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    Managing heart disease: Improve coding and quality scores

    As the only primary care physician in her rural Wisconsin town—and the nearest cardiologist more than an hour away—Melissa Lucarelli, MD, manages patients with heart disease and identifies those at risk of developing it. Doing so isn’t only good for patient care, it also positions her for higher quality scores under Medicare payment reform. 

    To keep pace with heart disease best practices, Lucarelli participates in medical staff meetings at a local hospital where she often learns about new medications. She brings this information to monthly staff meetings at her own practice where she and her team discuss clinical protocols, including which drugs they’ll give to patients and in what order. 

    “We try to be purposeful about that so that we follow standards of care and give our patients a consistent experience,” she says. Staying on top of new clinical guidelines, medications and tests helps physicians treat heart disease effectively, says Lucarelli. “It takes time, but I think it’s important,” she adds.

    Lucarelli also uses her EHR to see whether patients follow through with obtaining the medications she prescribes. A pharmacy interface allows her to see the last time she prescribed the medication, the number of times the patient filled it, the last time it was filled and the number of refills remaining.

    Even in less rural areas, internists and primary care physicians often are among those most qualified to help patients prevent and manage heart disease, says Lucarelli, who is also a member of  the Medical Economics Editorial Advisory Board. “We’re on the front lines, and we have the unique opportunity to create a relationship with patients that’s longitudinal,” she says, adding that a long-term connection built on trust helps physicians convince patients to undergo preventive tests, take medications and reduce risk—all of which bode well under payment reform that rewards good outcomes.

    John Osborne, MD, Ph.D., a cardiologist at the Dallas Cardiovascular Center at the Dallas Medical Center in Dallas, Tex., agrees. “The huge opportunity in cardiovascular disease prevention is not in cardiology. It’s in primary care,” he says. “Primary care physicians are the ones who can identify people at risk, motivate people to change and help lower the risk of cardiovascular death.”


    Leveraging primary care

    By focusing on heart disease prevention and management, physicians can improve outcomes and be paid more while doing so. Heart disease is one of many conditions targeted under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the federal law that seeks to reform Medicare payments while improving outcomes and reducing costs. 

    Beginning in 2019, physicians in the Merit-based Incentive Payment System (MIPS), one of two participation tracks under
    MACRA, will be penalized for costs that exceed anticipated amounts, or rewarded for keeping costs under the projected amounts. 

    By identifying patients who are at risk of developing heart disease, physicians choosing to report on related MIPS measures may boost their quality scores and receive a bonus. 



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