Part Two: MACRA More MIPS, and APMs
In part two of our MACRA analysis, we continue our look at MIPS and evaluate the APM pathway of MACRA’s new quality payment program.
Small Practice Considerations
Exemption
Key finalized policies include a small practice-friendly low volume threshold. In 2017, the threshold has been set at “less than or equal to $30,000 in Medicare Part B allowed charges or less than or equal to 100 Medicare patients.” CMS says this new threshold represents 32.5 percent of Medicare clinicians but only 5 percent Medicare Part B spending.
CMS says that the new flexibilities from the final rule lessen the impact on smal...
Source: Policy and Medicine - December 4, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
A Policy Agenda to Address New Unintended Adverse Consequences of EHRs
We describe six new categories of UACs in this blog and then conclude with three concrete policy recommendations to achieve the promised, transformative effects of health IT.
1. Complete clinical information unavailable at the point of care
Adoption of EHRs was supposed to stimulate a tremendous increase in availability of patients’ clinical data, anytime, anywhere. This ubiquitous increase in data availability depended heavily on the assumption that once clinical data were routinely maintained in a computable format, they could seamlessly be transmitted, integrated, and displayed between health care systems’ EHRs, ...
Source: The Health Care Blog - December 4, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized EHRs HITECH Patient Safety Source Type: blogs
Part One: MACRA Overview and MIPS
In its final MACRA rule, CMS significantly revamped the physician pay rule to make it easy for physicians to avoid penalties and to earn bonuses, and the agency is leaving the final rule open for comment to make it easier to revise. Among the changes, physicians need only report on one quality measure in each of two categories next year to avoid penalties, a third of practices are exempted from the program entirely, and there is a new alternative pay model option aimed at making it easier for small practices to qualify for the 5 percent bonus that comes with being counted as an alternative pay model.
MACRA: An Overview
T...
Source: Policy and Medicine - November 27, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
Fail to Scale: Why Great Ideas In Healthcare Don ’ t Thrive Everywhere
By JEFF GOLDSMITH and LAWTON BURNS
In the world of fine wine, it is well known that some types of wine grapes grow only in very specific climates and ecologies. The concept borrowed from the French is “terroir” (ter-WAHR). Terroir explains why the finest champagne grapes grow only in a small district in northeastern France, characterized by rolling hills and a chalky limestone subsoil that provides a steady level of moisture and imparts a mineral note to the wine’s flavor.
Health policy advocates have sought for generations to propagate promising forms of health care organization across the country. Yet one finds rep...
Source: The Health Care Blog - September 29, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
Fail To Scale: Why Great Ideas In Health Care Don ’t Thrive Everywhere
In the world of fine wine, it is well known that some types of wine grapes grow only in very specific climates and ecologies. The concept borrowed from the French is “terroir” (ter-WAHR). Terroir explains why the finest champagne grapes grow only in a small district in northeastern France, characterized by rolling hills and a chalky limestone subsoil that provides a steady level of moisture and imparts a mineral note to the wine’s flavor.
Health policy advocates have sought for generations to propagate promising forms of health care organization across the country. Yet one finds repeatedly that some forms of organiza...
Source: Health Affairs Blog - September 29, 2016 Category: Health Management Authors: Jeff Goldsmith and Lawton Burns Tags: Costs and Spending Featured Insurance and Coverage Medicare Payment Policy Independent Practice Association Medicare fraud States Source Type: blogs
Advancing Health IT and Preventing Data Blocking through Model Contract Language
By ANDY SLAVITT and VINDELL WASHINGTON, MD
As we move to transform the health care system into one that delivers more coordinated care across various clinicians and providers, it is important that data is available to providers and patients when and where they need it. To achieve this goal of ensuring the flow of health data and, ultimately, better care, the country has invested in the technology and infrastructure to connect patients’ clinical experiences.
That is why CMS and ONC are working together to make sure this investment stays on the right track. We are simplifying regulations, taking steps to require open techn...
Source: The Health Care Blog - September 26, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
CMS Delay ’s Full MACRA Implementation to the Next Administration
In a blog post, CMS announced changes to the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) that will allow physician practices to choose the level and pace at which they comply with the new payment reform model aimed at emphasizing quality patient care over volume. The announcement comes after pressure from industry stakeholders and policymakers to ease implementation of MACRA, which is set to start January 1, 2017. We previously reported that CMS was considering a potential MACRA delay, and this appears to be what the agency will finalize in its November rule.
The Announcement
Acting CMS Administrator...
Source: Policy and Medicine - September 11, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
The Roadmap To Physician Payment Reform: What It Will Take for All Clinicians to Succeed under MACRA
As the largest change in Medicare physician payment since the Sustainable Growth Rate formula, the Medicare Access and CHIP Reauthorization Act (MACRA) will affect up to 836,000 clinicians and allocate more than $1.2 billion in payment bonuses and penalties in its first year alone. Reflecting the importance of this policy, the 962 page proposed rule for its implementation generated thousands more pages of comments, with nearly 4,000 organizations and individuals submitting formal comment letters to the Centers for Medicare and Medicaid Services (CMS).
