Healthmonix Advisor

The NAACOS Fall 2021 Conference was the first live meeting that the Healthmonix team attended since HIMSS 2020 was cancelled in March of that year. It was certainly reinvigorating to meet in person, discuss the state of payment models, and hear from CMS regarding their vision.

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.

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.

It felt as if the Medical Group Management Association (MGMA) Annual Conference, which we have attended for years, was smaller this year. The hall was down 10 percent, and the foot traffic was slower. Regardless, we left with plenty of insights into the state of the industry. Here are some of the highlights of what we learned:

Since 2017, the Centers for Medicaid and Medicare Services (CMS) Merit-Based Incentive Payment System (MIPS) has provided eligible clinicians a score of zero -100 annually based on the clinician’s efforts and data collection in four program categories: Quality, Improvement Activities, Promoting Interoperability, and Cost. A clinician’s final score for each year’s MIPS performance ultimately dictates a payment adjustment that is applied to his or her Medicare Part B reimbursement rate two years later. In practical terms, this means that a clinician’s 2017 performance impacts all of his or her Medicare claims that are filed in the 2019 calendar year.

In last week’s blog, Point: The Promise of Blockchain, we discussed some of the exciting features of blockchain technology as it begins to take hold of the healthcare IT field. This week, we’re looking at the other side of the coin by outlining some of the pitfalls related to this technology.

Blockchain. It’s one of the biggest buzzwords in the Health IT industry today⁠—and no wonder, because it seems to be an extremely promising technology, one that we've been keeping our eyes on for a few years now. Still, as cool as it seems, we have a long way to go. That’s why in this pair of blogs, we’re going to look closely first at the possibilities, and then at the hazards, that go hand in hand with this exciting trend.

Look, we understand, we really do. MACRA is frustrating for doctors who want to spend more time talking to patients than checking boxes, and it’s often hard to recognize what, if anything, its requirements are actually doing to move practices toward value-based care. So of course it’s tempting to believe all those rumors (you know, the ones that have been flying around since the law was passed in 2015) about how MACRA and MIPS are on their way out, how CMS will be repealing the law any minute, how maybe it is an option to cover your ears and whistle until it goes away.

But we’ve been paying close attention to the shifting landscape of CMS policy since we released MIPSPRO in 2009, and in our expert opinion, the law isn’t going anywhere any time soon. Here are three reasons why.

CMS recently released the 2017 Quality Payment Program Experience Report, which provides an overview of the clinician reporting experience during the first year of the QPP with the intent of helping clinicians, stakeholders, researchers, and others to better understand the program. The report discusses both MIPS and Advanced APMs during the 2017 performance year, breaking the data down into the following four categories: