Archive for the ‘MACRA’ Category

CMS Quality Payment Program: Clinicians Should Expect MIPS Participation Status Letter This Month

May 4th, 2017 by Melanie Matthews

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CMS has specified two key criteria for MIPS participation.

The Center for Medicare and Medicaid Services (CMS) is reviewing claims and letting practices know which clinicians need to take part in the Merit-based Incentive Payment System (MIPS), according to information on MLNConnects, the CMS Medical Learning Network.

MIPS is an important part of the new Quality Payment Program (QPP). In late April through May, clinicians will get a letter from their Medicare administrative contractor that processes Medicare Part B claims, providing the participation status of each MIPS clinician associated with their Taxpayer Identification Number (TIN).

Clinicians should participate in MIPS in the 2017 transition year if they meet the following conditions:

  • Bill more than $30,000 in Medicare Part B allowed charges a year; and
  • Provide care for more than 100 Part B-enrolled Medicare beneficiaries a year.

The QPP intends to shift reimbursement from the volume of services provided toward a payment system that rewards clinicians for their overall work in delivering the best care for patients. It replaces the Sustainable Growth Rate (SGR) formula and streamlines the “Legacy Programs:” Physician Quality Reporting System, the Value-based Payment Modifier, and the Medicare Electronic Health Records Incentive Program.

During this first year of the QPP program, CMS said it is committed to working with clinicians to streamline the process as much as possible. The federal payor stated that its goal is to further reduce burdensome requirements so that providers can deliver the best possible care to patients.

Infographic: Preparing for MACRA

April 21st, 2017 by Melanie Matthews

Only 35 percent of health systems have a MACRA strategy and are going to be ready to participate, according to a new infographic by Health Catalyst.

The infographic examines the top MACRA concern, preparation levels and potential benefits.

Under CMS’s “Pick Your Pace” choices for Year 1 Quality Payment Program participation, physician practices may opt for the minimum activity necessary to avoid a payment penalty in 2019 by simply submitting some data in 2017.

However, instead of delaying MACRA participation to the later part of this year, physicians should prepare and better position themselves today for MIPS success by analyzing their existing CMS data on their practices’ performance and laying a path now toward performance improvement.

Physician MACRA-Readiness: Mining QRUR and Other CMS Data to Maximize MIPS Performance describes the wealth of data analytics available from the CMS Enterprise Portal–Quality Resource Use Reports (QRURs) and other reports providing a window into practice performance under the Merit-Based Incentive Payment System (MIPS). MIPS is one of two MACRA reimbursement paths and the one where most physician practices are expected to align.

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5-Part Framework for MIPS Success Under MACRA

March 2nd, 2017 by Patricia Donovan

Before picking MACRA pace, physician practices should construct a framework for MIPS success.

Along with picking a MACRA pace, physician practices should construct a framework for MIPS success.

Regardless of the pace a healthcare organization sets for Quality Payment Program participation, there are some key tactics that should form the framework of any MACRA initiative. Here, William Holding, consultant with PDA Inc., outlines the critical elements organizations need to achieve “MACRA-readiness.”

  • The first component for success is perhaps the most important, and that’s having a culture of provider support. A willingness to explore new options. This component is free, so if you don’t have that culture in place today, before going and investing in analytics products, performance improvement or new staffing, you’ve got to put this culture in place. We have seen organizations do this successfully, and make the journey into accountable care organizations (ACOs) or value-based programs by working on this piece first.
  • Second is strategic planning. Set measurable goals. That’s important. Look ahead one year, two years, three years. Set goals that have timelines, and goals that are reasonably achievable.
  • The next piece is strong leadership. If you don’t have a quality committee or a Merit-Based Incentive Payment System (MIPS) committee, consider establishing one, and establishing a position lead in that program. It should be a multidisciplinary effort. Pull physicians, mid-levels, nursing leadership, IT and program management into that program. You should have tailored reporting strategies that align with your planning efforts.

