Healthmonix Advisor

When I was in graduate school, I was the only woman in the department of Computer and Electrical Engineering. At my first job, at an engineering company, out of perhaps 300 engineers, there were 3 women. We became close and were recruited to the company volleyball team because it needed to be co-ed in order to compete in the league. I can go on about the myriad of times I was the only woman in a meeting, group, or department.

The 2020 final rule dropped yesterday and at first glance, there are some interesting highlights.  

It felt as if the Medical Group Management Association (MGMA) Annual Conference, which we have attended for years, was smaller this year. The hall was down 10 percent, and the foot traffic was slower. Regardless, we left with plenty of insights into the state of the industry. Here are some of the highlights of what we learned:

For many years now, Healthmonix has supported clients who engage with the Merit-based Incentive Payment System (MIPS) on a variety of levels, in terms of the maturity of their process. At the lowest level—let’s call it Level 0—we have clients that come to us because they just want to report and avoid a penalty. Just beyond that, at Level 1, are those clients that seek an incentive.

Now, as we continue to settle into the brave new world of value based payments, we have noticed that our clients at Level 1 are starting to get comfortable. Clearly they are investing time and effort into the process, but with incentives still relatively small, MIPS can unfortunately seem more like an annoyance than an opportunity, and it can be hard to see beyond the immediate requirements.

But we’re thinking bigger, and we want you to do the same.

In last week’s blog, Point: The Promise of Blockchain, we discussed some of the exciting features of blockchain technology as it begins to take hold of the healthcare IT field. This week, we’re looking at the other side of the coin by outlining some of the pitfalls related to this technology.

Blockchain. It’s one of the biggest buzzwords in the Health IT industry today⁠—and no wonder, because it seems to be an extremely promising technology, one that we've been keeping our eyes on for a few years now. Still, as cool as it seems, we have a long way to go. That’s why in this pair of blogs, we’re going to look closely first at the possibilities, and then at the hazards, that go hand in hand with this exciting trend.

A recent perspective article in the New England Journal of Medicine begins with a bold claim: that patient relationship categories and billing-code modifiers, which clinicians have been able to voluntarily submit since January 1, 2018, “may be one of the least known but most important provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).” In today’s blog we’ll explore how patient relationship codes may, as the article predicts, end up impacting reimbursement.

As laid out in the 2019 MACRA final rule*, one of the ways CMS hopes to expand participation options in the program’s third year is by offering certain facility-based clinicians, if they participate as a group, the option to use facility-based Quality and Cost performance measures. CMS expects to release a facility-based scoring preview for this option, which does not require any data submission, in Q1 of 2019. In today’s blog, we’ll take an in-depth look at the details of facility-based scoring and how it will be applied.

Value-based care seems like such a good idea. Who doesn’t want better health, and better care, at a lower cost? It is one of the premises of the MACRA legislation: “Change the way that Medicare rewards clinicians for value over volume.” We all think, in theory, preventive care is better than fixing problems after they occur. That’s why we take our cars in for regular maintenance, we have our furnace checked each year before winter, we get our teeth cleaned and checked every six months.

Yet, the current evolution to value-based care is adding burden and distracting from care in many ways, rather than focusing on the intended goals. I attended the Patient-Centered Oncology Care (PCOC) 2018, the annual meeting presented by The American Journal of Managed Care, last week and listened to some of our most highly-trained and most needed oncologists talk about how the current payment models have affected their practices. Oncology practices have been asked to take on risk for the cost of care and manage that cost. These practices are now responsible for costs that are not within their control, and that they don’t even know about until long after decisions have been made.