Federal Update Issues Impacting Rheumatologists and their Patients. Emily L. Graham, RHIA, CCS-P VP, Regulatory Affairs Hart Health Strategies, Inc.
|
|
- Theodora Burke
- 5 years ago
- Views:
Transcription
1 Federal Update Issues Impacting Rheumatologists and their Patients Emily L. Graham, RHIA, CCS-P VP, Regulatory Affairs Hart Health Strategies, Inc.
2 Just a spoon full of DC?
3 Agenda MACRA & Rheumatology 2018 MPFS Proposals MedPAC & PBMs Red Tape Relief Project Other Regulatory Issues
4 MACRA & Rheumatology
5 MACRA Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Enacted into law on April 16, 2015 Repealed the flawed Sustainable Growth Rate (SGR) formula! Established a two-track Medicare physician payment system Merit-Based Incentive Payment System (MIPS) Alternative Payment Models (APMs) Framework for these two programs is known as the Quality Payment Program MACRA QPP MIPS APMs
6 MACRA Payment Adjustments MPFS Updates % MPFS Update % MPFS Update 2026 & Beyond 0.25% or 0.75% MPFS Update MIPS Adjustment Current Programs % TO +4% (3x) + min 0.5% TO 10% % TO +5% (3x) + min. 0.5% TO 10% % TO +7% (3x) + min. 0.5% TO 10% 2022 & Beyond -9% TO +9% (3x) + min. 0.5% TO 10% APM Bonus Exceptional Performance Adjustment % bonus 2025 & Beyond no bonus
7 MIPS Year 1 Participation & Rheumatology While more than half of clinicians approximately 738,000 to 780,000 billing under the Medicare PFS will be excluded from MIPS, most Rheumatologists will be subject to MIPS Specialty Rheumatology (5,629) Newly- Enrolled 208 (3.7%) Qualifying APM Participant Status 79 (1.4 %) Low- Volume 841 (14.9%) Total Exclusions 1,128 (20%) Total Inclusions 4,501 (80%) Source: CMS MIPS/APMs Final Rule Table 58: MIPS EXCLUSIONS BY REASON AND SPECIALTY FOR MIPS TRANSITION YEAR
8 MIPS Year 1 Snapshot MIPS Year 1 Snapshot Quality (60%; 60 pts) Report 6 quality measures, including one outcome/high priority measure, for a minimum of 90 days (or a specialty measure set) Bonus points for reporting high priority measures 3-point floor for all submitted quality measures CMS will only count the top 6 reported measures toward quality score Improvement Activities (15%; 40 pts) Attest that you completed up to 4 improvement activities for a minimum of 90 continuous days* Activities are weighted high (20 pts) and medium (10 pts) CMS doubled the points for small practices* If at least one clinician in the group performs the activity, the entire group may count it Advancing Care Information (ACI) (25%; 155 pts/ 100 pts) Fulfill required measures for a minimum of 90 consecutive days (BASE 50%) Submit up to 9 measures for additional credit (PERFORMANCE 90%) Bonus points available 5%) Cost (0%; 0 pts) Calculated from claims data; no additional submissions required * 15 or fewer and solo s
9 Exceptional performance threshold set at 70 points MIPS Year 1 Transition Policies Source: CMS QPP Web site Performance threshold set at 3 points
10 From the MACRA statute: Application of MIPS adjustment factors.--in the case of items and services furnished by a MIPS eligible professional during a year (beginning with 2019), the amount otherwise paid under this part MIPS Adjustment & Part B Drugs Clarification in the 2018 QPP Proposed Rule: For Part B items and services furnished by a MIPS eligible clinician such as purchasing and administering Part B drugs that are billed by the MIPS eligible clinician, such items and services may be subject to MIPS adjustment based on the MIPS eligible clinician s performance during the applicable performance period or included for eligibility determinations. For those billed Medicare Part B allowable charges relating to the purchasing and administration of Part B drugs that we are able to associate with a MIPS eligible clinician at an NPI level, such items and services furnished by the MIPS eligible clinician would be included for purposes of applying the MIPS payment adjustment or making eligibility determinations
11 MIPS Year 2: Proposals More clinicians will be exempt from MIPS CMS proposes to increase the low-volume threshold exempt individuals or groups with fewer than $90,000 in Part B charges or 200 Part B patients (up from $30,000 and 100 patients in Year 1) This means 63% of all Medicare clinicians will be exempt from MIPS in 2018 Pick your pace will continue in Year 2 with modifications CMS proposes to maintain the 3-point floor for quality measures (in most instances) CMS proposes to increase the MIPS performance threshold from three to 15 Cost will continue to be held at 0% of the final score
12 MIPS Year 2: Proposals Use of 2015 Edition CEHRT is optional in 2018, with the option for bonus points for those who do upgrade their systems Small practices may be exempt from MIPS ACI under new significant hardship exemptions authorized under 21 st Century Cures Only 90-days of reporting for the ACI performance category will be required in 2018 and 2019 Virtual groups will be offered as a new way for practices to participate in MIPS Reporting can be accomplished through multiple mechanism with the ACI, quality and improvement activities categories to meet program requirements