    I’ve experienced teams that didn’t work well. In working with large systems, even with the support of clinical leadership and with the right analytical skills, efforts, I have witnessed efforts that were slower than they should have been until they brought in the right team member. This team member possessed in-depth knowledge of clinical workflows, had clout within the organization, knew personnel across IT, could talk to providers, and was a good communicator. When that person was on the team, the efforts began to move forward much faster. You’ve got to find the right people to be involved.

  • Next, data analytics is key. This starts with an individual with the right skills. It doesn’t mean you have to buy the most expensive solution for this. Sometimes ad hoc solutions work just fine for certain organizations. However, you need the right individual who knows the data, who knows how to respond to requests from leadership, and who can really own it.
  • Lastly, clinical documentation is essential. Doing that well will improve your position in this program.

Source: Physician MACRA-Readiness: Mining QRUR and Other CMS Data to Maximize MIPS Performance

social determinants of health

Physician MACRA-Readiness: Mining QRUR and Other CMS Data to Maximize MIPS Performance describes the wealth of data analytics available from the CMS Enterprise Portal—Quality Resource Use Reports (QRURs) and other analyses providing a window into practice performance under the Merit-Based Incentive Payment System (MIPS). MIPS is one of two MACRA reimbursement paths and the one where most physician practices are expected to align.

Infographic: Navigating the Merit-Based Incentive Payment System

February 17th, 2017 by Melanie Matthews

The goal of the Centers for Medicare and Medicaid Services’ new quality program, the Merit-Based Incentive Payment System (MIPS), is to streamline quality reporting to CMS and improve care, according to a new infographic by athenaInsight, Inc.

The infographic examines how MIPS will impact an average clinician this year…and in 2019 when the 2017 reporting will impact a clinician’s reimbursement rates.

Infographic: EHR + CRM = Superior Patient Engagement

Under CMS’s “Pick Your Pace” choices for Year 1 Quality Payment Program participation, physician practices may opt for the minimum activity necessary to avoid a payment penalty in 2019: simply submitting some data in 2017.

However, instead of delaying MACRA participation to the later part of this year, physicians should prepare and better position themselves today for MIPS success by analyzing their existing CMS data on their practices’ performance and laying a path toward performance improvement.

Physician MACRA-Readiness: Mining QRUR and Other CMS Data to Maximize MIPS Performance describes the wealth of data analytics available from the CMS Enterprise Portal–Quality Resource Use Reports (QRURs) and other reports providing a window into practice performance under the Merit-Based Incentive Payment System (MIPS). MIPS is one of two MACRA reimbursement paths and the one where most physician practices are expected to align.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today. Have an infographic you’d like featured on our site? Click here for submission guidelines.

Providers, Patients Outline Healthcare Priorities to New HHS Secretary

February 16th, 2017 by Patricia Donovan

As HHS secretary Tom Price begins his tenure, the ACA and physician reimbursement are on constituents' minds.

As HHS secretary Tom Price begins his tenure, the ACA and physician reimbursement are on constituents’ minds.

As Rep. Tom Price settles into his new role as secretary of the Department of Health and Human Services (HHS), organizations representing physician practices, nurses, patient groups and actuaries are making their healthcare priorities known to the newly confirmed administrator.

Concerns range from the future of the Affordable Care Act, which President Trump pledged to repeal in a January 2017 executive order, to specifics of new physician reimbursement programs resulting from MACRA (Medicare Access and CHIP Reauthorization Act of 2015).

In a news release from the American Association of Nurse Practitioners, America’s leading nursing organizations called on the Trump administration and Congress to prioritize patient health and the patient-provider relationship in any health reform proposals. Representing over 3.5 million nurses, the organizations affirmed their shared commitment to advancing patient-centered healthcare and healthcare policies that reflect five key areas ranging from ensuring patients access to healthcare with affordable coverage options regardless of preexisting conditions to creating greater efficiency in the Medicare system.

On the patient side, I Am Essential, a coalition of more than 200 patient groups, asked Price to preserve key ObamaCare protections, including one that guarantees coverage for those with pre-existing conditions.

