Healthmonix Advisor

In our last blog we gave an overview of the MIPS Quality Performance Category and discussed its reporting requirements. This week, we'll look more in-depth at how this category will be scored for the 2019 performance year.

The CY 2019 Medicare Physician Fee Schedule Final Rule involves a slew of regulatory changes that will apply to the 2019 performance year. Of course, wading through the final rule to find and understand the most important features of the policy can be grueling; but you’re in luck, because we’ve already done it so you don’t have to! In today’s blog, we’re focusing on the MIPS Promoting Interoperability (PI) category.

The CY 2019 Medicare Physician Fee Schedule Final Rule involves a slew of regulatory changes that will apply to the 2019 performance year. Of course, wading through the final rule to find and understand the most important features of the policy can be grueling; but you’re in luck, because we’ve already done it so you don’t have to! In today’s blog, we’re focusing on the MIPS Quality Performance category.

Between 2018 and 2019, 74 of Medicare’s 561 accountable care organizations (ACOs)—or 13%—left the program, according to research by Leavitt Partners. The same research also found that 26% of ACOs that reached the end of their three-year agreement opted to not renew it at the end of 2018.

Health systems face a unique challenge when navigating the CMS Quality Payment Program (QPP). All currently available options to comply with the QPP require the submission of some form of clinical quality measures. With multiple specialties and often multiple sources for tracking billing and clinical data, aggregating all available data in a coherent, efficient, and centralized way can seem nearly impossible for the average health system. This case study demonstrates how MIPSPRO assisted one of their health system clients by streamlining their quality reporting process.

A new CMS toolkit, released through the CMS ACO learning system, shows five innovative care coordination strategies that have helped Medicare ACOs find success through shared savings.

On April 22, the U.S. Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) announced the CMS Primary Cares Initiative, a new set of payment models that are part of HHS Secretary Alex Azar’s value-based transformation initiative. The CMS Primary Cares Initiative will be administered through the CMS Innovation Center. CMS expects the new programs to shift at least one quarter of people in traditional Medicare out of fee-for-service.

The 2018 MIPS reporting year is finally behind us, and you know what that means: time to plan for 2019!

Although this may seem like the last thing you want to think about in the days following the 2018 deadline, MIPS can be very rewarding for those who optimize their scores—and devastating for those on the other end of the spectrum. 2019 is no longer considered a transition year, unlike the first two years of MACRA, which means that the program is doing away with much of the leniency that made reporting easier in the past. The financial risk is now as high as 7%, while the performance threshold has increased to 30 points. In other words, there will be winners and losers, and if you want to stay ahead of the curve it’s imperative to strategize as soon as possible.

According to a recent announcement from the National Association of ACOs (NAACOs), CMS failed to adequately communicate significant changes to measure ACO-17, Preventive Care and Screening, Tobacco Use- Screening and Cessation Intervention, until after 2018 quality reporting had begun. NAACOs believes that CMS’s failure to communicate these changes will result in unintended consequences such as lowered or even eliminated shared savings rates for ACOs that consequently received a lower performance score or failed to meet quality standards.

The future is here!

This Wednesday, the CMS Innovation Center, in collaboration with the American Academy of Physicians and the Laura and John Arnold Foundation, announced the Artificial Intelligence (AI) Health Outcomes Challenge to predict unplanned hospital and skilled nursing facility admissions and adverse events.