The proposed rule has been summarized by CMS, and there have been severa...
Source: Health Affairs Blog - August 30, 2016 Category: Health Management Authors: Mark McClellan, Frank McStay and Robert Saunders Tags: Costs and Spending Insurance and Coverage Medicare Payment Policy ACOs Alternative Payment Models Comprehensive Primary Care Plus MACRA Merit-Based Incentive Payment System Source Type: blogs
Building Better Metrics: Invest in “Good” Primary Care and Get What You Pay For
By NIRAN Al-AGBA, MD
In 1978, the Institute of Medicine published A Manpower Policy for Primary Health Care: Report of a Study (IOM, 1978) where they defined primary care as “integrated, accessible services by clinicians accountable for addressing a majority of heath care needs, developing a sustained partnership with patients, and practicing in the context of family and community.” The four main features of “good” primary care based on this definition are: 1. First-contact access for new medical issues, 2. Long-term and patient (not disease)-focused care, 3. Comprehensive in scope for most medical issues, and 4. C...
Source: The Health Care Blog - August 16, 2016 Category: Consumer Health News Authors: John Irvine Tags: 2016 Town Hall Physicians Building Better Quality Metrics Niran Al-Agba primary care Source Type: blogs
Rural America: A Primer for Washington Officials, Columnists and Dartmouth Economists
By NIRAN AL-AGBA
Earlier this week , physicians in small private practices and rural areas breathed a collective sigh of relief. There is a possibility the implementation of changes to physician reimbursement (known as MACRA) could be delayed. Thank you, Mr. Slavitt, for listening. I am grateful to Orrin Hatch (R-UT) and Ron Wyden (D-OR) for keeping our rural needs in mind. We have a window of opportunity for rural health care to survive but we must communicate our needs as physicians and patients’ loud and clear.
Whether in reference to health care or public education, trying to increase quality while simultane...
Source: The Health Care Blog - July 22, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
3 Types of Services Physicians Can Use to Build their Practice
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Source: ePharma Summit - July 21, 2016 Category: Pharmaceuticals Tags: HCPs health marketing IT Medical Billing Medical practices Pharma Physicians technology Source Type: blogs
Dear Mr. Slavitt, Please Come Visit My Office
By NIRAN AL-AGBA, MD
Andy, if you want to fix primary care you must do some field research. Come spend one day, or even a week at my office or another small primary care physicians’ office. You need to see what we do on a daily basis and actually understand the view from a small practice perspective. This knowledge deficit is at the core of CMS’s problem. You cannot repair what you do not comprehend.
Once you understand what we are capable of doing, how we do it, and how it actually SAVES money in the long run, while still providing high quality, then you are ready to tackle Focusing on Primary Care for Bett...
Source: The Health Care Blog - July 11, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
Value Based Reimbursement: The Rock Thrown Into The Health Care Pond
Editor’s note: This post is part of a series based on the 5th Forum: Learning from each other – Scaling ideas up to the next level. The forum was held in Berlin, Germany on June 9 and 10, 2016 and organized by the Center for Healthcare Management.
Value-based reimbursement (VBR), it seems to be everywhere. Launched by the Patient Protection and Affordable Care Act (ACA), a multitude of new payment models and organizations are rapidly reshaping the health care system in ways that are known and, as the ripples of change radiate out from the ACA, in ways that are yet to be understood.
For too many years, the traditiona...
Source: Health Affairs Blog - July 8, 2016 Category: Health Management Authors: Bruce Merlin Fried and Jeremy David Sherer Tags: Costs and Spending Featured Insurance and Coverage Medicaid and CHIP Medicare Organization and Delivery Payment Policy Quality Center for Healthcare Management 5th Forum fee-for-service MACRA value-based insurance design value-base Source Type: blogs
Focusing on Primary Care for Better Health
By ANDY SLAVITT
In the United States, we have historically invested far more in treating sickness than we do in maintaining health. The result of this imbalance is not only poorer health, but more money spent in institutions, hospitals, and nursing homes.
The road to a better health care system means correcting this imbalance. We should reinvest in what we value — primary care — as a practice, as a profession, and as an abundant resource for patients. In recent years, we have begun taking a number of meaningful steps to begin this reinvestment process. Today, we are proposing significant actions to improve how we pay p...
Source: The Health Care Blog - July 7, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
MACRA Comment: CMS + MIPS/APM = Death of the Private Practice Physician
By NIRAN AL-AGBA
Small, independent private practices are closing, increasing numbers of physicians are retiring early, and fewer medical school graduates are choosing primary care. The old-fashioned practice my father and I have built is a dying entity. Parents say coming to see us for an appointment feels more like a visit with a friend than a medical encounter. I am fighting for the subsistence of rural primary care practices. Most will not survive MACRA proposed changes to the reimbursement structure.
Seven days ago, I attended an “informational listening session,” sponsored by the Center for Medicare and...
Source: The Health Care Blog - July 5, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized CMS MACRA Reporting Small Practice Source Type: blogs
