Archive for the ‘MACRA’ Category

4 Ways CMS 2018 Quality Payment Program Supports ‘Patients Over Paperwork’ Pledge

November 6th, 2017 by Patricia Donovan

“Patients Over Paperwork” is committed to removing regulatory obstacles that get in the way of providers spending time with patients.

Year 2 of the CMS Quality Payment Program promises continued flexibility and reduced provider burden, according to the program’s final rule with comment issued by the Centers for Medicare and Medicaid Services (CMS) last week.

The Quality Payment Program (QPP), established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), is a quality payment incentive program for physicians and other eligible clinicians that rewards value and outcomes in one of two ways: through the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

A QPP Year 2 fact sheet issued by CMS highlights 2018 changes for providers under the QPP’s MIPS and APM tracks. The Year 2 fact sheet noted that stakeholder feedback helped to shape policies for QPP Year 2, and that  “CMS is continuing many of its transition year policies while introducing modest changes.”

In keeping with the federal payor’s recently launched “Patients Over Paperwork” initiative, QPP Year 2 reflects the following changes:

    • More options for small practices (groups of 15 or fewer clinicians). Options include exclusions for individual MIPS-eligible clinicians or groups with less than or equal to $90,000 in Part B allowed charges or less than or equal to 200 Part B beneficiaries, opportunities to earn additional points, and the choice to form or join a virtual group.
    • Addresses extreme and uncontrollable circumstances, such as hurricanes and other natural disasters, for both the 2017 transition year and the 2018 MIPS performance period, by offering hardship exception applications and limited exemptions.
    • Includes virtual groups as another participation option for Year 2. A virtual group is a combination of two more taxpayer identification numbers (TINs) made up of solo practitioners and groups of 10 or fewer eligible clinicians who come together ‘virtually’ (no matter specialty or location) to participate in MIPS for a performance period of a year. A CMS Virtual Groups Toolkit provides more information, including the election process to become a virtual group.
    • Makes it easier for clinicians to qualify for incentive payments by participating in Advanced APMs that begin or end in the middle of a year. Updated QPP policies for 2018 further encourage and reward participation in APMs in Medicare.
  • CMS describes its Patients Over Paperwork effort as “a cross-cutting, collaborative process that evaluates and streamlines regulations with a goal to reduce unnecessary burden, increase efficiencies and improve the beneficiary experience. This effort emphasizes a commitment to removing regulatory obstacles that get in the way of providers spending time with patients.”

    Infographic: Healthcare Payment Model Reform

    November 3rd, 2017 by Melanie Matthews

    As the 79 million baby boomers turn 65, they will grow the
    Medicare-eligible cohort from 13.1 percent to 20.3 percent in 2030, according to a new infographic by HORNE Healthcare.

    The infographic provides advice for providers to prepare for success in the ever-changing healthcare reimbursement environment.

    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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    Infographic: Banking the Upside from Value-Based Reimbursement

    October 11th, 2017 by Melanie Matthews

    As healthcare reimbursement shifts toward paying for value, there’s significant revenue at stake for physician practices, according to a new infographic by athenahealth, Inc.

    The infographic examines five different types of physician practices and how participation in value-based reimbursement models would impact practice revenue.

    No matter which level of participation physician practices choose for the first Quality Payment Program performance period beginning January 1, 2017, CMS’s “Pick Your Pace” announcement means practices should proactively prepare for the impact of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) on physician quality reporting and reimbursement.

    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), expected to begin in 2017 and one of two payment paths Medicare will offer to practices.

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    Infographic: Are Specialty Practices Prepared for MACRA?

    September 18th, 2017 by Melanie Matthews

    A growing number of specialty physicians, comprised mainly of oncologists and urologists, recognize that clinical, financial and operational changes are needed to be successful under value-based healthcare reimbursement models stemming from MACRA regulations. However, the majority has not yet invested in organizational, IT, or service improvements needed to achieve them, according to a new study by Integra Connect.

    A new infographic by Integra Connect highlights the survey findings, including details on the barriers to MIPS success and practices’ plans to optimize MIPS success.

    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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    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.

    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.

    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.