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Proposed 2019 Physician Fee Schedule and MACRA – MIPS Changes Announced by CMS #PatientsOverPaperwork #QPP

Proposed changes to the Medicare Physician Fee Schedule and Quality Payment Program would streamline clinician billing and expand access to high-quality care

Today, the Centers for Medicare & Medicaid Services (CMS) proposed historic changes that would increase the amount of time that doctors and other clinicians can spend with their patients by reducing the burden of paperwork that clinicians face when billing Medicare. The proposed rules would fundamentally improve the nation’s healthcare system and help restore the doctor-patient relationship by empowering clinicians to use their electronic health records (EHRs) to document clinically meaningful information, instead of information that is only for billing purposes.

“Today’s reforms proposed by CMS bring us one step closer to a modern healthcare system that delivers better care for Americans at a lower cost,” said HHS Secretary Alex Azar. “Such a system requires empowering American patients by giving them price and quality transparency and control over their own interoperable health records, goals supported by CMS’s proposals. These proposals will also advance the successful Medicare Advantage program and accomplish a historic regulatory rollback to help physicians put patients over paperwork. Further, today’s proposed reforms to how CMS pays for medicine demonstrate the commitment of HHS to implementing President Trump’s blueprint for lowering drug prices. The ambitious reforms proposed by CMS under Administrator Verma will help deliver on two HHS priorities: creating a value-based healthcare system for the 21st century and making prescription drugs more affordable.”

“Today’s proposals deliver on the pledge to put patients over paperwork by enabling doctors to spend more time with their patients,” said CMS Administrator Seema Verma. “Physicians tell us they continue to struggle with excessive regulatory requirements and unnecessary paperwork that steal time from patient care. This Administration has listened and is taking action. The proposed changes to the Physician Fee Schedule and Quality Payment Program address those problems head-on, by streamlining documentation requirements to focus on patient care and by modernizing payment policies so seniors and others covered by Medicare can take advantage of the latest technologies to get the quality care they need.”

The proposals, part of the Physician Fee Schedule (PFS) and the Quality Payment Program (QPP), would also modernize Medicare payment policies to promote access to virtual care, saving Medicare beneficiaries time and money while improving their access to high-quality services no matter where they live. Such changes would establish Medicare payment for when beneficiaries connect with their doctor virtually using telecommunications technology (e.g., audio or video applications) to determine whether they need an in-person visit. Additionally, the QPP proposal would make changes to quality reporting requirements to focus on measures that most significantly impact health outcomes. The proposed changes would also encourage information sharing among health care providers electronically, so patients can see various medical professionals according to their needs while knowing that their updated medical records will follow them through the healthcare system. The QPP proposal would make important changes to the Merit-based Incentive Payment System (MIPS) “Promoting Interoperability” performance category to support greater EHR interoperability and patient access to their health information, as well as to align this clinician program with the proposed new “Promoting Interoperability” program for hospitals.

If today’s proposals were finalized, clinicians would see a significant increase in productivity – leading to substantially more and better care provided to their patients. Removing unnecessary paperwork requirements through the PFS proposal would save individual clinicians an estimated 51 hours per year if 40 percent of their patients are in Medicare. Changes in the QPP proposal would collectively save clinicians an estimated 29,305 hours and approximately $2.6 million in reduced administrative costs in CY 2019.

PROPOSED CY 2019 PHYSICIAN FEE SCHEDULE KEY CHANGES

The Physician Fee Schedule establishes payment for physicians and medical professionals treating Medicare patients. It is updated annually to make changes to payment policies, payment rates and quality-related provisions. Extensive public feedback the agency has received has highlighted a need to streamline documentation requirements for physician services known as “evaluation and management” (E&M) visits, as well as a need to support greater access to care using telecommunications technology.

The proposed changes to the Physician Fee Schedule would reinforce CMS’ Patients Over Paperwork initiative focused on reducing administrative burden while improving care coordination, health outcomes, and patients’ ability to make decisions about their own care.

