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Merit-Based Incentive Payment System

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Don’t lose those CCM dollars



Nearly two years after the Centers for Medicare & Medicaid Services (CMS) launched CPT code 99490, many physician practices, especially smaller ones,  still haven’t  launched chronic care management (CCM) programs, thus giving up a lot of money.

CMS says that of the 35 million Medicare patients eligible for CCM programs, the agency has only received reimbursement requests for about 100,000 patients.

What might be scaring the practices: A CCM program can be resource- and labor-intensive to start and  patients may bear some costs  in the form of co-pays for services provided between point-of-care visits.

Still,  for a practice not to launch risks losing  it tens of thousands of dollars per month in value-based reimbursements as Medicare payment reform and its Merit-based Incentive Payment System (MIPS) goes into effect soon (unless the Trump administration gets in the way). And, Medical Economics notes, many of the feared challenges to launching a CCM program can be overcome at relatively modest costs and effort with the help of a partner.”

To read the Medical Economics article on this, please hit this link.

CMS to let providers set pace to move to value-based payments


The tortoise and the hare.

The Centers for Medicare & Medicaid Services has  announced that it   will let providers choose the level and speed at which they comply with the new payment-reform model  that emphasizes the medical value/outcomes of patient care over the volume of procedures. In the current, predominately “fee for service” system, the more procedures that providers order, the more they get paid. That is one reason that America’s physicians are by far the highest paid in the world.

Healthcare industry stakeholders have put the CMS under intense pressure  to ease implementation of the Medicare Access and CHIP Reauthorization Act, which is set to start Jan. 1, 2017. Two months ago, CMS Acting Administrator Andy Slavitt said the agency was considering delaying the start date.

And so eligible physicians and other clinicians next year will be given four options to comply with  such new payment schemes such as the Merit-based Incentive Payment System (MIPS) or an alternative payment model (APM), such as Accountable Care Organizations.

Modern Healthcare reported that under MIPS, physician payments “will be based on a compilation of quality measures and the use of electronic health records. About 90 percent of physicians are expected to pursue MIPS because a qualifying APM requires a hefty amount of risk.

“In the first option offered Sept. 8, any data reported will allow providers to avoid a negative payment adjustment. The goal is to ease providers into broader participation in the following two years, ” the publication reported.

The second option lets providers  submit data for a reduced number of days. “This means their first performance period could begin later than Jan. 1 and that practice could still qualify for a small payment if it submits data on how the practice is using technology and how it’s improving,” Modern Healthcare reported.

The third option is for practices that are ready to go in 2017.

To read the Modern Healthcare story, please hit this link.



Growing importance of patients’ reporting their medical outcomes


MedCity News reports:

Just 18 percent of hospitals always consult patient-reported outcomes when making clinical decisions and setting care guidelines, according to a survey of hospital executives, conducted by Salt Lake City-based analytics firm Health Catalyst. Still, that is a higher rate than some expected.

“Patient-reported outcomes seem to be the next horizon in quality reporting and scoring. To date, reports on outcomes and patient safety have mostly indicated whether a hospital has harmed individuals, not how patients perceive care or whether treatment improved their quality of life.”

“That is changing. Notably, the Centers for Medicare and Medicaid Services already incorporates patient-reported outcomes into its value-based payment program for knee and hip replacements, though reporting is voluntary for now. But the Merit-based Incentive Payment System (MIPS), which is scheduled to take effect in 2019, will consider patient-reported outcomes in the calculation of Medicare payments to physicians.”

To read the MedCity News article on this, please hit this link.

Touting a successful care-coordination venture


In the Scottsdale Arts District.

This Physicians Practice article touts  the  care-coordination  model of Scottsdale Health Partners (mostly serving the rich Phoenix suburb of Scottsdale) — a joint venture between  the HonorHealth hospital system and about 700 physicians.
The publication says that “The clinical integrated network and Accountable Care Organization (ACO) is a primary example of how hospitals and physicians can successfully work hand-in-hand in a value-based environment. SHP has enjoyed success in achieving its goals of improving quality of care and lowering costs. In particular, it has reduced its hospital readmissions rate to 9 percent, well below the state average of 15 percent, and saved up to 10 percent in medical costs for its population of 40,000 patients.

“For physician practices looking to get a jump start on value-based care, before CMS’s Merit-Based Incentive Payment System’s (MIPS) likely first performance year in 2017, SHP can be a source of inspiration. Since starting up in 2012, it’s found a way to use technology and personnel to coordinate care almost seamlessly from the hospital to the practice-level.”

Impressive indeed, but a major factor in its success is that the Scottsdale patient population includes many very affluent people with lots of very good health insurance.


MIPS deadly for many small physician practices?

In this interview, Robert A. Berenson, M.D., a fellow at the Urban Institute speculates on whether Medicare’s new  new Merit-based Incentive Payment System (MIPS), which is part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), might be the death knell of many small practices.



Some senators want to expand telemedicine service via Medicare



The U.S. Senate Chamber.

A bipartisan group of U.S. senators are introducing a bill  to  expand telemedicine service through Medicare benefits.

Modern Healthcare reports that the  Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act (PDF), “would expand the use of remote patient-monitoring for some patients with chronic conditions, increase telemedicine services in community health centers and rural health clinics, and provide basic telemedicine benefits through Medicare Advantage.”

Backers also tout the measure as having the added benefit of helping providers meet the goals of the Medicare Access and CHIP Reauthorization Act and the Merit-based Incentive Payment System.

The CONNECT Act  is supported by  several industry groups, including America’s Health Insurance Plans, the American Heart Association and Kaiser Permanente.

“This bill would ensure that patients and their physicians are able to use new technologies that remove barriers to timely quality care. Importantly, the bill would maintain high standards whether a patient is seeing a physician in an office or via telemedicine,” said Dr. Steven J. Stack, president of the American Medical Association.

Life after the SGR


Robert Doherty discusses how physicians should deal with the exit of the Sustainable Growth Rate and the arrival of the Merit-Based Incentive Payment System.


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