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:

 

 

What doctors need to know about MACRA’s new patient relationship codes

 

Hospitals cost

 

Doctors may have heard plenty about MACRA. But they may be far less familiar when it comes to new patient relationship categories and codes.

But, according to a perspective piece in the New England Journal of Medicine, they are one of the “more important provisions” of the Medicare Access and CHIP Reauthorization Act (MACRA). And they may ultimately be tied to physicians’ payments under the Merit-Based Incentive Payment System (MIPS).

The billing-code modifiers, which allow clinicians to report their relationship to a patient at a given point in time and for a particular service rendered, kicked in last Jan. 1 on a voluntary basis. They help Medicare determine the extent to which a provider is responsible for elements of a patient’s care.

Ultimately, Medicare will use the new codes to assess clinician performance, particularly the use of resources and cost, and will likely tie them to reimbursement, wrote Samuel U. Takvorian, M.D., Justin E. Bekelman, M.D., and Matthew J. Press, M.D.

The patient relationship categories and codes will help payers to evaluate clinicians not only on patient outcomes but also on the resources they use and the costs they incur to achieve those outcomes, the doctors say.

“Thus, it will continue to be necessary to measure and attribute clinician responsibility for various aspects of care when assessing performance on cost-related measures under any new value-based payment program,” the authors write.

The codes characterize the relationships between clinicians and patients as either continuous or episodic and the care they provide as broad versus focused.

As an example, the authors describe the case of a patient with a new diagnosis of early-stage breast cancer, which might require care from a surgeon, oncologist, pathologist, radiologist and primary care physician. The primary care doctor would provide continuous and broad services, whereas a breast surgeon would provide episodic and focused services while the patient underwent surgery and immediate follow-up. An oncologist might then oversee chemotherapy, providing episodic and focused services initially, but then provide ongoing monitoring and care, which could be reported as continuous and broad services.

The codes, therefore, reflect changes over time in a clinician’s relationship with the patient, and they can help identify which clinicians participating in MIPS were responsible for costs incurred.

Reporting of these billing-code modifiers is voluntary for now, and the Centers for Medicare & Medicaid Services plans further study before making reporting mandatory, the doctors said. There’s no time frame for implementation.

The authors highlighted several potential consequences, including clinicians accurately self-reporting their role in a patient’s care, adding to the administrative load of already overburdened clinicians and the risk that simplified codes won’t reflect the roles and responsibilities of clinicians while caring for a patient.

It gets complex trying to attribute costs and ultimately access each providers’ performance on cost-related measures and their resulting payment adjustment, they said, arguing that CMS should move slowly to vet and validate the measures they use.

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.


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