Streamlining Evaluation and Management (E&M) Payment and Reducing Clinician Burden

CMS and the Office of the National Coordinator for Health Information Technology (ONC) have heard from stakeholders that CMS’s extensive documentation requirements for Evaluation and Management codes have resulted in unintended consequences. To meet these documentation requirements, providers have to create medical records that are a collection of predefined templates and boilerplate text for billing purposes, in many cases reflecting very little about the patients’ actual medical care or story.

Responding to stakeholder concerns, several provisions in the proposed CY 2019 Physician Fee Schedule would help to free EHRs to be powerful tools that would actually support efficient care while giving physicians more time to spend with their patients, especially those with complex needs, rather than on paperwork. Specifically, this proposal would:

  • Simplify, streamline and offer flexibility in documentation requirements for Evaluation and Management office visits — which make up about 20 percent of allowed charges under the Physician Fee Schedule and consume much of clinicians’ time;
  • Reduce unnecessary physician supervision of radiologist assistants for diagnostic tests; and
  • Remove burdensome and overly complex functional status reporting requirements for outpatient therapy.

Advancing Virtual Care

“CMS is committed to modernizing the Medicare program by leveraging technologies, such as audio/video applications or patient-facing health portals, that will help beneficiaries access high-quality services in a convenient manner,” said Administrator Verma.

Getting to the doctor can be a challenge for some beneficiaries, whether they live in rural or urban areas. Innovative technology that enables remote services can expand access to care and create more opportunities for patients to access personalized care management as well as connect with their physicians quickly.

Provisions in the proposed CY 2019 Physician Fee Schedule would support access to care using telecommunications technology by:

  • Paying clinicians for virtual check-ins – brief, non-face-to-face appointments via communications technology;
  • Paying clinicians for evaluation of patient-submitted photos; and
  • Expanding Medicare-covered telehealth services to include prolonged preventive services.

Lowering Drug Costs

President Trump is putting American patients first and lowering prescription drug costs, and CMS is committed to advancing this effort. CMS is today proposing changes as part of the continued rollout of the Administration’s blueprint to lower drug prices and reduce out-of-pocket costs.

The changes would affect payment under Medicare Part B. Part B covers medicines that patients receive in a doctor’s office, such as infusions. CMS is proposing a change in the payment amount for new drugs under Part B, so that the payment amount would more closely match the actual cost of the drug. This change would be effective January 1, 2019, and would reduce the amount that seniors would have to pay out-of-pocket, especially for drugs with high launch prices. This is one of many steps that CMS is taking to ensure that seniors have access to the drugs they need.

PROPOSED CY 2019 QUALITY PAYMENT PROGRAM KEY CHANGES

To implement the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), CMS established the Quality Payment Program (QPP), which consists of two participation pathways for doctors and other clinicians – the Merit-based Incentive Payment System (MIPS), which measures performance in four categories to determine an adjustment to Medicare payment, and Advanced Alternative Payment Models (Advanced APMs), in which clinicians may earn an incentive payment through sufficient participation in risk-based payment models.

The proposed changes to QPP aim to reduce clinician burden, focus on outcomes, and promote interoperability of electronic health records (EHRs), including by:

  • Removing MIPS process-based quality measures that clinicians have said are low-value or low-priority, in order to focus on meaningful measures that have a greater impact on health outcomes; and
  • Overhauling the MIPS “Promoting Interoperability” performance category to support greater EHR interoperability and patient access to their health information, as well as to align this performance category for clinicians with the proposed new Promoting Interoperability Program for hospitals.

Under the requirements of the Bipartisan Budget Act of 2018, CMS is continuing the gradual implementation of certain MIPS requirements to ease administrative burden on clinicians. The proposed changes to the Quality Payment Program reflect feedback and input from clinicians and stakeholders, and we will continue to offer free and customized support from CMS’s technical assistance networks.

MEDICARE ADVANTAGE QUALIFYING PAYMENT ARRANGEMENT INCENTIVE (MAQI) DEMONSTRATION

Aligning with the agency’s goals of improving quality of care and responding to the feedback we have received from clinicians, CMS also proposes waivers of MIPS requirements as part of testing a demonstration called the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration. The MAQI demonstration would test waiving MIPS reporting requirements and payment adjustments for clinicians who participate sufficiently in Medicare Advantage (MA) arrangements that are similar to Advanced APMs.

