Healthmonix Advisor

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.

With the first performance year of the Merit-based Incentive Payment System (MIPS) drawing to a close, you may have just started getting accustomed to how MIPS reporting works. Although the 2018 MACRA final rule introduced changes to how MIPS performance data should be captured for the upcoming performance year, it may be a relief to hear that largely the changes just build upon the existing 2017 regulations.

Yesterday afternoon, CMS released the 2018 Final Rule for the MACRA Quality Payment Program. The rule finalized some changes we were expecting, and others that came as a surprise. The second year of the Quality Payment Program will be more advanced than the first, aiming to get clinicians ready for the even more intense requirements mandated by the MACRA legislation to be enacted in 2019.

The Second National MACRA MIPS/APM Summit is the leading forum on MACRA, MIPS, APMs, and other Value Based Payment Models. With no fee increases across-the-board for physicians from 2020-2025, value-based payment is going to become key for any health system's viability. Healthmonix was pleased to attend this summit and see MACRA policy and perspective in the making, with thought leaders in the medical, research, and business fields convening to break down MACRA and it's implementation now, as well as look towards the future of what MACRA can and should be.

We put together a brief list of takeaways from this event.

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.

To prosper in an industry challenged by constantly changing reform and increasing competition, healthcare organizations must continually increase their quality of care and become more efficient. Reporting MIPS in 2017 is a low-risk, high reward condition to stress-test your clinical workflows for optimized value-based program reporting.

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.