Healthmonix Advisor

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.

Last week, we introduced some of the core concepts of the MIPS Quality Performance Category. This week, we are going to elaborate on these premises with Part 2 of our "10 PRO tips for Conquering the Quality Performance Category of MIPS."

The proposed rule for the implementation of MACRA and its underlying Quality Payment Program has inspired many clinicians to voice their opinions about how excessive reporting leads to a reduction in the quality of patient care, and how the rule disadvantages small and rural practices. Two months ago, in response to this feedback, Andy Slavitt announced to senate that there was a possibility of a MACRA delay, or some restructuring of the proposed rule to reduce the burden of compliance. On Thursday, September 8, CMS announced that providers will be able to choose the level and pace at which they will comply with MACRA.

Under the forthcoming Medicare Access and CHIP Reauthorization Act (MACRA), the Physician Quality Reporting System (PQRS) is being absorbed into the Merit-Based Incentive Payment System (MIPS). Specifically, PQRS will transition into one of the four Performance Categorys of MIPS, the Quality Performance Category.

Last week, we discussed what clinicians are eligible for MIPS, the base score for Advancing Care Information (ACI), and what the performance period is for ACI. This is part two of our "5 Key Facts You Need to Know for Advancing Care Information" series. 

Per the blog post last week, the proposed rule for MACRA's MIPS, effective January 1, 2017, the Meaningful Use electronic health records (EHR) incentive program will be folded into the Merit-Based Incentive Payment System (MIPS) for Eligible Providers. The successor to Meaningful Use, known as Advancing Care Information, includes fewer measures than the current program, intends to provide more flexibility in meeting those criteria, and stresses the use of technology to improve patient care.

Per the MACRA Quality Payment Final Rule, effective January 1, 2017, the Electronic Health Records (EHR) Incentive Program (Meaningful Use) will be folded into the Merit-Based Incentive Payment System (MIPS) for Eligible Providers. The successor to Meaningful Use, known as Advancing Care Information, includes fewer measures than the current program (yeah!), intends to provide more flexibility in meeting those criteria, and stresses the use of technology to improve patient care. To help you maximize your performance in this category, we have compiled the top five things you need to know now to prepare for next year.

As a young adult from a small town in Ohio, the prospect of leaving my hometown to go to college was a frightening one. I was anxious to leave the familiarity of my high school, and the routine I had perfected to remain an A student. The only expectation that I had was given to me by my teachers, who reported that college would be significantly different and more challenging than high school. As I packed up my ‘63 International Scout to drive to college in August of 1975, the fear of failure was present and strong. However, when I arrived, I found the classes were similar, the pedagogical approach was the same, and as long as I showed up and did the work, I could do as well as I did in high school.