Some Medicare Advantage plans are developing innovative arrangements that resemble Advanced APMs. However, without this demonstration, physicians are still subject to MIPS even if they participate extensively in Advanced APM-like arrangements under Medicare Advantage. The demonstration will look at whether waiving MIPS requirements would increase levels of participation in such MA payment arrangements and whether it would change how clinicians deliver care.

PRICE TRANSPARENCY: REQUEST FOR INFORMATION

Finally, as part of its commitment to price transparency, CMS is seeking comment through a Request for Information asking whether providers and suppliers can and should be required to inform patients about charge and payment information for healthcare services and out-of-pocket costs, what data elements would be most useful to promote price shopping, and what other changes are needed to empower healthcare consumers.

Public comments on the proposed rules are due by September 10, 2018.

For a fact sheet on the CY 2019 Physician Fee Schedule proposed rule, please visit:
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-07-12-2.html

To view the CY 2019 Physician Fee Schedule proposed rule, please visit: https://www.federalregister.gov/public-inspection/

For a fact sheet on the CY 2019 Quality Payment Program proposed rule, please visit: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/2019-QPP-proposed-rule-fact-sheet.pdf

To view the CY 2019 Quality Payment Program proposed rule, please visit: https://www.federalregister.gov/public-inspection/

For a fact sheet on the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration, please visit:https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-07-12.html

July 12, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 5 blogs containing over 11,000 articles with John having written over 5500 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 18 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Industry Report Highlights Widespread Dissatisfaction with EHRs and PHMs for Quality Performance Management

97% of Surveyed Health Systems Relying on Solutions Considered Unsatisfactory

CHICAGO – November 15, 2017 – SA Ignite Inc., a leading provider of solutions that simplify and automate the management of complex value-based programs, today announced key findings from its recent industry study. The State of QPP Preparedness Industry Report, conducted in collaboration with Porter Research, analyzed feedback from nearly 120 health system executives regarding their organizations’ preparedness for CMS’s Quality Payment Program (QPP). Researchers found that while most health systems are relying solely on electronic health record (EHR) or population health management (PHM) solutions for quality reporting, the majority are unsatisfied with the performance of those systems, indicating that organizations are at risk of missing out on their goals of maximizing payment incentives.

The QPP is a CMS initiative created under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to improve health outcomes and aid the transition to value-based care. Ninety-four percent of the study respondents are actively participating in the QPP, which is indicative of the rapid national adoption of value-based programs.

According to the study, 97% of respondents say their organizations are relying on their EHRs or PHMs for QPP reporting. However, they have very low confidence in these tools, especially when it comes to the most critical functions related to QPP performance, such as:

  • Identifying all eligible clinicians
  • Pinpointing focus areas to increase scores
  • Seeing overall MIPS score/estimated financial impact

Additional study findings include:

  • The majority (64%) of health systems are seeking to maximize their QPP payment incentives.
  • 73% of respondents reported that their system vendor does not offer a specific QPP management solution.
  • There is a lack of consistency across organizations as to which department manages the QPP. Respondents cited quality, clinical, administrative, IT, and population health departments as various managers of the program.

“EHR and PHM solutions were designed to manage patient care, not to optimize performance in value-based programs,” said Matt Fusan, Director of Customer Experience of SA Ignite. “It should come as no surprise that these solutions don’t have the necessary functionality to support quality performance management. Healthcare leaders hoping to maximize their incentives must look beyond the EHR to solutions that mitigate complexity and facilitate proactive program management.”

Click here to learn more about this study and its results, and to receive practical guidance on how to manage quality performance and maximize payment incentives.

About SA Ignite, Inc.

SA Ignite’s compliance management and predictive analytics platform simplifies the complexities of evolving value-based initiatives, including MIPS and Meaningful Use for Medicaid. Some of the nation’s largest healthcare organizations optimize their quality scores to reduce reputational and financial risk with the help of timely, actionable insights from SA Ignite. For more information, visit www.saignite.com.