13 MIPS Year 2 Impact on Rheumatology Measure Set Addition of: Measure #24: Communication with the Physician or Other Clinician Managing On-going Care Post- Fracture for Men and Women Aged 50 Years and Older Measure #39: Screening for Osteoporosis for Women Aged Years of Age Measure #110: Preventive Care and Screening: Influenza Immunization Measure #111: Pneumonia Vaccination Status for Older Adults Measure #236: Controlling High Blood Pressure Measure #238: Use of High-Risk Medications in the Elderly Removal of: Measure #337: Tuberculosis (TB) Prevention for Psoriasis, Psoriatic Arthritis and Rheumatoid Arthritis Patients on a Biological Immune Response Modifier
14 MIPS Year 2 Impact on Rheumatology In 2018, approximately 37 percent of 1,548,022 Medicare clinicians billing to Part B will be included in MIPS, which includes a majority of rheumatologists Number of MIPS eligible clinicians by specialty Rheumatology (3,340) % engaging with quality reporting % w/ + or null payment adj. % w/ exp. payment adj. % w/ - payment adj. 95% 95.5% 80.5% 4.5% Source: CMS 2018 QPP Proposed Rule Table 87
15 2018 QPP Comments Oppose inclusion of Part B drugs in MIPS payment adjustment Maintain rheumatology specialty measure set Maintain 0% cost weight in 2018; reweight cost category to 0% for rheumatology in 2019 or until appropriate episode-based measures are available Finalize FRAX tool as standalone IA or under different IA subcategory Support of Alliance of Specialty Medicine Comments
16 MedPAC Policy Considerations related to MACRA MACRA Policy Considerations Revise the MIPS program Eliminate clinician measure reporting Use a uniform set of CMS-calculated outcome and patient experience measures to assess clinicians at an aggregate level CMS-defined referral area or cliniciandefined virtual group All clinicians contribute to quality pool (e.g., 1% withhold) Withhold returned for joining Advanced APM; Do nothing and lose withhold Rebalance from MIPS toward Advanced APMs Limit potential upside in MIPS Remove 5% incentive payment cliff No threshold; incentive would be proportional to AAPM involvement Use $500M exceptional performance bonus to encourage 2-sided ACOs Improve payment for PCP Upfront payment for PCPs in 2-sided ACOs Future work to address PCP payments
17 Possible MACRA Legislative Reforms Extend Transition Policies Provide Additional Flexibility for Assessing Clinician Performance Increase Availability of Virtual Groups Delay Requirements of 2015 Edition CEHRT Apply MIPS Adjustment to Covered Professional Services Only Reduce Thresholds for Achieving Qualifying APM Participant Status Extend the Availability of APM Incentive Payment Allow Exceptions for the Use of CEHRT
18 2018 MPFS
19 2018 MPFS Comments Concerns about digital radiography incentive program and multiple modifiers; hold harmless from financial and criminal repercussions Oppose reductions in practice expense for MSUS Oppose single J-code for biosimilars Support of Alliance of Specialty Medicine and Cognitive Care Alliance Comments
20 MedPAC & PBMs
21 MedPAC & PBMs Background on PBMs and specialty pharmacies Specialty drugs will increasingly drive growth in drug spending (Part A and B) Complex transitions and incentives in the drug supply chain for specialty drugs) Potential policy questions for managing specialty drugs in Medicare Exclusive specialty pharmacy networks CMS data transparency requirement Allow MA-PDs to manage specialty drugs under the medical benefit
22 MedPAC & PBMs Commissioner Discussion Complex issue, not well understood, many terms of art Entanglement of financial interests Unclear financial impact on beneficiaries, pass-through of rebates Plans are in control of the benefit, rules, and formularies - not the PBMs Transparency of data remains an issue; PBMs say this is being provided One commissioner: Consolidation can be good, why are we opposed? Specific interest in RA drugs Need to consider other players in the drug supply chain, not just PBMs, specialty pharmacies No mention of non-medical switching, quality of care, or access to medicines
23 Red Tape Relief Project
24 Red Tape Relief Project New initiative by Ways & Means Health Subcommittee Chairman Pat Tiberi (R-OH) Aimed at delivering relief from the regulations and mandates that impede innovation, drive up costs, and ultimately stand in the way of delivering better care for Medicare beneficiaries Three stages: Request feedback Host roundtables Take Congressional action CSRO coordinated a response with the Alliance of Specialty Medicine; submitted individually on MIPS adjustment of Part B drugs
25 Other Regulatory Issues
26 Other Regulatory Issues Cancellation of Episode Payment Models; Modifications to Comprehensive Care for Joint Replacement What does this mean broadly for new payment models? Direction of CMMI? Impending 2019 Notice of Benefit and Payment Parameters Network adequacy in Marketplace plans? Revisions to program integrity programs Targeted Probe and Educate to replace original Medicare review 30-day waiting period before sending claims for adjustment; may allow providers to appeal, resubmit claims ZPICs move under UPICs FDA efforts to comply with EO 13771, Reducing Regulation and Controlling Regulatory Costs, and EO 13777, Enforcing the Regulatory Reform Agenda Seeking comments from stakeholders to identify regulations that could be modified, repealed or replaced to achieve meaningful burden reduction
