Healthmonix Advisor

The MACRA Quality Payment Program final rule, released Oct. 14, finalizes the payment programs for physicians under MACRA’s Advanced Alternative Payment Models (APMs) and the Merit-Based Incentive Payment System (MIPS), beginning January 1, 2017. 

Recently, we highlighted one of the fastest growing types of initiatives for improving the delivery of value-based care--the bundled payment model--and offered some popular opinions about why it is taking off. This week we’ll dive into some specific bundled payment initiatives past and present.

Healthmonix has hosted several MIPS webinars to help our clients and the wider community understand the program, and we have just completed our first MIPS-related webinar since the final rule was released in an unscheduled, but much anticipated manner. As I listened to our team present the webinar, I felt strangely akin to a presidential debate fact checker. With over 2,000 pages of new material, less than a week to process and present, and a fully booked webinar, the stakes had never been higher.

Today, the Department of Health and Human Services (HHS) released the final rule with comment period for the Quality Payment Program under MACRA. Consistent with what was discussed in the proposed rule, the MACRA Quality Payment Program will have two tracks: (1) Advanced Alternative Payment Models (APMs) and the Merit-Based Incentive Payment System (MIPS). This is part two of our summary of the final rule, and will cover the pacing options available under MIPS. To read more about MIPS Eligibility and the MIPS performance categories, please check out Part 1!

Today, the Department of Health and Human Services (HHS) released the final rule with comment period for the Quality Payment Program under MACRA. Consistent with what was discussed in the proposed rule, the MACRA Quality Payment Program will have two tracks: (1) Advanced Alternative Payment Models (APMs) and the Merit-Based Incentive Payment System (MIPS). 

In recent years, the medical industry has seen a host of initiatives for improving the delivery of value-based care, but perhaps the fastest growing of these is the bundled payment model.  CMS has received both praise and criticism for their enthusiastic approach to bundles, but regardless, payment models are clearly changing and providers must stay informed if they want to reap the benefits of these changes.

Recently, we discussed how otherwise eligible clinicians could be exempted from the entire MIPS program. However, under the individual performance categories for MIPS (Quality, Advancing Care Information, Resource Use, and Clinical Practice Improvement Activities), there are some special circumstances that will allow for a partial exemption. 

After hosting our first ever MIPS webinar, we found that the majority of the questions being asked surrounded MIPS eligibility. In particular, the low-volume threshold was of interest. Since this is a topic we have yet to fully delve into, we decided that we should do so now!

Compared to the current CMS quality initiatives, the pool of eligible clinicians (formerly called eligible providers) will be shrinking significantly for the 2017 performance year. However, any clinician that bills Medicare Part B can practice reporting for MIPS in 2017. Considering that by 2019, when the pool of eligible clinicians will expand, the MIPS payment adjustment will be up to 9%, it is likely wise to report even if you are not an eligible clinician in 2017.

Evolving Medical Education is not Without Controversy

Competency Based Medical Education (CBME) Is clearly an area of discussion and controversy worldwide. Medical education is in the middle of a paradigm shift from the old style of medical education, referred to as “Structure/Process” education, initiated in 1910, to CBME. To learn about CBME, a good starting point is AM Rounds. During the AMEE conference, some cynical delegates stated that ‘Competency Based Medical Education’ (CBME) could be misinterpreted as ‘Checklist Based Measurable Education’.

Nevertheless, the paradigm shift is well underway and one aspect of evaluation is the discussion of levels of competency as they align with the physician’s career and practice of medicine.



At AMEE, the question was posed as “do you want to be treated by a competent doctor or an excellent doctor?” Clearly the level of competency needs to be set a particular level and may take some learners longer to achieve than others.

There was a tension across medical educators and at the conference between the idea of "striving for excellence" versus "aiming competence." Pose yourself the following question: Which one of these ‘competent‘ pilots do you want to land the plane?

Medical education is not straightforward. At a meeting of over 3,500 healthcare educators from around the world, there were theories and approaches put forward about the best way to education of physicians and there were debates around these. I’ve been attending these meetings for almost ten years, and the conversation is continuing and evolving. It’s never without controversy. Some of the comments I heard this year:

“Embrace complexity but act with simplicity.”

“If you torture data long enough, it will confess to anything.”

“Learning is not knowledge transmission but knowledge reconstruction.”

The opening plenary at AMEE 2016 was delivered by Graham Brown-Martin, an innovator in education. Graham’s talk was focused on education in the school sector, leaving it to us, the audience, to translate into the implications for medical professional education. We also heard that the idea of teaching critical thinking, one of my personal passions, gets lost in teaching facts needed to pass a test or get to the next course. Sound familiar? Graham highlighted how schools need to equip children with the knowledge and skills to reimagine society, to meet the challenges of their generation. Surely this is true for medical education as well.