November 15, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 5 blogs containing over 11,000 articles with John having written over 5500 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 18 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Amazing Charts Makes Five Predictions for Health IT in 2017

BOSTON, MA–(Marketwired – December 01, 2016) – Amazing Charts, LLC, a leading developer of Electronic Health Record (EHR) and Practice Management (PM) systems for physician practices, today issued five health IT predictions for 2017.

#1 Telemedicine will no longer be futuristic. Contrary to popular belief, telemedicine does not necessarily mean live video conferencing with a physician halfway across the country who lacks a full picture of the patient’s health status. Patients would rather receive “low tech” remote care from a local primary care physician they already know.

Telemedicine happens whenever an EHR system adds to a patient’s clinical chart the messages, pictures, or videos sent securely via smartphone. Use of smartphones for telemedicine will further increase with the introduction of add-on hardware for real-time collection of biometric data such as temperature, blood pressure and pulse.

This trend will be fueled by the expansion of reimbursement for non-face-to-face services. Medicare’s new billing code for Chronic Care Management is just one example of how the future of value-based care is not about 15-minute office visits, but instead keeping patients out of the office with follow-up phone calls about medications and answering patient questions via text.

#2 Practices will focus on reengineering patient access. As part of Medicare’s new Quality Payment Program, the Merit-based Incentive Payment System (MIPS) is designed to encourage providers to expand patient access with “practice improvement activities,” such as same-day appointments for urgent needs, longer office hours, and after-hours clinician advice.

Physicians also want to shift the responsibilities such as appointment scheduling from the office staff to the patient. Delegating that type of chore to the patient saves the staff time; and, patients not only don’t mind doing the work, they perceive value in self-service options that give them total control.

While tablet-based patient intake solutions have not become widespread because the hardware is costly and requires complex systems integration, simple web forms and PDF attachments can get the job done just as well.

#3 Physicians will get financially creative. A host of factors is pushing independent physicians to be more financially creative. These include the frustrations of making claims to insurance carriers, the new Medicare fee-for-value payments creating uncertainty in gauging reimbursement levels, and burnout with the “corporate medicine” model of seeing dozens of patients each day for lower fees.

One example of financial creativity is the direct care model which establishes a financial relationship between patient and provider, cutting out the middleman of insurance payers. This model includes concierge and direct primary care, where patients become members who pay a fixed monthly fee for unlimited care. There are also a growing number of cash-only practices for walk-in and urgent care.

Beleaguered small practices under financial stress are also looking for novel ways to generate cash. The new rules allowing reimbursement of telemedicine and other non-face-to-face services will encourage physicians to bill for activities they were already doing for free, such as phone calls with patients to discuss medications.

#4 Physicians will opt out of Medicare thanks to MACRA. Like all well-intentioned laws, The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will have unintended consequences. Some providers in small independent practices will either opt-out of Medicare entirely, or decline to accept new Medicare patients if they currently fall below the threshold for exemption (less than $30,000 in Part B billings or 100 Part B patients).

To ease small practices into MACRA, the Final Rule issued by the Centers of Medicare & Medicaid Services (CMS) relaxed many of the requirements for 2017. By 2018, however, MACRA starts to impose more financial risk and stricter reporting requirements with less clarity around the return on investment. Small practices might just drop Medicare altogether and transition to a direct-care practice based on cash, membership, or a hybrid (see prediction #3 above).

#5 EHRs will become more interoperable. The next certification cycle from the Office of the National Coordinator for Health Information Technology (ONC) positions the EHR as a secure repository, allowing certified ancillary tools to be “snapped” into it. This will be driven by a new Application Programming Interface (API) called Fast Healthcare Interoperability Resources (FHIR). FHIR is a more granular way to exchange data without the rigid workflow of traditional Health Level Seven International (HL7).