27 Thank you!
CY 2018 Quality Payment Program Final Rule Summary
CY 2018 Quality Payment Program Final Rule Summary On November 2, 2017, the Centers for Medicare and Medicaid Services (CMS) released its final rule outlining the requirements for year two of the Quality
More information4/8/17. The Changing Nature of Physician Payment and Health Care Reform in The AMA A Unifying Voice for Physicians
The Changing Nature of Physician Payment and Health Care Reform in 2017 U of Mo Family Medicine Update April 7, 2017 David Barbe, MD MHA President-elect American Medical Association VP Regional Operations
More informationPRIMER: MACRA and the Merit-based Incentive Payment System (MIPS) Tara O Neill Hayes January 31, 2016
PRIMER: MACRA and the Merit-based Incentive Payment System (MIPS) Tara O Neill Hayes January 31, 2016 Background On April 16, 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) was signed into
More informationMACRA: THE FINAL RULE. Last updated 12/13/16
MACRA: THE FINAL RULE Last updated 12/13/16 1 Background April 2015 MACRA (Medicare Access & CHIP Reauthorization Act) is signed into law to repeal the sustainable growth rate (SGR) which drastically cut
More information2018 Quality Payment Program Final Rule. Summary
Summary On Thursday, November 3, 2017, CMS issued the 2018 Quality Payment Program (QPP) final rule. Comments on the final rule are due January 1, 2018. The QPP encompasses the Merit-based Incentive Payment
More informationMACRA Final Rule Summary
MACRA Final Rule Summary On October 14, 2016, the Centers for Medicare and Medicaid Services (CMS) released its final rule implementing the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA),
More informationMedicare Releases Final Rule for the Second Year of the Quality Payment Program
Medicare Releases Final Rule for the Second Year of the Quality Payment Program On Nov. 2, 2017, CMS issued the Calendar Year 2018 Quality Payment Program (QPP) final rule for the second transition year
More informationCopyright Scottsdale Institute All Rights Reserved.
Copyright Scottsdale Institute 2017. All Rights Reserved. No part of this document may be reproduced or shared with anyone outside of your organization without prior written consent from the author(s).
More informationTopics to be covered. Do I have to participate in MACRA/MIPS/QPP? Choices for participation. Timelines. What is changing with QPP
Topics to be covered Do I have to participate in MACRA/MIPS/QPP? Choices for participation Timelines What is changing with QPP I have no relevant financial relationships to disclose. Participant engagement
More informationMACRA Update: The Top 8 For Amy Mullins, MD, CPE, FAAFP Medical Director, Quality Improvement AAFP
MACRA Update: The Top 8 For 2018 Amy Mullins, MD, CPE, FAAFP Medical Director, Quality Improvement AAFP Disclosure Statement It is the policy of the AAFP that all individuals in a position to control content
More informationProposed 2018 Medicare Physician Payment and Quality Reporting Changes. Executive s Insights
Proposed 2018 Medicare Physician Payment and Quality Reporting Changes MGMA MEMBER-EXCLUSIVE ANALYSIS The Centers for Medicare & Medicaid Services (CMS) recently proposed changes to both Medicare physician
More informationMEDICARE ACCESS AND CHIP REAUTHORIZATION ACT (MACRA) MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) REVIEW
MEDICARE ACCESS AND CHIP REAUTHORIZATION ACT (MACRA) MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) REVIEW I. MIPS Overview 1) Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) i) Signed into Law
More informationGet Straight on MACRA in 2018
Quality Reporting Roundtable Get Straight on MACRA in 2018 FAQs, Advisory Board Guidance, and Resources Ye Hoffman, MS, CPHIMS Consultant March 27, 2018 research technology consulting 2 Manage Your Audio
More information9/7/17. MACRA: The Knowns and the Unknowns. Disclosures. Goals and Objectives
MACRA: The Knowns and the Unknowns Sharon K. Merrick, M.S., CCS-P Director of Payment and Practice Management American Society of Anesthesiologists Wisconsin Society of Anesthesiologists September 10,
More informationMACRA: Alternative Payment Models Proposed Rule CY 2016
powered by Vizient & AAMC MACRA: Alternative Payment Models Proposed Rule CY 2016 June 2, 2016 Page 1 Housekeeping When you called in, did you enter your attendee ID number? Dial-in number: 1-866-469-3239
More informationThe Future Of Medicare Physician Reimbursement
