2019 MIPS Proposed Rule Webinar 12.20.2018

This presentation will review the MIPS 2019 Final Rule. I will review changes that may impact your practice. Prepare now to report successfully for MIPS 2019.


Recommended attendees:

  • Office Managers
  • Reporting Clinicians
  • Assisting Medical Staff


Register for our 2019 MIPS Proposed Rule Webinar Today:



2019 MIPS Proposed Rule Webinar 12.13.2018

This presentation will review the MIPS 2019 Final Rule. I will review changes that may impact your practice. Prepare now to report successfully for MIPS 2019.


Recommended attendees:

  • Office Managers
  • Reporting Clinicians
  • Assisting Medical Staff


Register for our 2019 MIPS Proposed Rule Webinar Today:



2019 MIPS Proposed Rule Webinar 11.29.2018

This presentation will review the MIPS 2019 Final Rule. I will review changes that may impact your practice. Prepare now to report successfully for MIPS 2019.


Recommended attendees:

  • Office Managers
  • Reporting Clinicians
  • Assisting Medical Staff


Register for our 2019 MIPS Proposed Rule Webinar Today:



Teaching patients portal usage improves satisfaction, engagement



Dive Brief:

  • Teaching patients how to access a patient portal and its role in their post-discharge care increases engagement during and after hospitalization. It also improves patient experience, a new JAMIA study finds.
  • Researchers gave digital tablets to 97 patients for one day, showing them how to register and log in to the patient portal. Of those, 50 also received a bedside tutorial on key functions of the portal and the importance of those functions in their transition to follow-up care.
  • Patients in the intervention group had a higher mean number of logins (3.48 versus 2.94) than controls. They also had a higher mean number of specific portal tasks than controls, though no individual comparison was statistically significant. Those in the test group had an easier time logging in and navigating the portal and were generally happy with the tablet approach — 88% reported being satisfied or very satisfied.

Dive Insight:

As MACRA and the Quality Payment Program place more emphasis on patient access to information, patient portals provide an effective means of engaging patients and improving outcomes.

And patients have indicated they want more communication from their doctors. In a recent Aetna report, 77% of consumers said it is very important for them to speak to them in easy-to-understand language and 59% would like access to other healthcare professionals to coordinate care. Younger consumers also expressed a high interest in digital tools to improve communication with providers.

While previous interventions have focused on engaging providers to improve completion of key tasks during transitions of care, this is the first randomized clinical trial to assess patient engagement as a way to increase portal use in and outside the hospital, the authors note.

The fact that the intervention took just 15 minutes to deliver made it “highly feasible and consistent to patients,” they say.

Still, while use of the hospital’s tablets increased engagement, the uptick was not significant in most instances, perhaps due to unfamiliarity with the devices, they suggest. Teaching patients to access the portal on their own devices could perhaps boost efficacy even more.

“As the movement towards ‘bring your own device’ (BYOD) gains momentum for patient engagement with the EHR and other health-related platforms (eg, diet, activity, and medication logs or other health-related apps), there is tremendous opportunity for patient in acute and post-acute phases of care,” the authors write.

Future research should explore use of BYOD, such as whether personal devices could facilitate stored credentials and use of biometrics to log in to patient portals, they say. More research on portal use in hospitals is also needed, “especially given that most hospitals have not yet deployed this feature of EHR, and Meaningful Use will require higher use in the near future, suggesting an impending implementation boom — more evidence is needed to guide this process,” they write.

Also needed is research on the ability to share data among disparate systems and how that affects use of portals when patients receive care at multiple institutions.

MGMA18: Physicians frustrated over lack of advanced APMs


Hospitals cost


BOSTON—There’s a big problem with advanced alternative payment models (APMs). There aren’t enough of them.

Opportunities for doctors and physician practices to participate in advanced APMs remain stifled, according to the Medical Group Management Association’s (MGMA) government affairs staff.

Only one new advanced APM has been approved so far under the Trump administration, Mollie Gelburd, J.D., an associate director of government affairs, told participants at MGMA’s annual conference in Boston this week.

“We are about two full years into the program, and we find we are in the same place,” she said about advanced APMs, one of two tracks under the Medicare physician payment system implemented by the Medicare Access and CHIP Reauthorization Act (MACRA).

The frustration is being felt by MGMA members. In an MGMA survey conducted over the last month of 426 individuals from group practices, 55% said Medicare does not offer an advanced APM that is clinically relevant to their practice. Only 11% said an advanced APM is available to them.

Yet 44% said their practice would be interested in participating in an advanced APM if it was clinically relevant and aligned with the medical group’s quality goals.

The interest exceeds the opportunity to move to an APM, said Anders Gilberg, senior vice president of government affairs for the MGMA. “We’re definitely stuck in a rut,” he said.

MIPS, the other track under MACRA, is often seen as an “on ramp” to move physicians to advanced APMs, where they can earn a 5% incentive payment.

So how do new advanced APMs get approved? One route is the Center for Medicare & Medicaid Innovation (CMMI), which was established under the Affordable Care Act to test new payment models. The Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services are promising to develop new models, Gelburd said.

The other route is the Physician-focused Payment Model Technical Advisory Committee (PTAC), which was created by the MACRA legislation to make comments and recommendations to the secretary of HHS on proposals for physician-focused payments models submitted by physicians and physician groups. That’s a bottom-up approach, Gelburd said, in which physicians submit proposals for APMs.

The PTAC makes recommendations to HHS to implement or test these proposed payment models.

So far, CMS has been slow in pushing out CMMI models, Gelburd said. And HHS has yet to implement any of the options recommended by the PTAC, resulting in growing frustration. There was also little discussion of advanced APMs in the new proposed rule to establish a physician fee schedule for 2019 and set the rules for year three of MACRA, she said.

The Bundled Payments for Care Improvement (BPCI) Advanced model was the first advanced payment model launched by CMS under the Trump administration last January.

Are more advanced APMs on the way? MGMA government affairs staff said that remains to be seen. “CMS isn’t speaking loudly,” said Gelburd.

One bit of good news: Under a demonstration project, CMS will move ahead with plans to test whether certain Medicare Advantage plans should qualify as an advanced APM and exempt doctors from MIPS. CMS announced over the summer that it plans to move ahead with the demonstration, which would waive MIPS requirements for clinicians in certain at-risk Medicare Advantage plans.

MGMA18: Underwhelming MIPS payments leave physicians ‘feeling like it was just for nothing’


Doctor putting money in pocket


BOSTON—For all the work involved in the Merit-based Incentive Payment System (MIPS), the highest-scoring physicians ended up with a 2.02% payment adjustment, leaving them disheartened with the program.

Doctors who scored the maximum 100 points under MIPS received only a 2.02% positive payment adjustment, said Drew Voytal, associate director for government affairs for the Medical Group Management Association (MGMA).

For many physicians, “It’s a wash,” Voytal told an audience at the MGMA’s annual conference in Boston on Monday. “They are feeling like it was just for nothing.”

Physicians and physician practices had to report quality and other data to achieve high scores in the MIPS program, often investing in additional resources from personnel to technology.

The problem? In the first year of the program, CMS made reporting easier in its “transition year.” The program is supposed to be budget neutral so that doctors and practices that incur penalties for failure to participate or poor performance pay for the positive payment adjustments for those who score well. In 2017, the first year of the program, CMS estimated that 91% of eligible physicians participated in the payment program. That kept them from avoiding a penalty that would have resulted in a 4% cut in their Medicare reimbursement—money that would have funded incentive payments to others.

When all was said and done and the Centers for Medicare & Medicaid Services (CMS) released the 2017 final scores for physicians who participated in the Medicare payment program—payments that will be made in 2019—many were disappointed.

“Many people are just disheartened,” Voytal said.

Voytal urged physicians to log into CMS’ Quality Payment Program website to review their scores. In fact, CMS recently discovered it made mistakes calculating MIPS payments to some physicians and revised many scores. Physicians and practices who believe errors were made in their scores now have until Oct. 15 to request a targeted review by CMS.

MGMA officials said CMS’ feedback to physicians was also not sufficient and for some was inaccurate.

To stay on track with MIPS, physicians should take the following steps moving forward, Voytal recommended:

  • Assess your performance under past reporting programs to compare with how you are doing under MIPS.
  • Evaluate your vendor readiness and costs, including asking about the use of 2015 Edition Certified Electronic Health Record Technology, which CMS proposes to require next year.
  • Protect your practice against a MIPS penalty, including by failing to participate in the program if required.
  • Determine your 2018 MIPS goal and establish a reporting strategy for the data you are required to submit.
  • Comply with deadlines, such as those for submitting quality and other data.
    Analyze your data at year end to see how you are doing and where you can improve

CMS is currently reviewing more than 15,000 comments on a proposed rule issued in July that will outline changes for year three of the physician payment program implemented under MACRA.

CMS will issue a final rule this fall. One proposed change will allow doctors in small practices who don’t meet the existing threshold to participate in MIPS to opt in, allowing them to be eligible for bonus incentives.