Healthmonix Advisor

In a recent update on 2017 MIPS Performance Feedback, CMS announced that they have identified errors in their scoring logic. CMS wrote that their targeted review process “worked exactly as intended, as the incoming requests quickly alerted us to these issues and allowed us to take immediate action.”

According to the proposed rule for 2019, use of 2015 Certified EHR Technology (CEHRT) will be required in the 2019 performance year. Many EHRs have already become 2015 CEHRT or plan to do so before next year, but not all have.

If you are a clinician trying to stay compliant and meet MIPS reporting requirements, there are a few things you should keep in mind to make sure that this new change won’t negatively affect you.

Conferences are a reality of business life.  Whether this is your first conference or your 10th, it's easy to be overwhelmed by the exciting blend of travel, free meals, sessions, contacts, conversations, and business cards.  Truth be told, conferences are a great way to learn from experts in your field and an essential networking opportunity (yes, even for introverts!). As we prepare for the upcoming MGMA Conference, we want to share some tips and tricks for new and experienced conference attendees. From the pre- conference planning to the post- conference follow up, we're here to provide you with 10 tips and tricks to get the most out of your next conference.

CMS estimates that between the 2013 and 2015 performance years, accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) saved $954 million. But according to a new analysis from Dobson DaVanzo & Associates, commissioned by the National Association of ACOs (NAACOS), they actually saved $1.84 billion—almost twice as much.

The analysis also found that MSSP delivered net savings of $541.7 million for 2013-2015 after accounting for shared savings bonuses; this is in contrast to the CMS benchmark calculation, which found that the organizations increased Medicare spending by $344.2 million.

You have been dealing with the bureaucracy behind quality reporting for years - silly questions with no relevance to your field or specialty, EMRs changing the way measures are recorded, CMS changing requirements during the reporting period. It’s hard enough to get your fingers around the changes as a manager or provider, but imagine the confusion on your staff’s side! Plus, they don’t have the incentive of financial responsibility or a reputation to uphold.

So, how do we get their buy-in?

The tracks of the Medicare ACO model vary greatly, but have been steadily gaining in prevalence since their launch in 2011. Despite the steady increase in ACO participation, most groups are staying at the Track 1 level. In fact, in 2018, 460 of the 649 ACOs existed at the Track 1 level.

The new proposed rule for 2019 features a lot of changes to the Quality Payment Program, but CMS has also announced changes impacting Medicare reimbursement in general. One big change proposed would affect how much money a clinician receives for billing office or outpatient Evaluation and Management (E&M) visits for new and existing patients.

In a new proposal titled “Pathways to Success,” the Centers for Medicare & Medicaid Services (CMS) has laid out a modified set of participation options for ACOs (accountable care organizations) in the Medicare Shared Savings Program (MSSP). The proposed participation options would no longer include an “upside-only” risk model; instead, ACOs would be required to select one of two tracks, both of which ultimately include some downside risk.

I speak with a lot of different types of practices and healthcare organizations on a weekly basis, and so I get to learn about a lot of different challenges that organizations face in the shift towards value-based care and the adoption and implementation of Certified EHR Technology. Both are critical to maintaining a high level of quality of care and maximizing reimbursements from Medicare.

When I was in graduate school, I quickly gravitated to projects and classes that focused on the relatively new field of database design and database technology. I loved the deep analysis of data and exploring the question of how to leverage technology to support storage and access to data in order to find answers. It was challenging, it was new, and it was a field that I knew would have a huge impact. My thesis was about data organization and optimization, and I was lucky to be able to experiment with all sorts of database challenges and software as I ultimately built my own contribution to the science.

At the Optum Forum conference this year, once again I was brought back to the data. As a recent partner with Optum, Healthmonix provides MACRA (MIPS and ACO) reporting for Optum clients in addition to our existing client base. At the conference, I heard the cries of how fundamental the data really is as we move forward in the value-based care market. As much as we need to work with providers and payers to change patterns of practice, a critical component is the data that supports the change and that measures the impact.

This is because data is what drives precision medicine and AI initiatives. It drives understanding, affirms what we already know, points out new patterns that we haven’t realized, and shows us where our perceptions are correct and where they are not.