Portfolio Media. Inc. 111 West 19 th Street, 5th Floor New York, NY 10011 www.law360.com Phone: +1 646 783 7100 Fax: +1 646 783 7161 customerservice@law360.com The Future Of Medicare Physician Reimbursement
More informationYou Down with QPP? Daniel Collins Director of Finance Orlando Health Physician Enterprise
You Down with QPP? Daniel Collins Director of Finance Orlando Health Physician Enterprise Why Was the QPP created? Source: https://www.youtube.com/watch?v=7df7chghas4 What is QPP? Quality Payment Program
More informationCMS PROPOSES KEY PROVISIONS OF MACRA PHYSICIAN PAYMENT SYSTEM FOR 2019
Thursday, April 28, 2016 CMS PROPOSES KEY PROVISIONS OF MACRA PHYSICIAN PAYMENT SYSTEM FOR 2019 The Centers for Medicare & Medicaid Services (CMS) late yesterday issued a proposed rule implementing key
More informationSummary of the Quality Payment Program (QPP) Year 2 Final Rule
November 8, 2017 Summary of the Quality Payment Program (QPP) Year 2 Final Rule Medicare Program; CY 2018 Updates to the Quality Payment Program; and Quality Payment Program: Extreme and Uncontrollable
More informationQuality Payment Program Year 3
Quality Payment Program Year 3 Final Rule Overview The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate (SGR) formula for clinician payment, and established
More informationQuality Payment Program Year 2
Quality Payment Program Year 2 MIPS Highlights Raising the performance threshold to 15 points in Year 2 (from 3 points in the transition year). Allowing the use of 2014 Edition and/or 2015 Certified Electronic
More informationKey Financial and Operational Impacts from the Proposed Rule to Implement MACRA:
Key Financial and Operational Impacts from the Proposed Rule to Implement MACRA: The proposed rule implementing Access and CHIP Reauthorization Act of 2015 (MACRA) was made available on May 9, 2016. A
More informationAMERICAN COLLEGE OF GASTROENTEROLOGY MAKING $ENSE OF MACRA
AMERICAN COLLEGE OF GASTROENTEROLOGY 6400 Goldsboro Road, Suite 200, Bethesda, Maryland 20817-5842; P: 301-263-9000; F: 301-263-9025 MAKING $ENSE OF MACRA CMS.SGR MACRA MIPS APMs QCDRs ACOs Why does Washington
More informationMedicare Quality Payment Program Overview (MACRA)
Medicare Quality Payment Program Overview (MACRA) December 2016 Rev. 12/1/16 Some general observations MACRA is complex More than a replacement for the SGR Many of the new requirements are revisions to
More informationQUALITY PAYMENT PROGRAM YEAR 3 (2019) FINAL RULE OVERVIEW NOVEMBER 15, 2018
QUALITY PAYMENT PROGRAM YEAR 3 (2019) FINAL RULE OVERVIEW NOVEMBER 15, 2018 Disclaimers This presentation was prepared as a tool to assist providers and is not intended to grant rights or impose obligations.
More informationOn Track for MACRA The Provider s Guide to QPP
On Track for MACRA The Provider s Guide to QPP Bizmatics, Inc. 4010 Moorpark Avenue, Suite 222 San Jose, CA 95117 www.prognocis.com training@bizmaticsinc.com Copyright 2017 Bizmatics, Inc. Overview CMS
More informationQUALITY PAYMENT PROGRAM YEAR 3 (2019) FINAL RULE OVERVIEW
QUALITY PAYMENT PROGRAM YEAR 3 (2019) FINAL RULE OVERVIEW NEAL LOGUE, HEALTH INSURANCE SPECIALIST, DIVISION OF FINANCIAL MANAGEMENT & FEE FOR SERVICE OPERATIONS DECEMBER 12, 2018 Disclaimers This presentation
More informationHoly MACRA! Mark D. Kaufmann, M.D. Associate Clinical Professor Department of Dermatology Icahn School of Medicine at Mount Sinai October 27, 2017
Holy MACRA! Mark D. Kaufmann, M.D. Associate Clinical Professor Department of Dermatology Icahn School of Medicine at Mount Sinai October 27, 2017 DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Mark
More informationDEPARTMENT OF HEALTH AND HUMAN SERVICES & 42 CFR 414 [CMS-5522-FC
Executive Summary DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Part 414 [CMS-5522-FC and IFC] RIN 0938-AT13 Medicare Program; CY 2018 Updates to the Quality Payment
More informationAMERICAN COLLEGE OF GASTROENTEROLOGY MAKING $ENSE OF MACRA
AMERICAN COLLEGE OF GASTROENTEROLOGY 6400 Goldsboro Road, Suite 200, Bethesda, Maryland 20817-5842; P: 301-263-9000; F: 301-263-9025 MAKING $ENSE OF MACRA CMS.SGR MACRA MIPS APMs QCDRs ACOs Why does Washington
More informationScripps Health ACO Update
June 2016 Scripps Health ACO Update Marc Reynolds Senior Vice President, Payer Relations Scripps Health Anil N. Keswani, MD Corporate Vice President, Population Health Management Scripps Health 10 Key
More informationThank you, and enjoy the webinar.
Disclaimer This webinar may be recorded. This webinar presents a sampling of best practices and overviews, generalities, and some laws. This should not be used as legal advice. Itentive recognizes that
More informationPredictive Qualifying Alternative Payment Model (APM) Participants (QPs) Methodology Fact Sheet What is the Predictive QP Status Analysis?
Predictive Qualifying Alternative Payment Model (APM) Participants (QPs) Methodology Fact Sheet What is the Predictive QP Status Analysis? One of the Quality Payment Program s goals is to be clear about
More informationHealth Care Policy Landscape: Market Trends & Frontline Perspectives
Health Care Policy Landscape: Market Trends & Frontline Perspectives December 1, 2016 www.leavittpartners.com Post-Election, New Administration Insights Top 10 Health Policy Actions to Watch 1 2 3 4 Substantial
More informationEverything You Need to Know About the MIPS Payment Adjustment
Everything You Need to Know About the MIPS Payment Adjustment Sandy Swallow and Michelle Brunsen June 12, 2018 1 This material was prepared by Telligen, the Medicare Quality Innovation Network Quality
More informationFinal Policy, Payment, and Quality Provisions in the Medicare Physician Fee Schedule for Calendar Year 2018
Final Policy, Payment, and Quality Provisions in the Medicare Physician Fee Schedule for Calendar Year 2018 Date 2017-11-02 Title Contact Final Policy, Payment, and Quality Provisions in the Medicare Physician
More information2018 Merit-Based Incentive Payment System (MIPS) Scoring Overview
The Physicians Advocacy Institute s Medicare Quality Payment Program (QPP) Physician Education Initiative 2018 Merit-Based Incentive Payment System (MIPS) Scoring Overview 1 P a g e MEDICARE QPP PHYSICIAN
More informationMedicare Red Tape Relief Project Submissions accepted by the Committee on Ways and Means, Subcommittee on Health
Please Provide Responses to the Fields Below Electronically to be Accepted Medicare Red Tape Relief Project Submissions accepted by the Committee on Ways and Means, Subcommittee on Health Date: August
More informationAugust 21, Ms. Seema Verma Administrator Centers for Medicare and Medicaid Services 7500 Security Boulevard Baltimore, Maryland
August 21, 2016 Ms. Seema Verma Administrator Centers for Medicare and Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244-1850 Dear Ms. Verma: On behalf of AMGA, we appreciate the opportunity
More informationRUPRI Center for Rural Health Policy Analysis. Rural Policy Brief. Brief No NOVEMBER
RUPRI Center for www.banko Rural Health Policy Analysis Rural Policy Brief Brief No. 2018-6 NOVEMBER 2018 http://www.public-health.uiowa.edu/rupri/ Changes to the Merit-based Incentive Payment System Pertinent
More informationOther Payer Advanced APM Determination
Other Payer Advanced APM Determination Process: CMS Multi-Payer Models Quality Payment Program Final Rule for Year 2 On November 2, 2017, the Department of Health and Human Services (HHS) issued a final
More informationMACRA: How the 2018 Quality Payment Program Final Rule Impacts Providers
Medical Group Strategy Council MACRA: How the 2018 Quality Payment Program Final Rule Impacts Providers Rob Lazerow Managing Director Tony Panjamapirom Senior Consultant Hamza Hasan Practice Manager Julie
More informationMACRA: Redefining How CMS Pays Doctors. White Paper ELLIS MAC KNIGHT, MD DAN KIEHL, JD CONTACT. Senior Vice President/CMO. Associate Consultant
MACRA: Redefining How CMS Pays Doctors White Paper ELLIS MAC KNIGHT, MD Senior Vice President/CMO DAN KIEHL, JD Associate Consultant June 2016 CONTACT For further information about Coker Group and how
More informationAAOS MACRA Proposed Rule Summary (Short)
AAOS MACRA Proposed Rule Summary (Short) Merit-Based Incentive Payment System (MIPS), Advanced Alternative Payment Model (APM) Incentive, and Criteria for Physician-Focused Payment Models Ref: CMS-5517-P
More informationFact Sheet: 2019 Merit-based Incentive Payment System (MIPS) Payment Adjustments based on 2017 MIPS Final Scores
Fact Sheet: 2019 Merit-based Incentive Payment System (MIPS) Payment Adjustments based on 2017 MIPS Final Scores The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repealed the Medicare sustainable
More informationThe MACRA Proposed Rule on MIPS and APMs: Summary and Key Takeaways
