Tag: MACRA

2019 MIPS Proposed Rule Webinar 9.13.2018

This presentation is to review the MIPS 2019 Proposed Rule. Please join us to see what changes you may expect in MIPS 2019. The MIPS 2019 Final Rule will be released in November 2018.

 

Recommended attendees:

  • Office Managers
  • Reporting Clinicians
  • Assisting Medical Staff

 

Register for our 2019 MIPS Proposed Rule Webinar Today:

 

 

2019 MIPS Proposed Rule Webinar 8.23.2018

This presentation is to review the MIPS 2019 Proposed Rule. Please join us to see what changes you may expect in MIPS 2019. The MIPS 2019 Final Rule will be released in November 2018.

 

Recommended attendees:

  • Office Managers
  • Reporting Clinicians
  • Assisting Medical Staff

 

Register for our 2019 MIPS Proposed Rule Webinar Today:

 

 

2019 MIPS Proposed Rule Webinar 8.9.2018

This presentation is to review the MIPS 2019 Proposed Rule. Please join us to see what changes you may expect in MIPS 2019. The MIPS 2019 Final Rule will be released in November 2018.

 

Recommended attendees:

  • Office Managers
  • Reporting Clinicians
  • Assisting Medical Staff

 

Register for our 2019 MIPS Proposed Rule Webinar Today:

 

 

2019 MIPS Proposed Rule Webinar 8.2.2018

This presentation is to review the MIPS 2019 Proposed Rule. Please join us to see what changes you may expect in MIPS 2019. The MIPS 2019 Final Rule will be released in November 2018.

 

Recommended attendees:

  • Office Managers
  • Reporting Clinicians
  • Assisting Medical Staff

 

Register for our 2019 MIPS Proposed Rule Webinar Today:

 

 

4 changes physician groups don’t like in proposed MACRA, physician fee schedule rule

Female-Patient-Doctor-Women's-Health-Credit:Getty/monkeybusinessimages

Doctors’ groups are still digesting the 1,473-page proposed federal rule updating the Medicare physician fee schedule and outlining changes for year three of the physician payment program implemented under MACRA.

But in their preliminary review of the proposal released by the Centers for Medicare & Medicaid Services last Thursday, they’ve already found plenty to fault, including changes that would slow the move of physician practices to value-based payment and a failure to lower drug costs.

That, even as CMS Administrator Seema Verma sent out a “Dear Doctor” letter on Monday to various clinician groups saying the proposed final rule is aimed at restoring the doctor-patient relationship and reducing “burdensome and often mindless administrative tasks.”

“CMS’s focus is on putting patients first, and that means protecting the doctor-patient relationship. We believe that you should be able to focus on delivering care to patients, not sitting in front of a computer screen,” Verma wrote in the letter that describes changes CMS is proposing.

What exactly do these groups representing physicians find problematic? Here are some of the changes the groups pointed out:

It could slow the move to value-based payment. The AMGA, a trade association that is pushing for the transformation of healthcare, said in a statement that the agency “missed the opportunity” to move Medicare provider payments to a value-based system.

The group said it was disappointing that CMS kept a high low-volume threshold for providers to participate in MIPS, one of two payment tracks under the Medicare Access and CHIP Reauthorization Act (MACRA). That will continue to reduce the payment adjustments for providers that are invested in value-based care, the AMGA said.

As authorized by MACRA, providers can earn an adjustment of up to 7% on their Medicare Part B payments in 2021 based on their 2019 performance. However, as indicated in the proposed rule, CMS estimates the overall payment adjustment will be 2%. “We are concerned that CMS has again opted not to recognize the efforts of high-performing AMGA members. As we enter the program’s third year, it is time for CMS to honor congressional intent and use MIPS to create value for Medicare,” said Jerry Penso, M.D., AMGA president and CEO.

Not everyone held that viewpoint. America’s Physician Groups President and CEO Donald Crane said the group is cautiously optimistic that CMS has taken real action to advance the value movement. In particular, he cited the reaffirmation of the recently announced Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration.

It could raise, not lower, drug prices. The Community Oncology Alliance, a nonprofit association of independent oncology centers, said CMS’ proposal to cut a 6% fee doctors get for drugs dispensed in their offices to 3%, which would apply to new drugs during their introductory period, will not lower drug prices as the government indicated. The proposal was likely to trigger pushback, and it did.

“COA believes that this payment cut for new cancer therapies will result in drug manufacturers actually increasing WAC [wholesale acquisition cost] list prices so that their new products will not be at a competitive disadvantage to existing products which are reimbursed at average sales price (ASP) plus 6%,” the group said in a statement.

“No words can adequately describe how puzzling the CMS proposals are,” said Ted Okon, executive director of COA. “At a time when the Trump administration is floating its blueprint to bring down drug prices, they are proposing a move that will actually fuel list prices of chemotherapy and other lifesaving drugs.”

The American Society of Clinical Oncology said the move to cut physician reimbursement for Part B drugs would make the cancer care delivery system more unstable. “Additionally, the cuts could hinder patient access to newer, innovative therapies—potentially stalling progress against cancer and almost certainly making it more difficult for oncologists to provide essential services to patients with cancer,” said Monica M. Bertagnolli, M.D., the group’s president, in a statement.

It could cut payments for evaluating complex cases. While CMS is proposing to overhaul the Evaluation and Management (E&M) documentation and coding system to dramatically reduce the amount of time doctors must spend on documentation, the COA was worried about the impact.

Under the proposal, CMS would drastically cut payment for the critical evaluation and management of more complex cancer cases from $172 to $135 (a 22% payment cut) for a new patient and from $148 to $93 (a 37% payment cut) for an existing patient, the group said. While the intent is to streamline reporting, it will severely undervalue the thorough and critical evaluation and management of seniors with cancer, especially life-threatening complex cases, the group said.

“Their scheme to pay a physician the same amount for evaluating a case of sniffles and a complex brain cancer simply defies all logic. It is the antithesis of value-based healthcare and cheapens the medical care seniors are entitled to under Medicare,” said Okon.

In her letter to doctors, Verma said most specialties will see changes in their overall Medicare payments in the range of 1% to 2% up or down from the new E&M policy, but she said any small negative payment adjustments would be outweighed by the significant reduction in documentation burden.

It could increase costs, keep reporting burden. The Medical Group Management Association (MGMA) said it was disappointed that CMS decided to continue its policy requiring physicians to document a full 365 days of quality measures rather than 90 consecutive days.

The proposed rule would also require physicians to upgrade to 2015 Edition Certified Electronic Health Record Technology beginning in 2019. The MGMA was also unhappy that the rule would require physicians to make costly upgrades to their electronic health records for 2019 and take further steps toward implementing burdensome appropriate use criteria.

“At first glance, the rule doesn’t meet MGMA’s definition of administrative simplification,” said Anders Gilberg, senior vice president of government affairs.

CMS to Test Medicare Advantage as Alternative Payment Model under MACRA

CMS to Test Medicare Advantage as Alternative Payment | DAS Health

The CMS wants to launch an experiment that allows doctors in Medicare Advantage plans to qualify as participating in an alternative pay model.

To comply with MACRA, clinicians have two tracks to choose from: MIPS, which requires clinicians to report and meet quality goals, and advanced alternative payment models, which require clinicians to take on financial risk as part of efforts to improve care and lower costs. If goals are met under an APM they’re eligible for bonuses.

RELATED: Do you have a MIPS reporting action plan? See how our MIPS and MACRA consultants can help.

Clinicians in Medicare Advantage plans have urged the CMS to consider those plans as APMs since some are offering risk-based contracts.

The White House’s Office of Management and Budget must approve any experiment. It is now collecting comments on documentation that providers will need to fill out before participating in the demonstration. Comments on these forms are due Sept. 3.

In order to get credit as participating in an APM, doctors must receive a certain amount of Medicare fee-for-service revenue, but that threshold is too high for some providers who may primarily see Medicare Advantage patients. For doctors in Advantage plans to get credit, a demonstration must be launched, according to the CMS. Otherwise, physicians are still subject to MIPS.

The CMS hopes to launch the five-year demonstration this year. The CMS will ask providers about the payment arrangements they have with Medicare Advantage plans and about the number of patients covered in such arrangements. That information will determine whether the payment arrangements meet the risk standards to count as an APM.

The American Medical Association, America’s Essential Hospitals and the Medical Group Management Association urged the CMS to take this step in a joint letter sent last year.

“Leading-edge clinicians who take risk under APMs within these MA contracts will not get credit for their efforts,” the letter said. “Our proposal would encourage broader participation in risk arrangements by clinicians from the start, creating synergies that will reinforce their population-based strategies and translate into higher quality and more efficient care within Medicare.”

An AMA spokesman said it appreciates that HHS took its concerns into consideration and said the demonstration will especially benefit practices in communities where there is a disproportionately high number of Medicare Advantage patients.

Medicare Advantage enrollment is projected to grow by 9% to 20.4 million in 2018. The CMS estimated that more than one-third of all Medicare enrollees, or 34%, will be in a Medicare Advantage plan in 2018.