Healthmonix Advisor

The American Health Care Act (AHCA), also known as Trumpcare, was narrowly passed through the House of Representatives on Thursday May 4th. On Thursday June 22nd, after a secretive seven-week revision process led by Majority Leader Mitch McConnell, a draft of the Senate version of the bill has been released. Following is a comparison of some of the important changes between the ACA (Obamacare) and both versions of the AHCA.

Maybe you’ve reported PQRS in the past and are already preparing to make the transition to MIPS this year. Or, maybe this year is the first time your practice plans to report. Either way, your method of reporting can help determine whether or not you achieve your quality and revenue goals, and the benefits and drawbacks of different methods must be weighed in relation to the unique needs of your practice. To give you a place to start, this post compares and contrasts some considerations related to two common submission mechanisms: EHR and Qualified MIPS Registry reporting.

HIMSS is the seminal event in healthcare technology each year.  This year it grew to 45,000 attendees and literally a mile of exhibit hall.  We logged miles of walking in one day just to cover the exhibit floor, and still did not see it all.  At this pivotal time in healthcare information technology, there were many important themes that were covered.

Early on the morning of February 10th, the Senate approved the nomination of now-former Rep. Tom Price to be the Secretary of Health and Human Services.  While some say his chief priority is “dismantling of the Affordable Care Act”  (Sen. Maria Cantwell of Washington), the tasks that will be put in front of him also include five major health IT initiatives:  appointments to ONC and other agencies, the future of MACRA and Meaningful Use, the enforcement of interoperability, telemedicine, and cybersecurity. 

The MIPS Quality Performance Category is replacing PQRS reporting in 2017, folding it into the Merit-Based Incentive Payment System. The Quality portion will comprise 60% of an eligible clinician's MIPS Composite Performance Score for 2017.  To calculate that score, there is significant math involved.  This article will walk you though the calculations and logic used to determine your Quality score, but it is important to note that many data submission vendors will automatically give you a predictive calculation.

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.