The MACRA Proposed Rule on MIPS and APMs: Summary and Key Takeaways A White Paper May 2016 Impact Advisors LLC 400 E. Diehl Road Suite 190 Naperville IL 60563 1-800- 680-7570 Impact- Advisors.com Executive
More informationNAACOS Analysis Shows ACOs In Top MIPS Performance Tier
NAACOS Analysis Shows ACOs In Top MIPS Performance Tier The National Association of Accountable Care Organizations (NAACOS) is sharing results of its analysis of ACO performance in the Quality Payment
More informationWashington Update. Suzanne Falk, MPP Associate Director, Government Affairs
Washington Update Suzanne Falk, MPP Associate Director, Government Affairs sfalk@mgma.org Agenda 2017 Medicare Physician Fee Schedule Changes Miscellaneous Updates 2016 Quality Reporting Wrap-Up MACRA
More informationWashington Update. Suzanne Falk, MPP Associate Director, Government Affairs
Washington Update Suzanne Falk, MPP Associate Director, Government Affairs sfalk@mgma.org Agenda 2017 Medicare Physician Fee Schedule Highlights Miscellaneous Updates 2016 Quality Reporting Wrap-Up Quality
More informationMedicare Access and CHIP Reauthorization Act of 2015 (HR. 2; MACRA)
Fact Sheet April 23, 2015 H.R.2 - Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Background. The Medicare Sustainable Growth Rate formula (SGR), passed by Congress in 1997, was intended to
More informationMACRA: APPLICATIONS & IMPLICATIONS September 13, /13/2016. Mark Blessing, CPA, FHFMA Partner
MACRA: APPLICATIONS & IMPLICATIONS September 13, 2016 Mark Blessing, CPA, FHFMA Partner mblessing@bkd.com Zach Remmich Managing Consultant zremmich@bkd.com 1 TO RECEIVE CPE CREDIT Participate in entire
More informationGrowth and Success of Accountable Care Organizations (ACOs) in the US from Dennis Horrigan June 2016
Growth and Success of Accountable Care Organizations (ACOs) in the US from 2010-2016 Dennis Horrigan June 2016 Introducing Dennis Horrigan Dennis R. Horrigan President and Chief Executive Officer Catholic
More informationMACRA: New Medicare Reimbursement Models Sharp HealthCare
MACRA: New Medicare Reimbursement Models Sharp HealthCare August 15, 2016 Nathan M. Bays, Esq. General Counsel, The Health Management Academy Executive Director, Advisors Caitlin Greenbaum, MPH Director,
More informationA PRIMER FOR PRIMARY CARE
MACRA / MIPS Transition to value-based payment in Medicare A PRIMER FOR PRIMARY CARE Robert Resnik MD MBA Source: CMS What does MACRA Accomplish? Repeals the Sustainable Growth Rate (SGR) Formula Changes
More informationRe: Department of Health and Human Services: Promoting Healthcare Choice and Competition Across the United States
Assistant Secretary for Planning and Evaluation Room 415F U.S. Department of Health and Human Services 200 Independence Avenue, SW Washington, D.C. 20201 Submitted via email CompetitionRFI@hhs.gov Re:
More informationJanuary 16, Dear Administrator Verma,
January 16, 2018 Ms. Seema Verma, Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Room 445-G, Hubert H. Humphrey Building 200 Independence Avenue, SW Washington,
More informationAll About APMs: What Will It Take for Physicians to Earn the APM Bonus Under MACRA?
All About APMs: What Will It Take for Physicians to Earn the APM Bonus Under MACRA? By Robert F. Atlas, David B. Tatge, and Lesley R. Yeung June 2016 On May 9, 2016, the Centers for Medicare & Medicaid
More informationFirst a word about the rising cost of retiree healthcare
Medicare Trends First a word about the rising cost of retiree healthcare The average 66-year-old couple is expected to spend nearly 60% of their Social Security income on medical bills, according to a
More informationUnityPoint Accountable Care Aligning Provider Incentives in Risk- Bearing, Value-Based Contracts. March 10, 2018
UnityPoint Accountable Care Aligning Provider Incentives in Risk- Bearing, Value-Based Contracts March 10, 2018 1 Aligning Provider Incentives in Risk- Bearing, Value-Based Contracts UnityPoint Accountable
More informationTitle I - Health Care Coverage
September 21, 2009 The Honorable Max Baucus Chairman, Senate Finance Committee 511 Hart Senate Office Building Washington, DC 20510 Dear Senator Baucus: On behalf of the American College of Physicians,
More informationA Practical Discussion of Value and Quality Based Payments What Do I Do Now?