In its letter, the coalition said certain ObamaCare provisions have provided improved access to care to millions living with chronic and serious health conditions.

“While it is not a perfect law,” the letter stated, “The ACA has provided health coverage and improved access to care for tens of millions of Americans living with chronic and serious health conditions, many of whom were previously uninsured or underinsured. If they lose access and coverage for even one day, their health and well-being can be immediately jeopardized.”

The letter concluded with the following statement: “As you make any changes, we urge you not to go back on the promise of affordable and quality care and treatment for everyone, especially those living with chronic and serious health conditions.”

Meanwhile, a letter from the Medical Group Management Association (MGMA), which represents more than 18,000 U.S. healthcare organizations in which 385,000 physicians practice, asked the new administrator to “significantly reduce the regulatory burden on physician practices and improve the quality and efficiency of healthcare delivery in this country.”

Focused on the federal payor’s new Quality Payment Program resulting from MACRA, the MGMA requested the following from Price, who worked in private practice as an orthopedic surgeon for nearly twenty years prior to launching his political career:

  • A reduction in the cost and reporting burden of the Merit-Based Incentive Payment System (MIPS);
  • A careful review of the eligible Advanced Alternate Payment Program (APM) risk standard and contend there is significant inherent risk in moving from fee-for-service to risk-bearing arrangements, including substantial investment and operational costs, as well as misaligned financial incentives between the payment systems; and
  • Legislative relief from the Federal Physician Self-Referral Law, which MGMA referred to as “a regulatory monster of mind-numbing complexity.”

MGMA represents physician groups of all sizes, types, structures and specialties, and has members in every major healthcare system in the nation.

And finally, the American Academy of Actuaries released three new issue briefs examining a number of key public policy considerations policymakers should weigh when evaluating specific proposals for reforming or replacing the Affordable Care Act.

The three papers, which address high-risk pools, selling health insurance across state lines, and association health plans, are available on the academy’s site.

“Differences in a reform’s structure can have wide implications for stakeholders and for how it interacts with other reforms that have been or may be adopted,” said Academy Senior Health Fellow Cori Uccello. “For example, high-risk pools can be structured in different ways, with different implications for access to coverage, premiums, and government spending. Further, how regulatory authority is defined for both cross-state insurance sales and association health plans affects whether insurers would compete on a level playing field.”

Physician Supplemental QRUR: Episode-Specific Patient-Level Data Tells Story of High Utilizers

February 7th, 2017 by Patricia Donovan

QRUR reports provide a mirror into physicians’ cost and quality performance under MACRA.

As year one of MACRA unfolds, healthcare providers deterred by security hurdles associated with CMS Enterprise Portal access may want to reconsider. The wealth of aggregate quality and cost performance data available through the portal is well worth the trouble of accessing it, advises William Holding, consultant with PDA, Inc.

Specifically, Quality Resource and Utilization Reports (QRURs) downloadable from the portal are essential tools for physician practices that hope to succeed on MACRA-defined reimbursement paths, Holding said—even practices equipped with robust internal reporting systems.

“This is the same system that accountable care organizations (ACOs) use, and that CMS uses for many other things, so it’s a good idea to get past those barriers,” he explained during Physician MACRA Preparation: Using QRUR and Other CMS Data to Maximize Your Performance, a February 2017 webinar now available for replay.

Originally designed for CMS’s value-based modifier, QRURs are good indicators of future cost performance under MACRA, via either Merit-Based Incentive Payment System (MIPS), where most physician practices are expected to fall initially, or Alternate Payment Models (APMs), he said.

After providing an overview of MIPS and APMs, including five essential prerequisites to MACRA preparation, Holding delved into the quality and cost metrics contained in QRURs, from aggregate data in the main report to detailed tables rich with patient-specific information.

The main QRUR report illustrates where a physician practice falls in relation to other practices on the overall composite for cost and quality. The QRUR’s Quality portion shows scores for a series of domains, including effective clinical care and patient experience, which offer a great window into how a practice might perform with different selected measures in MIPS.

Next, QRUR cost performance indicates per capita costs for attributed beneficiaries, which will remain a cost measure in MIPS.

