Healthmonix Advisor

In December we posted about a CMS announcement related to ICD-10 diagnosis and procedure code changes, and how this might affect payment adjustments in 2018. At the time CMS had not yet issued their addendum detailing specific code updates for measures being used in the Merit-Based Incentive Payment System (MIPS), but now that they have, here’s an update:

CMS and the National Library of Medicine (NLM) have published the addendum to the 2016 eCQM specifications which affects ICD-10 Clinical Modification (CM) and Procedure Coding System (PCS) value sets for 2017. Health Quality Measure Format (HQMF) specifications, value set object identifiers (OIDs), and measure version numbers for 2017 were not changed. The eCQM value set addendum for 2017 is published to the eCQM Library and the eCQI Resource Center. The NLM’s Value Set Authority Center also provides a complete list of revisions to the eCQM value sets.

Nearly 90 percent of healthcare organizations suffer data breaches according to the Ponemon Institute. ^[1] The level of data breaches is predicted to continue to grow.^[4] What if there was a technology to better encrypt our health data, while also providing improved access to comprehensive health data for a patient? The quality of healthcare would rise, patient satisfaction would increase by leaps and bounds and costs would likely fall.  Sound idylic?

Medicare for all?

"We’re going to have insurance for everybody,” President-elect Donald Trump told the Washington Post in an interview over the weekend.  "I don’t want single-payer. What I do want is to be able to take care of people.”  So while we hear of Affordable Care Act (ACA, sometimes called Obamacare) repeal during the first 100 days of the administration, it sounds as if new programs must be quickly in the works to meet his mandate. “ The Congress can’t get cold feet because the people will not let that happen,” Trump continued, giving further emphasis to his push (and probably tweets) behind this initiative.

As I sit in my office, I hear the Christmas decorations coming down.  There is comfort in the known passing of the seasons and excitement at Healthmonix as we move into MIPS for 2017.  Our new platform for MIPS is ready for launch.  We are excited to see our efforts pay off for healthcare.

While the national election means that the Affordable Care Act will likely be changed, MACRA was passed with wide bipartisan support so will likely be staying in place. We at Healthmonix don’t believe the change in administration will affect the underlying efforts to transition to value-based care, either for MIPS or any other initiatives that we currently support.  The triple aim (better care, lower cost, better patient experience) is still at the heart of what we do.    

In past weeks, we’ve looked at some reasons why bundled payments are taking off, and investigated a few specific CMS bundled payment initiatives happening now and in the near future. This week we’ve put together a list of three steps you can take right now to make bundled payments work for you and your practice.

The MACRA Quality Payment Program final rule, released Oct. 14, finalizes the payment programs for physicians under MACRA’s Advanced Alternative Payment Models (APMs) and the Merit-Based Incentive Payment System (MIPS), beginning January 1, 2017. 

Recently, we highlighted one of the fastest growing types of initiatives for improving the delivery of value-based care--the bundled payment model--and offered some popular opinions about why it is taking off. This week we’ll dive into some specific bundled payment initiatives past and present.

In recent years, the medical industry has seen a host of initiatives for improving the delivery of value-based care, but perhaps the fastest growing of these is the bundled payment model.  CMS has received both praise and criticism for their enthusiastic approach to bundles, but regardless, payment models are clearly changing and providers must stay informed if they want to reap the benefits of these changes.

Recently, we discussed how otherwise eligible clinicians could be exempted from the entire MIPS program. However, under the individual performance categories for MIPS (Quality, Advancing Care Information, Resource Use, and Clinical Practice Improvement Activities), there are some special circumstances that will allow for a partial exemption. 

After hosting our first ever MIPS webinar, we found that the majority of the questions being asked surrounded MIPS eligibility. In particular, the low-volume threshold was of interest. Since this is a topic we have yet to fully delve into, we decided that we should do so now!

Compared to the current CMS quality initiatives, the pool of eligible clinicians (formerly called eligible providers) will be shrinking significantly for the 2017 performance year. However, any clinician that bills Medicare Part B can practice reporting for MIPS in 2017. Considering that by 2019, when the pool of eligible clinicians will expand, the MIPS payment adjustment will be up to 9%, it is likely wise to report even if you are not an eligible clinician in 2017.