Emerging Challenges in Primary Care: 2016 A Practical Discussion of Value and Quality Based Payments What Do I Do Now? Modified from AHLA Physicians and Hospitals Law Institute 2016 Faculty Ellie Bane
More information2015 National Training Program. Lessons. Lesson 1 Legislative Updates. Module 4. Current Topics. July 2015
2015 National Training Program Module 4 Lessons 1. Legislative Updates 2. CMS Goals and Initiatives 3. Medicare Updates 4. Medicaid/Children s Health Insurance Program Updates 2 Lesson 1 Legislative Updates
More informationMoving to Accountable Care through the ACA & MACRA
Moving to Accountable Care through the ACA & MACRA Jim Whitfill, MD President Lumetis, LLC Clinical Associate Professor, Departments of Internal Medicine and Biomedical Informatics University of Arizona
More informationHealth IT Public Policy Update
Health IT Public Policy Update January 21, 2016 Tom Leary HIMSS Vice President Government Relations HHS Set Firm Goals for the Move to Value-Based Care Health Information Technology for Economic and Clinical
More informationMACRA Medicare Payment Reform and the Implications to Medicare Advantage Plans
BEYOND THE NUMBERS MACRA Medicare Payment Reform and the Implications to Medicare Advantage Plans True BUSINESS PowerPoint Presentation Template November 2018 PRESENTED BY Bob Moné, FSA, MAAA Liz Myers,
More informationCMS 1701 P UnityPoint Health. October 16, 2018
CMS 1701 P UnityPoint Health 1776 West Lakes Parkway, Suite 400 West Des Moines, IA 50266 unitypoint.org October 16, 2018 Seema Verma, Administrator Centers for Medicare & Medicaid Services Department
More information2018 Washington Update
2018 Washington Update Drew Voytal, MPA Associate Director MGMA Government Affairs 2018 MGMA. All rights reserved. - 1 - - 2 - Agenda Current political and legislative environment Evolving federal payment
More information2019 Merit-based Incentive Payment System (MIPS) Quality Performance Category: Medicare Part B Claims Data Submission Fact Sheet
2019 Merit-based Incentive Payment System (MIPS) Quality Performance Category: Medicare Part B Claims Data Submission Fact Sheet The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the
More informationDecember 15, Committee on Energy and Commerce United States House of Representatives 2125 Rayburn House Office Building Washington, DC 20515
December 15, 2014 The Honorable Fred Upton Chairman The Honorable Diana DeGette Representative Committee on Energy and Commerce United States House of Representatives 2125 Rayburn House Office Building
More informationWashington Update. Mollie Gelburd, JD - 1 -
Washington Update Mollie Gelburd, JD mgelburd@mgma.org - 1 - Agenda Political and regulatory environment Trending topics Medicare physician payment reform: Mid-year status report Practice executive s watch
More informationMACRA, MIPS, APMs & CPC+: What to Expect from All These Acronyms?! Monthly National Briefing April 26, 2016
MACRA, MIPS, APMs & CPC+: What to Expect from All These Acronyms?! Monthly National Briefing April 26, 2016 1 Shari Erickson, MPH Vice President, Governmental Affairs & Medical Practice American College
More informationMedicare s Shared Savings Program: Accountable Care Organizations Proposed Rule
Medicare s Shared Savings Program: Accountable Care Organizations Proposed Rule On March 31, 2011, the Centers for Medicare and Medicaid Services (CMS) issued its proposed rule on Medicare s Shared Savings
More informationI. Recommendations Related to the Definition of More Than Nominal Risk in Alternative Payment Models
320 Ft. Duquesne Boulevard Suite 20-J Pittsburgh, PA 15222 Voice: (412) 803-3650 Fax: (412) 803-3651 www.chqpr.org August 21, 2017 Seema Verma Administrator Centers for & Medicaid Services U.S. Department
More information2018 Merit-based Incentive Payment System (MIPS) Cost Performance Category Fact Sheet
2018 Merit-based Incentive Payment System (MIPS) Cost Performance Category Fact Sheet What is the Quality Payment Program? The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable
More informationNext Generation Accountable Care Organization (ACO) Model Overview
The Physicians Advocacy Institute s Medicare Quality Payment Program (QPP) Physician Education Initiative Next Generation Accountable Care Organization (ACO) Model Overview Ad 1 P a g e MEDICARE QPP PHYSICIAN
More informationMarch 1, Chairman Lamar Alexander United States Senate Committee on Health, Education, Labor, and Pensions Washington, DC 20510
March 1, 2019 Chairman Lamar Alexander United States Senate Committee on Health, Education, Labor, and Pensions Washington, DC 20510 Dear Chairman Alexander: On behalf of AMGA and our members, I appreciate
More informationMACRA and the Evolving Health Care Landscape. Jarrod Fowler, M.H.A. FMA Director of Health Care Policy and Innovation
MACRA and the Evolving Health Care Landscape Jarrod Fowler, M.H.A. FMA Director of Health Care Policy and Innovation MACRA The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Passed Congress
More informationMedicare Keeping Up With the Pace of Change. Presented by Medicare Part B Provider Outreach and Education 2017
Medicare Keeping Up With the Pace of Change Presented by Medicare Part B Provider Outreach and Education 2017 DISCLAIMER This information release is the property of Noridian Healthcare Solutions, LLC.
