Healthmonix Advisor

A new CMS toolkit, released through the CMS ACO learning system, shows five innovative care coordination strategies that have helped Medicare ACOs find success through shared savings.

On April 22, the U.S. Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) announced the CMS Primary Cares Initiative, a new set of payment models that are part of HHS Secretary Alex Azar’s value-based transformation initiative. The CMS Primary Cares Initiative will be administered through the CMS Innovation Center. CMS expects the new programs to shift at least one quarter of people in traditional Medicare out of fee-for-service.

The 2018 MIPS reporting year is finally behind us, and you know what that means: time to plan for 2019!

Although this may seem like the last thing you want to think about in the days following the 2018 deadline, MIPS can be very rewarding for those who optimize their scores—and devastating for those on the other end of the spectrum. 2019 is no longer considered a transition year, unlike the first two years of MACRA, which means that the program is doing away with much of the leniency that made reporting easier in the past. The financial risk is now as high as 7%, while the performance threshold has increased to 30 points. In other words, there will be winners and losers, and if you want to stay ahead of the curve it’s imperative to strategize as soon as possible.

According to a recent announcement from the National Association of ACOs (NAACOs), CMS failed to adequately communicate significant changes to measure ACO-17, Preventive Care and Screening, Tobacco Use- Screening and Cessation Intervention, until after 2018 quality reporting had begun. NAACOs believes that CMS’s failure to communicate these changes will result in unintended consequences such as lowered or even eliminated shared savings rates for ACOs that consequently received a lower performance score or failed to meet quality standards.

The future is here!

This Wednesday, the CMS Innovation Center, in collaboration with the American Academy of Physicians and the Laura and John Arnold Foundation, announced the Artificial Intelligence (AI) Health Outcomes Challenge to predict unplanned hospital and skilled nursing facility admissions and adverse events.

CMS recently released the 2017 Quality Payment Program Experience Report, which provides an overview of the clinician reporting experience during the first year of the QPP with the intent of helping clinicians, stakeholders, researchers, and others to better understand the program. The report discusses both MIPS and Advanced APMs during the 2017 performance year, breaking the data down into the following four categories:

The U.S. Department of Health and Human Services (HHS) recently proposed a new rule to support the access, exchange, and use of electronic health information (EHI). The proposed rule encourages the adoption of standardized application programming interfaces (APIs), which will help allow individuals to securely and easily access structured EHI using smartphone applications. This facilitates a patient's ability to access their health information by requiring that patients be able to electronically access all of their EHI for free. It also implements the information blocking provisions of the Cures Act.

The rule gives seven exceptions to the definition of information blocking (proposed at 45 CFR 171.201–207). If an actor (a healthcare provider, HIT developer, or HIE or network) satisfies one or more exception, their actions would not be treated as information blocking and they would not be subject to civil penalties and other disincentives under the law. These seven exceptions are outlined below (this information based on the CMS fact sheet found here).

Did you know that CMS has a variety of free resources and organizations dedicated to helping clinicians navigate the Quality Payment Program? In today’s blog, we’ll help you understand your options so that when you have a question, you’ll know where to turn. (This is a good one to bookmark for later!)

The CY 2019 Medicare Physician Fee Schedule Final Rule involves a slew of regulatory changes that will apply to the 2019 performance year. Of course, wading through the final rule to find and understand the most important features of the policy can be grueling; but you’re in luck, because we’ve already done it so you don’t have to! In today’s blog, we’re focusing on how MIPS final scores will be calculated, as well as factors that may lead to reweighting, in 2019.

In a recent announcement, CMS Administrator Seema Verma named Dr. Anand Shah, a radiation oncologist at the National Cancer Institute, as the new Senior Medical Advisor for Innovation at CMS.