Drilling down, Holding characterized seven associated QRUR downloads—including one table on individual eligible professional performance on the 2015 PQRS Measures—as even more useful than the QRURs themselves.

And finally, he termed the downloadable supplemental QRUR “a very powerful tool” that drills down to the beneficiary level, providing a snapshot of some of the highest cost events occurring among a practice’s patients.

“For high utilizers, for specific episodes, you can drill right down to the patient to try and understand the story. What’s happening to your patient when they’re not in your practice, and what can you do about it?” said Holding.

Having presented the available reports, Holding described four key benefits of using QRUR downloads, including as a priority setting tool, and then detailed the myriad of ways QRURs can be analyzed to improve MIPS performance.

However, Holding stressed, even physician practices with the most sophisticated reporting structures will not thrive under MACRA without the right team or culture of provider support in place. He closed his presentation with a formula for determining investment in performance improvement activities and a five-step plan for MACRA preparation.

Listen to an interview with William Holding on the use of QRURs to determine a physician practice’s highest value referral pathways.

At MACRA Launch, Think Like a MIPS Top Performer

January 9th, 2017 by Patricia Donovan
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A focus on quality activities like influenza vaccines is a good starting point for MIPS performance improvement.

With the opening of the first Quality Payment Program performance period on January 1, 2017, many eligible healthcare providers have picked their MACRA participation pace and begun to collect performance data. In certain cases, Merit-based Incentive Payment System (MIPS) top performers and MIPS exceptional performers potentially could fare better than Advanced Alternative Payment Model (APM) practices. Here, Barry Allison, chief information officer, the Center for Primary Care, describes some ways clinicians can aspire toward MIPS top performer or exceptional performer status.

According to the Centers for Medicare and Medicaid Services (CMS), a MIPS top performer must be one standard deviation point above the mean, as far as the total cost of care for the patient as well as for the quality metrics reported to CMS. This illustrates why it is critical to look at your organization’s Quality and Resource Use Report (QRUR) data. From looking at our own QRUR data internally, we want to be in the 90th percentile or higher for things like annual flu shots, influenza vaccines, Pneumovax® vaccinations, or Prevnar® vaccinations in conjunction with the Pneumovax 23.

These are very key points. For most EHRs and registries, if you look at quality, that 60 percent that CMS will review in MACRA’s first year, those are the activities where you should aim to report at the high end. I would recommend anywhere from 88 percent and upwards, but my minimum would be reporting on 90 percent of areas where you can use technology to deploy a short message service (SMS) outreach campaign for influenza vaccines or similar tasks.

You want to make sure that in the areas considered low hanging fruit, that you’re either rendering those services, or if you don’t render those types of services, you direct the patient toward a Medicare provider or provider that does render those services and from whom Medicare receives that information.

Let’s take flu shots, for example. Even though your particular practice may not render that service, you should refer your patients somewhere that does administer the shots. You want to refer that patient somewhere where you know that claim will be filed to Medicare, because through their attribution methodology, you’re still that patient’s primary care provider. You still get credit right now for that quality element, even though you may not have administered the shot.

Source: Physician Chronic Care Management Reimbursement: Roadmap to MIPS Success Under MACRA

http://hin.3dcartstores.com/Home-Visits-for-Clinically-Complex-Patients-Targeting-Transitional-Care-for-Maximum-Outcomes-and-ROI_p_5180.html

Physician Chronic Care Management Reimbursement: Roadmap to MIPS Success Under MACRA describes how early adoption of Medicare’s CCM Reimbursement program enhanced the Center’s MACRA-readiness, laying the foundation for success under the Merit-based Incentive Payment System (MIPS) path.

2016 Healthcare Headlines: MACRA Monopolizes News Until Election Shake-Up

December 26th, 2016 by Patricia Donovan
top 2016 news stories

The unexpected election of Donald J. Trump to the U.S. presidency threatened some healthcare initiatives from the Obama administration, including the Affordable Care Act.

