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Performance in MIPS can affect patient volume


Rita Numerof, in a FierceHealthcare essay,  warns providers that their performance under  the Merit-based Incentive Payment System can influence their overall patient volume.

She notes: “Though the program is not without its challenges and limitations, it does begin to give consumers some information they need to make informed choices and benefit from competition.

“The healthcare industry is in the position of having this transparency imposed upon it via federal action because the providers themselves have been slow to tackle true accountability. A lack of actionable information has led to a situation where the country’s largest payer must provide both carrots and sticks to collect performance information from providers.

“Over the long term, MIPS reporting has the potential to drive patient volume, either directly, through consumer choice, or indirectly, through network selections made by payers. There are significant implications for individual physicians, medical groups and the hospitals whose revenues depend on their referral streams.”

“Many physician groups have raised concerns about administrative burdens under MIPS, and the recent changes to the program were partially intended to address them. But this is still a heavy lift, and providers need to streamline the data collection that supports MIPS wherever possible in order to minimize overhead and ensure data integrity.”

To read more, please hit this link.

CMS further lightens the MACRA load.



CMS is continuing to lighten the MACRA load after smaller and rural providers  complained that their paucity of capital and other resources make complying with the reporting requirements too difficult.

Its latest proposed move would permit  the exemption of small providers participating in the program by increasing the low-volume threshold to $90,000 or less in Medicare Part B charges or 200 or fewer Medicare patients annually. The original threshold was $30,000 in Medicare Part B charges or 100 Medicare patients. The agency believes  that the move would let about 134,000 clinicians stay out of  MIPS.

The proposal follows more than 800,000 clinicians in May being told that  they will not be evaluated under the MIPS program

MACRA will replace Medicare’s Sustainable Growth Formula with a 0.5% annual rate increase through 2019. After that, CMS says, physicians are encouraged to shift to one of two Quality Payment Programs: 1) Merit-Based Incentive Payment System (MIPS) or 2): Alternative Payment Model (APM).

Most physicians are expected to enter the MIPS.

“We’ve heard the concerns that too many quality programs, technology requirements and measures get between the doctor and the patient,” said CMS Administrator Seema Verma. “That’s why we’re taking a hard look at reducing burdens. By proposing this rule, we aim to improve Medicare by helping doctors and clinicians concentrate on caring for their patients rather than filling out paperwork. CMS will continue to listen and take actionable steps toward alleviating burdens and improving health outcomes for all Americans that we serve.”

American Medical Association President David Barbe, M.D., praised  CMS.   “Not all physicians and their practices were ready to make the leap, and many faced daunting challenges. This flexible approach will give physicians more options to participate in MACRA and takes into consideration the diversity of medical practices throughout the country.”

To read more, please hit this link.

Panel asks for changes in MIPS

The Medicare Payment Advisory Commission (MedPAC) has proposed proposed changes in the Merit-based Incentive Payment System (MIPS) aimed at strengthening advanced alternative payment models and creating a prospective payment system for post-acute-care  settings.

The commission also suggests that MIPS should be based on population- health measures.

The commission notes that growing consolidation of  hospitals and physicians has generally increased prices without improving care. So, in response, the report’s authors recommend restraining Medicare prices to address  horizontal consolidation and imposing site-neutral pricing in response to vertical consolidation.

The panel has also asked policymakers to consider cutting payment rates for emergency departments that aren’t on hospital campuses and ending exemptions to site-neutral payments for ambulatory services.

To read more, please hit this link.

Hire more staff to help deal with MACRA?


An article in Physicians Practice looks at the pros and cons or hiring additional staff to address MACRA issues. Among the stuff:

The article asserts that Charles Saunders, M.D.,  who is CEO of Integra Connect, a technology and service provider specializing in value-based care,  is one of the few experts who says that hiring more staff may be necessary.

The article reports:  “He says this is the case if a practice chooses to participate in the other MACRA pathway, an advanced alternative payment model (APM). These models have requirements for certain activities such as care coordination and quality improvement programs, which can’t simply be automated. ‘To be successful in driving savings, some investments in these activities will be required for care coordinators and case managers,’ he says. This is because, as with MIPS measures, reporting on them can be a labor-intensive exercise requiring chart reviews, depending on the ability of the EHR to automate this process.”

