Healthmonix Advisor

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.

Evolving Medical Education is not Without Controversy

Competency Based Medical Education (CBME) Is clearly an area of discussion and controversy worldwide. Medical education is in the middle of a paradigm shift from the old style of medical education, referred to as “Structure/Process” education, initiated in 1910, to CBME. To learn about CBME, a good starting point is AM Rounds. During the AMEE conference, some cynical delegates stated that ‘Competency Based Medical Education’ (CBME) could be misinterpreted as ‘Checklist Based Measurable Education’.

Nevertheless, the paradigm shift is well underway and one aspect of evaluation is the discussion of levels of competency as they align with the physician’s career and practice of medicine.



At AMEE, the question was posed as “do you want to be treated by a competent doctor or an excellent doctor?” Clearly the level of competency needs to be set a particular level and may take some learners longer to achieve than others.

There was a tension across medical educators and at the conference between the idea of "striving for excellence" versus "aiming competence." Pose yourself the following question: Which one of these ‘competent‘ pilots do you want to land the plane?

Medical education is not straightforward. At a meeting of over 3,500 healthcare educators from around the world, there were theories and approaches put forward about the best way to education of physicians and there were debates around these. I’ve been attending these meetings for almost ten years, and the conversation is continuing and evolving. It’s never without controversy. Some of the comments I heard this year:

“Embrace complexity but act with simplicity.”

“If you torture data long enough, it will confess to anything.”

“Learning is not knowledge transmission but knowledge reconstruction.”

The opening plenary at AMEE 2016 was delivered by Graham Brown-Martin, an innovator in education. Graham’s talk was focused on education in the school sector, leaving it to us, the audience, to translate into the implications for medical professional education. We also heard that the idea of teaching critical thinking, one of my personal passions, gets lost in teaching facts needed to pass a test or get to the next course. Sound familiar? Graham highlighted how schools need to equip children with the knowledge and skills to reimagine society, to meet the challenges of their generation. Surely this is true for medical education as well.

Last week, we introduced some of the core concepts of the MIPS Quality Performance Category. This week, we are going to elaborate on these premises with Part 2 of our "10 PRO tips for Conquering the Quality Performance Category of MIPS."

Under the forthcoming Medicare Access and CHIP Reauthorization Act (MACRA), the Physician Quality Reporting System (PQRS) is being absorbed into the Merit-Based Incentive Payment System (MIPS). Specifically, PQRS will transition into one of the four Performance Categorys of MIPS, the Quality Performance Category.

The 2016 Healthmonix Office Olympics has concluded, and we wanted to share a piece of our culture and give you insight into what we do for fun.  

Over the course of two weeks, Health Monicas (as employees of Healthmonix begrudingly self-refer) competed in the following categories: Nerf Archery, Table Tennis, Rock’em Sock’em (robots), Foosball, Office Chair Rowing, and Trivia.  Teams were built to allow participants to interact cross-departmentally. The developers calculated as the sales people charisma-ed, teams were strong and the competition was feirce. 

Last week, we discussed what clinicians are eligible for MIPS, the base score for Advancing Care Information (ACI), and what the performance period is for ACI. This is part two of our "5 Key Facts You Need to Know for Advancing Care Information" series. 

Per the blog post last week, the proposed rule for MACRA's MIPS, effective January 1, 2017, the Meaningful Use electronic health records (EHR) incentive program will be folded into the Merit-Based Incentive Payment System (MIPS) for Eligible Providers. The successor to Meaningful Use, known as Advancing Care Information, includes fewer measures than the current program, intends to provide more flexibility in meeting those criteria, and stresses the use of technology to improve patient care.

Per the MACRA Quality Payment Final Rule, effective January 1, 2017, the Electronic Health Records (EHR) Incentive Program (Meaningful Use) will be folded into the Merit-Based Incentive Payment System (MIPS) for Eligible Providers. The successor to Meaningful Use, known as Advancing Care Information, includes fewer measures than the current program (yeah!), intends to provide more flexibility in meeting those criteria, and stresses the use of technology to improve patient care. To help you maximize your performance in this category, we have compiled the top five things you need to know now to prepare for next year.