Posts Tagged ‘MACRA’

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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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.

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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."

Infographic: MACRA Pathways

November 16th, 2016 by Melanie Matthews

Under MACRA, 2017 will be the first performance year physicians will be scored to determine payment adjustments in 2019. Physicians will choose between two payment tracks: the Merit-based Incentive Payment System (MIPS) or the Alternative Payment Model (APM), according to a new infographic by the American Academy of Family Physicians (AAFP).

The infographic highlights the path options physicians can choose.

Infographic: MACRA Pathways

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: 10 Things To Know About MACRA

October 3rd, 2016 by Melanie Matthews

The Medicare Access and CHIP Reauthorization Act provides a new framework for the drive toward value-based reimbursement for physicians, according to a new infographic by athenahealth Inc.

The infographic provides physicians with 10 critical steps to prepare for MACRA.

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: Which Physician Quality Payment Program Is Right for You?

September 19th, 2016 by Melanie Matthews

For Medicare physicians and groups that will be impacted by the new Merit-Based Incentive Payment Program (MIPS) and the Advanced Alternative Payment Model (APM) requirements, it is important to remember that planning for the Quality Payment Program is more nuanced than simply 'selecting a track,' according to a new infographic by Able Health.

To help make understanding the two Quality Payment Program tracks a bit easier, Able Health's infographic helps physicians and medical groups determine which track may be the most appropriate to prepare for in 2017.

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: Provider Risk Readiness

June 8th, 2016 by Melanie Matthews

The Medicare Access and CHIP Reauthorization Act (MACRA) dramatically changes Medicare physician reimbursement.

A new infographic by AMGA examines the MACRA timetable, groups affected, tools that physician groups will need for effective implementation and the biggest impediment to physician groups taking on downside risk.

With the nation's leading accountable care organizations already testing the waters with CMS' newest value-based reimbursement opportunity, the Next Generation Accountable Care Organization Model, healthcare organizations are evaluating how this new opportunity aligns with their value-based contracting strategy.

During Next Generation ACO: An Organizational Readiness Assessment, a 60-minute webinar on April 5, 2016, now available for replay, Healthcare Strategy Group's Travis Ansel, senior manager of strategic services, and Walter Hankwitz, senior accountable care advisor, will provide a value-based, risk contract roadmap to determine organizational readiness for participation in the Next Generation ACO Model in particular and in risk-based contracts in general.

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Infographic: MACRA Countdown to Measurement Year Goals

May 27th, 2016 by Melanie Matthews

Under MACRA, the physician quality measurement systems in place in 2017 will determine physician Medicare reimbursement in 2019, according to a new infographic by Geneia.

The infographic describes the pace of change in physician value-based reimbursement, the adjustments that will be made to Medicare claims starting in 2019 and three steps that practices should be taking now to be ready.

Since the January 2015 rollout by CMS of new chronic care management (CCM) codes, many physician practices have been slow to engage in CCM. Arcturus Healthcare, however, rapidly grasped the potential of CCM to improve patient outcomes while generating care coordination revenue, estimating it could earn up to $100,000 monthly for qualified patients treated in its four physician practices—or $1 million a year.

Medicare Chronic Care Management Billing: Evidence-Based Workflows to Maximize CCM Revenue traces the incorporation of CCM into Arcturus Healthcare's existing care management efforts for high-risk patients, as well as the bonus that resulted from CCM code adoption: increased engagement and improved relationships with CCM patients.

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MACRA Transition Bolstered by CMS Quality Measure Development Plan

May 9th, 2016 by Patricia Donovan

payment bundling shared savings

Partnerships are key to the final Quality Measure Development Plan by CMS.

The final Quality Measure Development Plan by CMS is an essential aspect of its transition to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), according to last week's blog post by Kate Goodrich, MD, MHS, director of CMS's Center for Clinical Standards & Quality.

The Quality Measure Development Plan is a strategic framework for clinician quality measurement development to support the new Merit-based Incentive Payment System (MIPS) and advanced alternative payment models (APMs), stated Dr. Goodrich.

CMS recently rolled out a proposed rule outlining MACRA's payment incentives for physicians and other clinicians based on quality rather than quantity of care.

The final Quality Measure Development Plan will provide the foundation for building and implementing a measure portfolio to support the quality payment programs under MACRA, Dr. Goodrich said.

After considering comments and suggestions for the plan, CMS finalized the Quality Measure Development Plan to include the following:

  • Identification of known measurement and performance gaps and prioritization of approaches to close those gaps by developing, adopting and refining quality measures, including measures in each of the six quality domains:
    • Clinical care;

    • Safety;

    • Care coordination;

    • Patient and caregiver experience;

    • Population health and prevention;

    • Affordable care.
  • CMS actions to promote and improve alignment of measures, including the Core Quality Measures Collaborative, a work group convened by America’s Health Insurance Plans (AHIP). On February 16, 2016, CMS and the collaborative announced the selection of seven core measure sets that will support multi-payor and cross-setting quality improvement and reporting across our nation’s healthcare systems.
  • Partnering with frontline clinicians and professional societies as a key consideration to reduce the administrative burden of quality measurement and ensure its relevance to clinical practices.
  • Partnering with patients and caregivers as a key consideration for having the voice of the patient, family, and/or caregiver incorporated throughout measure development.
  • Increased focus and coordination with federal agencies and other stakeholders to lessen duplication of effort and promote person-centered healthcare.