“Other experts disagree, suggesting that MACRA shouldn’t radically change the way physicians staff their practice or collect information from their patients. ‘In effect, MACRA simply is a requirement that physicians document that they’ve actually performed the next step in terms of a slightly more complicated process of documentation,’ says Stuart Hochron, M.D., chief medical officer and co-founder of Uniphy Health, a physician’s communication and collaboration app. He says the changes won’t require new staff, just more staff education. He recommends turning to CMS’s extensive online resources on the topic, as well as medical societies that offer MACRA education as a start. ‘I’d either attend a respectable conference that was targeted as your organization is focused, or hire a consultant,’  he says.”

To read the whole article, please hit this link.

As rural physicians move into MIPS



Cover by Sarah Wyman Whitman

Here’s some guidance in Hospitals & Health Networks for rural hospitals on how they can prepare for Medicare’s new Merit-based Incentive Payment System. Among the recommendations:

“Determine which clinicians are in and out’’

“A sizable percentage of small rural providers have been given a reprieve in 2017 from MIPS, which focuses on Medicare Part B. Exempt providers include Rural Health Clinics, Federally Qualified Health Centers and clinicians with low Medicare volumes. Specifically, clinicians who see fewer than 100 Medicare patients, or who bill less than $30,000 worth of Medicare services, will be exempt from MIPS participation in 2017.’’

“Identify who has to report what’’

“In 2017, eligible clinicians will be assessed in three MIPS categories: quality, improvement activities and advancing health information. Clinicians will be assessed on cost measures starting in 2018. CMS has also loosened reporting requirements for certain providers. For instance, rural providers can report two rather than four improvement activities.’’

“Avoid transition-year complacency’’

“CMS is allowing providers to choose how much data they report in 2017. While providers will receive a 4 percent penalty in 2019 if they don’t submit any data, they can avoid this penalty by reporting a minimum amount (for example, one quality measure). While small rural hospitals may welcome this respite, they need to be careful not to procrastinate and fail to get ready for 2018, when providers might have to submit a year’s worth of data or risk a 5 percent penalty in 2020.’’

“Determine the cost of participation’’

‘’Small rural hospitals should consider the costs and benefits associated with seeking MIPS bonuses, which will be at 4 percent or lower in 2017. ‘’ The cost could exceed the reward dollars organizations might potentially achieve.

To read more, 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.



How to live with MIPS


Many physicians are asking whether they can opt out of Medicare’s Merit-Based Incentive Payment System (MIPS), which is replacing the Sustainable Growth Rate formula.

Well, probably not. But in any case, suggests Medscape, physicians can reduce  their MIPS reporting burden by reporting with other physicians together in single submission.

“It would be administratively simple to report as a group,” says , founder and CEO of SA Ignite, a Chicago company that helps organizations manage value-based programs, told Medscape. Of course, this would be easier for  a large practice or group of hospital-employed physicians with the staff and IT capabilities to centralize reporting.

The Centers for Medicare & Medicaid Services (CMS) defines a clinical group as having at least two “eligible clinicians”. That could be a physician and a nurse practitioner or physician assistant in one practice.

Under its  proposed rule, CMS would let solo and small practices to get together in “virtual groups,” but owing to the difficulties of implementing such arrangements, this wouldn’t be possible in the first year of MIPS reporting.

Dr. Lee told Medscape that a downside of reporting in a group is that “you would have limited ability to choose specific measures. You may be forced to accept measures for activities where you don’t perform that well.”

To read the full article, 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 looms, but maybe you can opt out


Providers are girding their loins to comply not only  with the next stage of the Meaningful Use program, but also a  new mandated electronic reporting requirement: Medicare’s Merit-based Incentive Payment System (MIPS).

The MIPS combines parts of the Physician Quality Reporting System (PQRS), the Value-based Payment Modifier, and Meaningful Use into one single program based on quality, resource use and clinical-practice improvement.

Robert Tennant, senior policy adviser with the Medical Group Management Association (MGMA),  told MedPage Today that the two programs are very inter-twined:
“Even though Meaningful Use was sunsetted, it’s now effectively 25% of your MIPS score, so it never really goes away.” And because it is so much of the MIPS score, “it’s potentially more impactful on your reimbursement.”

But Linda Delo, D.O., a family physician in Port Saint Lucie, Fla., told the online news service that, as MedPage paraphrased her, “{P]hysicians can get out from under MIPS in some cases if they become part of an alternative payment model such as an Accountable Care Organization (ACO), a bundled payment model, or a patient-centered medical home (PCMH), rather than continue in the traditional fee-for-service Medicare program.”


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