There was only one thing capable of distracting the healthcare industry in 2016 from MACRA’s imminent rollout: the election of Donald J. Trump to the presidency of the United States.

Nevertheless, the majority of the last twelve months was spent on healthcare business as usual—the business of transitioning to value-based models of care delivery and reimbursement.

Here are the headlines that dominated the news feeds of healthcare executives in 2016:

New CMS ‘Accountable Health Communities’ Model Aims to Improve Patients’ Health by Addressing Social Needs

January 2016: In a first-ever CMS Innovation Center pilot project to test improving patients’ health by addressing their social needs, the HHS appropriated $157 million in funding to bridge clinical care with social services.

The new pilot will test whether screening beneficiaries for health-related social needs and associated referrals to and navigation of community-based services will improve quality and affordability in Medicare and Medicaid. Many of these social issues, such as housing instability, hunger, and interpersonal violence, affect individuals’ health, yet they may not be detected or addressed during typical healthcare-related visits.

Medicare Shares 6 Core Principles for 21 New ‘Next Generation ACOs’

January 2016: The Centers for Medicare & Medicaid Services (CMS) made waves when it launched a new accountable care organization (ACO) model called the Next Generation ACO Model (NGACO Model). The twenty-one ACOs participating in the NGACO Model in 2016 have significant experience coordinating care for populations of patients through initiatives, including, but not limited to, the Medicare Shared Savings Program and the Pioneer ACO Model.

Providers Slow to Adopt Population Health, Value-Based Models of Care: Study

February 2016: Most healthcare providers continue to lag in implementing population health management despite broad agreement it will be important for future market success, according to a national study by healthcare strategy consultancy Numerof & Associates. The study synthesized survey responses from more than 300 executives and in-depth interviews with over 100 key decision-makers across U.S. healthcare delivery organizations. It provided the first in-depth, national look at the pace of transition from fee-for-service to models based on fixed payments linked to outcomes.

Horizon BCBSNJ ‘Episodes of Care’ Program Pays $3 Million in Shared Savings to Specialty Medical Practice

February 2016: Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) announced that it paid out approximately $3 million to 51 specialty medical practices as part of shared savings generated through the company’s innovative Episodes of Care (EOC) Program. The doctors, in five different specialty areas, earned the payments by achieving quality, cost efficiency and patient satisfaction goals in 2014 while treating more than 8,000 Horizon BCBSNJ members. The EOC model, also known as bundled payments, is one in which specialists manage the full spectrum of care related to a specific procedure, disease diagnosis or health event—such as a joint replacement or pregnancy.

Bundled Payments Improve Care for Medicare Joint Replacement Patients: NYU Langone Study

March 2016: Implementing bundled payments for total joint replacements resulted in year-over-year improvements in quality of care and patient outcomes while reducing overall costs, according to a new three-year study from NYU Langone Medical Center. The three-year pilot at the medical center reported reductions in patient length-of-stay and readmission rates.

CMS to Test New SNF Payment Model to Curb Readmissions, Foster Multidisciplinary Care

March 2016: The Centers for Medicare & Medicaid Services (CMS) today announced it would test whether a new payment model for nursing facilities and practitioners will further reduce avoidable hospitalizations, lower combined Medicare and Medicaid spending, and improve the quality of care received by nursing facility residents. This next phase of the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents seeks to reduce avoidable hospitalizations among beneficiaries eligible for Medicare and/or Medicaid by providing new payments to practitioners for engagement in multidisciplinary care planning activities.

Proposed MACRA Rule Would Streamline Medicare Value-Based Payment Models

May 2016: In issuing a proposal to align and modernize how Medicare payments are tied to the cost and quality of patient care for hundreds of thousands of doctors and other clinicians, the Department of Health & Human Services took the first step in implementing certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Are You MACRA-Ready? Physician Groups Prep Members for Medicare Payment Modernization

May 2016: As they digested the HHS’s momentous proposal to modernize how Medicare provider payments are tied to the cost and quality of patient care, physician organizations began assembling arsenals of educational tools to de-mystify MACRA. The federal government’s first step in implementing certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was detailed in an April 2016 announcement.

