can probably see that number go back up.

It also helps that our Medisolv Clinical Quality Advisor is phenomenal in keeping us on top of regulatory changes. They are great about making sure the important stuff gets in front of us. We would not be performing as well without a Medisolv advisor or this product.

Do you have any advice for someone who might be new to MIPS?

First of all, don’t be afraid to reach out to your EHR vendor. Our EHR gives us a lot of how-to guides and troubleshooting tools, but that just feels like more homework I have to do. I’ve worked with them pretty closely to understand all the data points we need and where they live in the system.

Secondly, get your provider champions and nurse champions involved. Design the processes together. Ask them very direct questions: whose role should this data point be? Would you do this step before or after the vital signs? Is this something the patient could answer via our patient portal? Having their input in the design helps tremendously with practice-wide buy-in.

How do you go about identifying these champions?

Just ask! [laughs] It really is that simple. We had a few on staff with previous experience, but we put out a call to the whole team just to see who was interested. ‘Do you want to help us improve our workflows and our overall numbers?’ When you put it like that, people are happy to help.