Healthmonix Advisor

Malvern, PA – March 16, 2017 – Healthmonix was first-to-market with an all-inclusive solution for MIPS reporting, MIPSPRO^TM. This Qualified MIPS Registry is an end-to-end reporting solution, supporting the Quality, Advancing Care Information, and Improvement Activity Performance Categories of the Merit-Based Incentive Payment System (MIPS). The MIPSPRO engine also provides sophisticated real-time performance analytics, critical to competing for top MIPS incentives and improving patient outcomes.

This week, house Republicans introduced the long-anticipated Obamacare replacement plan. This plan, called the American Healthcare Act (AHCA), has received a high level of criticism already from a surprising mix of people. Although it certainly is too soon to tell, it seems as if the bill will likely not pass before significant edits are made.

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.

Compared to the commotion surrounding other Trump administration nominees, Seema Verma's confirmation hearing passed by last Thursday with relatively little controversy. Despite the low level of coverage, understanding the contents of this hearing is imperative for predicting the next few years in American health care. As the Administrator for the Centers for Medicare and Medicaid Services (CMS), Seema Verma will shape the future of health care for 34% of Americans. ^[1]

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 Advancing Care Information Performance Category will be replacing the EHR Incentive Program (colloquially known as Meaningful Use) for 2017 performance year, as a part of the Merit-Based Incentive Payment System (MIPS). One of three performance categories to be scored for 2017 reporting, ACI will be worth 25% of your total MIPS Composite Performance Score. Non-physician eligible clinicians, hospital-based eligible clinicians, and non-patient facing eligible clinicians are considered ineligible for Advancing Care Information, and will have this performance category automatically re-weighted to zero.

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.