CMS Releases MACRA Final Rule; Creates Two Pathways for Clinician Value-Based Payments

October 2016: The Department of Health & Human Services (HHS) finalized a landmark new payment system for Medicare clinicians that will continue the administration’s progress in reforming how the healthcare system pays for care. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program, which replaces the flawed Sustainable Growth Rate (SGR), will equip clinicians with the tools and flexibility to provide high-quality, patient-centered care.

ACA Afterlife: Unwinding Obamacare Under the Trump Administration

November 2016: If U.S. President-elect Donald J. Trump delivers on his campaign promises, the ‘repeal and replacement’ of the Affordable Care Act (ACA) should be an early priority for the nation’s chief executive-in-waiting. That prospect sent shock waves through the healthcare industry, as evidenced by a snapshot of post-election responses to the Healthcare Trends in 2017 survey sponsored by the Healthcare Intelligence Network.

Trump Taps Orthopedic Surgeon, Medicaid Architect to Helm U.S. Healthcare Posts, Determine ACA Fate

November 2016: Calling his nominees “the dream team that will transform our healthcare system for the benefit of all Americans,” President-elect Donald J. Trump announced his plan to nominate Chairman of the House Budget Committee Congressman Tom Price, M.D. (GA-06) as secretary of the U.S. Department of Health and Human Services (HHS) and Seema Verma as administrator of the Centers for Medicare and Medicaid Services (CMS).

To receive up-to-the-minute healthcare news and trends in your inbox in 2017, register for a complimentary subscription to the Healthcare Business Weekly Update.

Value-Based Reimbursement Dominates Healthcare in 2016 and 11 More Industry Trends

December 15th, 2016 by Patricia Donovan

MACRA-Ready: 9 percent said they would participate in an Advanced Alternative Payment (APM) model in 2017.

ACA anxieties aside, value-based reimbursement wielded the most influence over the business of healthcare in 2016, according to the thirteenth annual industry trends snapshot by the Healthcare Intelligence Network (HIN).

Value-based reimbursement also topped the list of lucrative business development areas for 18 percent of respondents, HIN’s industry survey found, followed by chronic care management (14 percent), integration of behavioral healthcare and primary care (11 percent), and telehealth (11 percent).

Sixty-nine percent of respondents consider themselves well positioned to succeed under value-based reimbursement models in the year to come. Additionally, 60 percent report that 2016 was a better year business-wise than 2015.

However, preoccupation with new models of care delivery and payment did not eliminate worry over the post-election fate of the Affordable Care Act (ACA), which President-elect Trump has vowed to repeal or replace. At least 10 percent referenced either the election, ACA uncertainty or the incoming presidential administration when identifying the greatest business challenges they expect to face in 2017.

The annual Healthcare Trends & Forecasts survey, administered in November 2016, captured year-end feedback from more than 100 hospitals, health plans, physician organizations, long-term care providers and others, pinning down the trends impacting the industry in the year to come.

A Look Back: Best and Worst Business Decisions of 2016

Community partnerships, training for integrated care and value-based payments, and participation in CMS Bundled Payment for Care Improvement (BPCI) were among the most successful business decisions of 2016, respondents reported. However, many cited lack of preparation for bundled payments and care delivery transformation, lack of communication, and lack of focus on quality as regrettable 2016 business decisions.

This 2017 roadmap for healthcare also identified the following metrics:

  • Respondents’ pace of MACRA participation for 2017:
    • Eight percent will test MACRA’s Quality Payment Program by submitting partial data in 2017 without fear of negative payment adjustments;
    • Six percent will participate for part of the calendar year;
    • Nine percent said they would participate for the full calendar year; and
    • Nine percent said they would participate in an Advanced Alternative Payment (APM) model in 2017.
  • Growth, hiring and recruitment, and sales and services were the three business areas most impacted by the 2016 economic climate.
  • Healthcare wearables, palliative care and health insurance exchanges had the least impact on respondents’ 2016 business operations.