Providers will benefit from the broader choice of technology solutions that can be used alongside the EHR to improve overall outcomes. Amazing Charts is currently developing a FHIR API to connect our EHR with other best-of-breed vendors for solutions such as population health management. This way small practices can leverage their investments in EHR systems to the maximum extent possible.

Furthermore, MIT researchers have proposed a cryptocurrency-backed system (like Bitcoin), called MedRec, for managing medical records that use the Ethereum blockchain. It is a novel, decentralized record management system for EHRs that uses blockchain technology to manage authentication, confidentiality, accountability, and data sharing.

About Amazing Charts

Amazing Charts provides Electronic Health Records (EHR/EMR), Practice Management, and other Health IT solutions to healthcare practices. Based on number one user ratings for usability, fair pricing, and overall satisfaction, Amazing Charts EHR has been adopted by more than 10,000 clinicians in over 7,100 private practices. Founded in 2001 by a family physician, today Amazing Charts, LLC operates as a subsidiary of Pri‐Med, an operating division of Diversified Communications (DC) and a trusted source for professional medical education to over 275,000 clinicians since 1995. Visit www.amazingcharts.com for more information.

Amazing Charts is a trademark of Amazing Charts, LLC. All products or service names mentioned herein are trademarks of their respective owners.

December 1, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 5 blogs containing over 11,000 articles with John having written over 5500 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 18 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

EHR Incentive Programs: Where We Go Next (Message from Andy Slavitt and Karen DeSalvo)

Where We’ve Been

As we mentioned in a speech last week, the Administration is working on an important transition for the Electronic Health Record (EHR) Incentive Program. We have been working side by side with physician organizations and have listened to the needs and concerns of many about how we can make improvements that will allow technology to best support clinicians and their patients. While we will be putting out additional details in the next few months, we wanted to provide an update today.

In 2009, the country embarked on an effort to bring technology that benefits us in the rest of our lives into the health care system. The great promise of technology is to bring information to our fingertips, connect us to one another, improve our productivity, and create a platform for a next generation of innovations that we can’t imagine today.

Not long ago, emergency rooms, doctor’s offices, and other facilities were sparsely wired. Even investing in technology seemed daunting. There was no common infrastructure. Physician offices often didn’t have the capital to get started and it was hard for many to see the benefit of automating silos when patient care was so dispersed. We’ve come a long way since then with more than 97 percent of hospitals and three quarters of physician offices now wired.

It’s taken a tremendous commitment by physicians, hospitals, technologists, patient groups and experts from all over the country to make the progress we’ve made together in a few short years. The EHR Incentive Programs were designed in the initial years to encourage the adoption of new technology and measure the benefits for patients. And while it helped us make progress, it has also created real concerns about placing too much of a burden on physicians and pulling their time away from caring for patients.

Transitioning From Measuring Clicks to Focusing on Care

Last year, the Administration and Congress took two extraordinary steps to put patients at the center of how we pay for care and support physicians. First, the Administration set a goal that 30 percent in 2016 and 50 percent in 2018 of Medicare payments will be linked to getting better results for patients, providing better care, spending healthcare dollars more wisely, and keeping people healthy.  And, second, Congress advanced this goal through the passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which considers quality, cost, and clinical practice improvement activities in calculating how Medicare physician payments are determined. While MACRA also continues to require that physicians be measured on their meaningful use of certified EHR technology for purposes of determining their Medicare payments, it provides a significant opportunity to transition the Medicare EHR Incentive Program for physicians towards the reality of where we want to go next.

What Comes Next

We have been working side by side with physician and consumer communities and have listened to their needs and concerns. As we move forward under MACRA, we will be sharing details and inviting comment as we roll out our proposed regulations this spring. All of this work will be guided by several critical principles:

  1. Rewarding providers for the outcomes technology helps them achieve with their patients.
  2. Allowing providers the flexibility to customize health IT to their individual practice needs. Technology must be user-centered and support physicians.
  3. Leveling the technology playing field to promote innovation, including for start-ups and new entrants, by unlocking electronic health information through open APIs – technology tools that underpin many consumer applications.  This way, new apps, analytic tools and plug-ins can be easily connected to so that data can be securely accessed and directed where and when it is needed in order to support patient care.
  4. Prioritizing interoperability by implementing federally recognized, national interoperability standards and focusing on real-world uses of technology, like ensuring continuity of care during referrals or finding ways for patients to engage in their own care. We will not tolerate business models that prevent or inhibit the data from flowing around the needs of the patient.

