Healthmonix Advisor

On October 30, CMS Administrator Seema Verma announced the Meaningful Measures initiative, which is intended to streamline quality reporting. This initiative is meant to address common criticisms of today’s performance measures, including their excessive focus on evaluating processes and the lack of alignment between programs. According to Verma, “Meaningful Measures will involve only assessing those core issues that are the most vital to providing high-quality care and improving patient outcomes.”

Today the president signed the Tax Cuts and Jobs Act, a bill which will have far-reaching implications for tax reform, into law. But the legislation may also affect the health insurance market through its elimination of the ACA individual mandate. In this week’s blog we look in-depth at what the repeal of the individual mandate entails, as well as its potential effect on the insurance marketplace.

Considering that the CMS Quality Payment Program can generate payment adjustments of up to 22% of Medicare Part B FFS reimbursements, it’s no wonder that many providers and health systems hope to maximize these incentives. But navigating complex Medicare requirements can be near impossible without the right tools.

CMS has recently lifted requirements for physicians participating in various bundled-payment initiatives. In a Proposed Rule released in August, the Health and Human Services agency proposed canceling the mandatory Episode Payment Models and Cardiac Rehabilitation Incentive payment model, which were scheduled to begin in January. HHS also plans to reduce the number of geographic areas mandatorily participating in the Comprehensive Care for Joint Replacement (CJR) model from 67 down to 34.

Value-based payment models aim to address rising healthcare costs, clinical inefficiency and duplication of services. To survive in an industry with increasing competition a solid understanding of the business case for implementing value based care is imperative.

The most notable value based care program currently is the MACRA Quality Payment Program, which provides the option to participate in MIPS or an advanced APM. If you’ve been keeping up with our blog posts recently you may already know that the deadline for the last MIPS performance period of the year is October 2nd, and that as long as you start collecting data by that date you will be able to report successfully.

CMS is worried about how few providers understand or are even aware of MACRA. As we near October 2nd, the deadline by which 400,000 eligible providers must start tracking data in order to avoid a financial penalty in 2019, CMS has found that around 40% of clinicians and even fewer nurse practitioners have a solid understanding of the requirements. Their concern is only supported by a recent Integra Connect survey which finds that most specialty physicians have not yet made the operational changes necessary to succeed in the new world of value based care.

Statistically, you aren’t sure how you’re supposed to comply with quality reporting requirements this year. As late as June 2017, the majority of providers were still unfamiliar or only somewhat familiar with MACRA; only 9 percent described themselves as “very familiar”. But unless you’re a part of that 9 percent, we highly recommend that you take some time ASAP to familiarize yourself with the requirements and to make a plan for the rest of the year. And as part of that plan, here are four reasons why we recommend that you select Improvement Activities for your practice today (yes, literally today):

In our last post, we covered some of the basic questions you should be asking yourself when choosing quality measures to report under MIPS. In part two of this series, we go over a few more specific questions that can help guide you to picking the best measures for your practice.

So you’re a MIPS-eligible clinician (if you’re not sure about your participation status, check out our post about how to find out), and you don’t want your practice to miss out on the reimbursement you know you deserve. But how should you decide which quality measures to actually report to CMS? How can you know if the measures you’re choosing will ultimately lead to reporting success, and is there a way to use those measures to not just fulfill the requirements but actually improve your practice? We’ve put together a two-part post to guide you through the most important factors to consider when deciding what might be best for you and your practice. First, the basics: