Healthmonix Advisor

The 2021 Proposed Rule was released last week, and there are some potential changes that you should keep your eye on. Scouring through the entire release, it’s apparent that the Centers for Medicare & Medicaid Services (CMS) kept to their two main objectives:

1. Minimize changes to reduce the burden on providers digging out of COVID-19
2. Keep the momentum of the Quality Payment program moving forward

The quick answer is NO!

There has been quite a bit of discussion, and some press, about the reporting period for MIPS for 2020. I have seen a few articles saying that no data reflecting services provided January 1, 2020 through June 30, 2020 will be used in the Center for Medicare & Medicaid Services (CMS’s) calculations for the Medicare quality reporting and value-based purchasing programs. However, if you read the Quality Payment Program – COVID-19 Response, Updated 6/24/2020, there is no mention of an all-inclusive change to the reporting period.

In the last couple of weeks, some major changes have been made to the immediate future of Value-Based Care payment models.

Some of these updates include:

• The extension of the Oncology Care Model (OCM) until June of 2022. The Centers for Medicare & Medicaid Services (CMS) is also giving practices the ability to abdicate downside and upside risk performance during the COVID-19 outbreak.
• The delay of starting the new Direct Contracting model to April 1^st, 2021.
• The extension of the Next-Gen ACO model until December 2021.
• The option for participating entities in the Bundled Payments for Care Improvement Advanced (BPCI) payment model  to eliminate upside or downside risk.
• The removal of COVID-19 episodes of care for certain Medicare ACO models.

Quality and Cost are two fundamental focus areas in the Volume to Value-Based Care transition.  The Centers for Medicare & Medicaid Services (CMS), seeks to incentivize higher quality care at a lower cost through programs like MIPS.  In recent years, the primary focus of MIPS has been Quality reporting, however Quality and Cost will be equally weighted in 2022.  Mandated increases and lack of insight into current MIPS scores make it a top priority for practices to learn how Cost impacts their revenue.

We know the current regulatory updates for the Quality Payment Program (QPP) program. To date,  the Centers for Medicare & Medicaid Services (CMS) has issued many changes. The 2019 MIPS reporting requirement had an extended deadline and options for hardship exemptions. The 2020 MSSP program reporting period had many changes in both of the interim final rule with comment periods (IFCs) issued by  CMS, at the end of March and the end of April. CMS has also added a COVID-19 improvement activity to the 2020 program, that provides full credit for the Improvement Activity category for MIPS, if an individual or 50% of a group (TIN) participates in clinical trial reporting. No changes to the reporting window or other parameters of the program have been issued.

Are you wondering how MIPS reporting in 2020 will be affected by the COVID-19 pandemic?  Are you holding off reporting because you are uncertain as to the requirements for 2020?  Has the responsibility of MIPS reporting shifted with the impact of the pandemic on your organization?

Practice Recovery

As public health experts determine that it is safe to see patients, and governments lift stay-at-home restrictions, physician practices are challenged to strategically plan when and how best to reopen.  As the AMA points out, there are many components of reopening. 

When the time is right, it will be critical to be prepared to reopen, ready to communicate and live a new practice “normal”. In these uncertain times, making sure physical practice changes, staff training, workflow and supplies align, will be important for a successful reopening. Filling your schedule in safe and meaningful ways will help the practice sustain itself and your team. Marketing and communication to patients will help restore confidence and build trust.

COVID-19 has presented clinicians with many new challenges that are transforming the entire care delivery model.  It is crucial for health IT companies to do everything possible to support clients with navigating these rapid changes and keeping patients healthy.  Strategic integration partnerships are an extremely effective method to provide clinicians with a reliable network that is packed with the resources needed to provide quality care.  By working together, health IT organizations will play a vital role in overcoming the challenges and adjustments brought forth by the COVID-19 pandemic. 

Physician practices are confronting new operational and business challenges as a result of the COVID-19 pandemic. There is a mounting financial and administrative toll this pandemic has placed on practices, forcing all to adapt in a variety of areas.  Much of the conversation around COVID-19 has appropriately focused on addressing the pandemic and treatment of COVID-19 patients, however, we are also keenly aware of the other impacts on practices. 

The Centers for Medicare & Medicaid Services (CMS) continues to relax regulations to enable hospitals, clinics and other providers to boost their front-line medical staff during the COVID-19  pandemic. This pandemic has created an urgency for expansion of the use of virtual healthcare to reduce the risk of spreading the virus. It has also created a need to relax practice restrictions and allow more flexible care practices to meet the needs of patients.