What This Means for Doctors and Hospitals 
As we work through a transition from the staged meaningful use phase to the new program as it will look under MACRA, it is important for physicians and other clinicians to keep in mind several important things:

  1. The current law requires that we continue to measure the meaningful use of ONC Certified Health Information Technology under the existing set of standards. While MACRA provides an opportunity to adjust payment incentives associated with EHR incentives in concert with the principles we outlined here, it does not eliminate it, nor will it instantly eliminate all the tensions of the current system. But we will continue to listen and learn and make improvements based on what happens on the front line.
  2. The MACRA legislation only addresses Medicare physician and clinician payment adjustments. The EHR incentive programs for Medicaid and Medicare hospitals have a different set of statutory requirements. We will continue to explore ways to align with principles we outlined above as much as possible for hospitals and the Medicaid program.
  3. The approach to meaningful use under MACRA won’t happen overnight. Our goal in communicating our principles now is to give everyone time to plan for what’s next and to continue to give us input.  We encourage you to look for the MACRA regulations this year; in the meantime, our existing regulations – including meaningful use Stage 3 – are still in effect.
  4. In December, Congress gave us new authority to streamline the process for granting hardship exception’s under meaningful use.  This will allow groups of health care providers to apply for a hardship exception instead of each doctor applying individually. This should make the process much simpler for physicians and their practice managers in the future. We will be releasing guidance on this new process soon.

These principles we’ve outlined here reflect the constructive and clear articulation of issues and open sharing of views and data by stakeholders across the health care system, but they also promote our highest priority – better care for the beneficiaries of the Medicare and Medicaid program and patients everywhere.

The challenge with any change is moving from principles to reality. The process will be ongoing, not an instant fix and we must all commit to learning and improving and collaborating on the best solutions. Ultimately, we believe this is a process that will be most successful when physicians and innovators can work together directly to create the best tools to care for patients. We look forward to working collaboratively with stakeholders on advancing this change in the months ahead.

January 19, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 5 blogs containing over 11,000 articles with John having written over 5500 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 18 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

AMIA Urges CMS to Rethink Informatics Policies as New Models of Care Emerge

Outcomes-oriented payment policy should enable more outcomes-oriented informatics policy

(BETHESDA, MD) — In comments submitted to the Centers for Medicare & Medicaid Services (CMS), the nation’s leading data scientists in healthcare urged federal officials to use new payment policies to reassess how providers are required to use informatics tools, and rethink how quality is measured in a digital world. Officials from the American Medical Informatics Association (AMIA) said new and novel ways to deliver care will rely on dynamic uses of information technology (IT) and other informatics tools, so government policies dictating the use of IT should be flexible and evolve as more experience is gained with new care models.

CMS issued a request for information (RFI) in October asking for stakeholder input on how best to implement a range of policies required by the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 (PL 114-10). The Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) established by MACRA will replace the current Fee-For-Service payment model for Medicare by 2017 and 2019, respectively. This system of reimbursement will rely heavily on electronically-specified clinical quality measures (eCQMs) to pay physicians based on how well their patients recover, rather than the number of services delivered. In comments, AMIA said it supported this move to value-based reimbursement, but voiced concern with the industry’s ability to generate accurate and complete eCQMs, and urged more focus on outcomes-oriented quality measurement.

“AMIA supports the overall direction of moving to an outcomes-based payment system, predicated on demonstrating value for payment,” the organization said in comments. “As we transition away from fee-for-service payment, so too must we move away from the quality measurement paradigm underlying that system. Despite earnest efforts, quality measurement has not become ‘a by-product of care delivered,’ as envisioned, and we are concerned the current mode is insufficient to enable this.”

