Healthmonix Advisor

Hospital readmissions can be bad news for patients, but they can also be bad news for a hospital’s bottom line. Readmissions cost $41.3 billion overall, a majority of which—about $26 billion annually—is paid by Medicare. Moreover, as much as $17 billion of Medicare-paid readmissions are considered to be avoidable.

But why would they care? If a clinician moves to a new practice, wouldn’t they receive the score, and adjustment, for that new practice? Unfortunately for clinicians looking to start fresh, the answer is no.

In late October, CMS launched a new initiative, Patients Over Paperwork, targeted to reduce unproductive regulatory burdens on health care providers and increase efficiency. CMS Administrator Seema Verma announced the initiative during a stakeholder meeting with more than 30 industry groups.

The initiative is potentially wide reaching, affecting a broad range of regulations surrounding practices such as prior authorizations, documentation of evaluation and management codes, OIG audits, and EHR requirements.

According to Verma, this has already touched the QPP final rule for 2018. As an outcome of this initiative, the QPP final rule includes policies that exclude individual MIPS eligible clinicians with less than or equal to $90,000 in Part B allowed charges or less than or equal to 200 Part B beneficiaries.

Depending on your performance and your desire to maximize your reimbursement in 2019 (who doesn’t want more revenue?), there are a number of options available in final submission of your MIPS data to CMS. All of these choices can seem overwhelming, but Healthmonix is here to help! Read on to find out what choices you'll face and how to make the best ones for your practice.

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.