Tag: MIPS

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:

 

 

Geisinger, Dignity Health among 1,300 providers to sign up for CMS’ bundled payment model

 

Medicine Money

 

Nearly 1,300 providers—including Adventist Health, Dignity Health, Geisinger Health System and Sutter Health—have signed up to participate in the first wave of CMS’ new voluntary bundled payment program.

The Centers for Medicare & Medicaid Services unveiled the new bundles in January, making it the first new advanced alternative payment model launched under the Trump administration.

CMS announced Tuesday that 1,299 providers signed on to its Bundled Payment for Care Improvement (BPCI) Advanced program. This includes 832 acute care hospitals and 715 physician group practices across 49 states, the District of Columbia and Puerto Rico. “To accelerate the value-based transformation of America’s health system, we must offer a range of new payment models so providers can choose the approach that works best for them,” CMS Administrator Seema Verma said.

“We look forward to launching additional models that provide an off-ramp to the inefficient fee-for-service system and improve quality and reduce costs for our beneficiaries,” she added.

The program began on Oct. 1 and will run through Dec. 31, 2023. The original version of BPCI ended on Sept. 30. CMS’ updated version of the model includes bundled payments for new episodes of care such as outpatient services, and the agency will provide target prices in the model before the start of each year of the program to allow providers to plan more easily.

Michael Abrams, managing partner of Numerof & Associates, told FierceHealthcare that one other new element may be particularly appealing: The model exempts participating providers from reporting requirements under the Medicare Access and CHIP Reauthorization Act (MACRA), as it is an APM that would exempt them from the Merit-Based Incentive Payment System (MIPS).

“Getting that monkey off of their back, I think, is very attractive,” Abrams said.

The program includes 32 episodes of care in total—29 inpatient and 3 outpatient—with the most popular with participants being lower extremity joint replacements, congestive heart failure and sepsis, CMS said. The simplicity and flexibility, Abrams said, is also going to draw hesitant providers into the program.

Despite those perks, Abrams said he doesn’t think that the modifications made in this version of bundles is driving interest. Instead, he said providers are growing wise to the fact that they need to evolve to stay alive.

CMS has made it clear that it intends to replace the fee-for-service model, and new entrants to the system—such as joint venture between Amazon, Berkshire Hathaway and JPMorgan Chase—could steal away a significant portion of their market share.

“The move to payment models like this one, that require accountability for cost and quality, has gotten off to a fairly slow start,” Abrams said, “but we could be approaching a tipping point, at which competitive pressure for a more responsive approach to patients becomes a de facto requirement for continuing to do business in the healthcare space.”

CMS unveiled BPCI Advanced shortly after it announced that it would cancel two mandatory bundles planned by the Obama administration. Those programs, which were for cardiac and joint replacement care episodes, were set to begin in January.

The mandatory bundles had been delayed twice under former Department of Health and Human Services Secretary Tom Price, who was a vocal critic of the programs as a congressman.

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.


Enter code DAShealth to view video.


Enter code DAShealth to view video.


Enter code DAShealth to view video.

Please complete the sign in form below.

[contact-form-7 404 "Not Found"]

Please complete the sign in form below.







Enter code DAShealth to view video.


Enter code DAShealth to view video.


Enter code DAShealth to view video.



Enter code DAShealth to view video.