To improve the current approach, AMIA urged officials to devote more resources to testing both the accuracy of the measure calculation, as well as the feasibility of the data collection requirements, and pilot all new eCQMs before their release for use. CMS should also establish a regular cadence of updates/revisions to eCQMs, ensuring adequate time is allowed for implementation of revisions by both the vendor and provider. Further, AMIA suggested these policies create new opportunities to develop better outcome measures, rather than relying on current process measures.

Additional questions posed by the RFI sought input on how officials should implement policies that require the use of certified EHR technology, and whether new certification criteria are needed to help providers succeed within new payment models. AMIA recommended federal officials avoid overly prescriptive requirements to determine how providers use informatics tools within APMs, but rather focus on the outcomes sought by the use of such tools.

“Ours is a dynamic environment of innovation and invention,” said Blackford Middleton, MD, MPH, MSc, FACMI and current AMIA Board Chair.  “AMIA sees policy development for MIPS and APMs as not just an opportunity to change our payment system, but as an opportunity to revisit policies meant to spur adoption and guide use of health IT.”

AMIA President and CEO Douglas Fridsma, MD, PhD, FACP, FACMI continued, “In much the same way that fee-for-service era policies skewed incentives and provider behavior, overly prescriptive documentation and ‘use’ requirements of the same era have influenced how health IT is developed, implemented and leveraged to improve care.  We must evolve both sets of policies if we are going to succeed in this new paradigm.”

Click here to read AMIA’s full comments to the CMS RFI regarding implementation of MIPS and promotion of APMs.

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AMIA, the leading professional association for informatics professionals, is the center of action for 5,000 informatics professionals from more than 65 countries. As the voice of the nation’s top biomedical and health informatics professionals, AMIA and its members play a leading role in assessing the effect of health innovations on health policy, and advancing the field of informatics. AMIA actively supports five domains in informatics: translational bioinformatics, clinical research informatics, clinical informatics, consumer health informatics, and public health informatics.

November 16, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 5 blogs containing over 11,000 articles with John having written over 5500 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 18 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

CMS Begins Implementation of Key Payment Legislation

Proposed Update to Physician Fee Schedule is First Since Repeal of SGR

Today, CMS released the first proposed update to the physician payment schedule since the repeal of the Sustainable Growth Rate through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).  The proposal includes a number of provisions focused on person-centered care, and continues the Administration’s commitment to transform the Medicare program to a system based on quality and healthy outcomes.

“CMS is building on the important work of Congress to shift the Medicare program toward a system that rewards physicians for providing high quality care,” said Andy Slavitt, Administrator of CMS.  “Thanks to the recent landmark Medicare and children’s health insurance program legislation, CMS and Congress are working together to achieve a better Medicare payment system for physicians and the American people.”

In the proposed CY 2016 Physician Fee Schedule rule, CMS is also seeking comment from the public on implementation of certain provisions of the MACRA, including  the new Merit-based Incentive payment system (MIPS). This is part of a broader effort at the Department to move the Medicare program to a health care system focused on the delivery of quality care and value.

The proposed rule includes updates to payment policies, proposals to implement statutory adjustments to physician payments based on misvalued codes, updates to the Physician Quality Reporting System, which measures the quality performance of physicians participating in Medicare, and updates to the Physician Value-Based Payment Modifier, which ties a portion of physician payments to performance on measures of quality and cost.  CMS is also seeking comment on the potential expansion of the Comprehensive Primary Care Initiative, a CMS Innovation Center initiative designed to improve the coordination of care for Medicare beneficiaries.

The proposed rule also seeks comment on a proposal that supports patient- and family-centered care for seniors and other Medicare beneficiaries by enabling them to discuss advance care planning with their providers. The proposal follows the American Medical Association’s recommendation to make advance care planning services a separately payable service under Medicare.

The release of the rule triggers a 60-day comment period, during which time CMS welcomes the input of stakeholders and the public.  A final rule will be published this fall. For a fact sheet on the proposed rule, please see here. For further information, please see the rule on display here.

July 8, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 5 blogs containing over 11,000 articles with John having written over 5500 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 18 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.