Download the complimentary HINtelligence report, “Healthcare Trends for 2017: ACA Anxieties Aside, Majority Well-Positioned for Value-Based Reimbursement.

Trump Taps Orthopedic Surgeon, Medicaid Architect to Helm U.S. Healthcare Posts; Industry Reacts

December 5th, 2016 by Patricia Donovan

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Healthcare industry reaction to President-elect Donald J. Trump’s choices to head the HHS and CMS was largely positive.

Calling his nominees “the dream team that will transform our healthcare system for the benefit of all Americans,” President-elect Donald J. Trump last week announced his plan to nominate Chairman of the House Budget Committee Congressman Tom Price, M.D. (GA-06) as secretary of the U.S. Department of Health and Human Services (HHS) and Seema Verma as administrator of the Centers for Medicare and Medicaid Services (CMS).

“Chairman Price, a renowned physician, has earned a reputation for being a tireless problem solver and the go-to expert on healthcare policy,” said President-elect Trump in a news release. “He is exceptionally qualified to shepherd our commitment to repeal and replace Obamacare and bring affordable and accessible healthcare to every American.”

Prior to serving in Washington, Rep. Price worked in private practice as an orthopedic surgeon for nearly 20 years.

In the same announcement, the President-elect called Seema Verma, his nominee for CMS administrator, one of the leading experts in the country on Medicare and Medicaid. “She has decades of experience advising on Medicare and Medicaid policy and helping states navigate our complicated systems,” he said.

Seema Verma is the president, CEO and founder of SVC, Inc., a national health policy consulting company. For more than 20 years, Ms. Verma has worked extensively on a variety of policy and strategic projects involving Medicaid, insurance, and public health, working with governors’ offices, state Medicaid agencies, state health departments, state insurance departments, as well as the federal government, private companies and foundations.

Ms. Verma has extensive experience redesigning Medicaid programs in several states. Ms. Verma is the architect of the Healthy Indiana Plan (HIP), the nation’s first consumer-directed Medicaid program, and served as the State of Indiana’s health reform lead following the ACA’s passage in 2010.

Responding to the announcement, the American Medical Association (AMA) said it supports the nomination of Dr. Tom Price, who would be the first physician to serve as HHS secretary since President George H.W. Bush appointed Louis W. Sullivan, MD, in 1989, and only the third doctor in the HHS’s 63-year history.

In a statement, Patrice A. Harris, MD, MA, AMA Board Chair, cited decades of interactions with Dr. Price as a member of the AMA House of Delegates, Georgia state senator and House of Representatives. “Over these years, there have been important policy issues on which we agreed (medical liability reform) and others on which we disagreed (passage of the Affordable Care Act). Two things that have been consistent are [Dr. Price’s] understanding of the many challenges facing patients and physicians today, and his willingness to listen directly to concerns expressed by the AMA and other physician organizations.”

On the payor side, America’s Health Insurance Plans (AHIP), the national trade association representing the health insurance community, said in a statement that it anticipates cooperative, collaborative relationships with the new leaders of HHS and CMS.

“For many years, Dr. Price has been committed to ensuring that patients and consumers are well-served,” said Marilyn Tavenner, AHIP president and CEO. “He will bring a balanced and thoughtful perspective to his role as Secretary of HHS. We look forward to working with him to promote competition, increase choice, and lower costs for every consumer.

“Likewise, we look forward to working with Seema Verma to strengthen our nation’s healthcare system and empower Americans to improve their health and financial well-being, particularly those who depend on the valuable support and services provided through Medicare and Medicaid.”

Related Resource: MACRA Physician Quality Reporting: Positioning Your Practice for the MIPS Merit-Based Incentive Payment System

MACRA MIPS

MACRA Physician Quality Reporting: Positioning Your Practice for the MIPS Merit-Based Incentive Payment System delivers a veritable MACRA toolkit for physician practices, with dozens of tips and strategies that lay the groundwork for reimbursement under Medicare’s Merit-based Incentive Payment System (MIPS), one of two payment paths Medicare will offer to practices beginning January 1, 2017.