More informationCurrent State of Medicare. Robert Roth & John Hellow Hooper, Lundy & Bookman, PC
Current State of Medicare Robert Roth & John Hellow Hooper, Lundy & Bookman, PC Rule for FY 2016 A. FY 2017 Final Rule Released Aug. 2, 2016 (printed in Federal Register Aug. 22, 2016) B. FY 2018 Proposed
More informationCurrent State of Medicare
Current State of Medicare Robert Roth & John Hellow Hooper, Lundy & Bookman, PC Rule for FY 2016 A. FY 2017 Final Rule Released Aug. 2, 2016 (printed in Federal Register Aug. 22, 2016) B. FY 2018 Proposed
More informationMACRA Overview. April 2016
MACRA Overview April 2016 CMS is Focused on Progression from Volume-Based to Value-Based Payments Hospitals have some value-based payment via Hospital VBP, readmissions, and HAC programs Other provider
More informationHealth Reform and Vaccine Policy and Practice
Health Reform and Vaccine Policy and Practice 2010 Association of Immunization Managers Program Meeting Atlanta, Georgia Alexandra Stewart, J.D. GWU/SPHHS Department of Health Policy November 18, 2010
More information2018 Healthcare Industry Outlook:
2018 Healthcare Industry Outlook: What Providers Need to Know Chris Emper, JD, MBA January 17, 2018 ON24 Interface Your Presenter Chris Emper, JD, MBA President, Chris Emper, JD, MBA, is the founder and
More informationThe 25th Princeton Conference
The 25th Princeton Conference Navigating Uncertainty in the U.S. Health Care System Where Medicare Is Today May 24, 2018 Mark E. Miller, Ph.D. Vice President of Health Care Laura and John Arnold Foundation
More informationDecember 19, Dear Acting Administrator Slavitt:
December 19, 2016 Mr. Andrew Slavitt Acting Administrator Centers for Medicare & Medicaid Services U.S. Department of Health and Human Services Hubert H. Humphrey Building 200 Independence Avenue, S.W.
More informationBipartisan Budget Act of 2018 Includes Significant Changes in Medicare, Other Federal Health Programs
Bipartisan Budget Act of 2018 Includes Significant Changes in Medicare, Other Federal Health Programs February 2018 On February 9, 2018 after a brief shutdown, Congress passed and President Trump signed
More informationVolume to Value The Great Transformation of American Medicine
Volume to Value The Great Transformation of American Medicine 2010-2020 Richard I. Fogel, MD FHRS Chief Clinical Officer St. Vincent Health October 2015 Fee for Service You get paid for what you do The
More informationThe Medicare Advantage program: Status report
C H A P T E R12 The Medicare Advantage program: Status report C H A P T E R 12 The Medicare Advantage program: Status report Chapter summary In this chapter Each year the Commission provides a status
More information2018 Final Rule from CMS for the Quality Payment Program
2018 Final Rule from CMS for the Quality Payment Program Starting at Noon EST Wed 12/6/2017 Dr. Dan Mingle Register for Webinars or Access Recordings http://mingleanalytics.com/webinars 2017 Mingle Analytics
More informationCMS Quality Payment Program
CMS Quality Payment Program Guide for Managed Care Organizations Providing State Medicaid Agencies with Information and Documentation for Submitting Medicaid Requests for Other Payer Advanced APM Determinations
More informationAMA vision for health system reform
AMA vision for health system reform Earlier this year, the American Medical Association put forward our vision for health system reform consisting of a number of key objectives reflecting AMA policy. Throughout
More informationMedicare Physician Fee Schedule (PFS) Proposed Rule 2019
Medicare Physician Fee Schedule (PFS) Proposed Rule 2019 (As on July 23, 2018; Note: This document may be updated) Executive Summary Physician Fee Schedule The 2019 Medicare Physician Payment Schedule
More informationStatus: Time: 12:00 pm. Date: 3/19/10
Federal Health System Reform 2010: An Update March 19, 2010 1 Status: Time: 12:00 pm. Date: 3/19/10 House votes: Saturday, Rules Committee 9:009 am Sunday, Floor consideration begins at 2:07 pm Process:
More informationCurrent Status Of Legislation on Quality Bench Marks
Conflicts of Interest Current Status Of Legislation on Quality Bench Marks None Sean P. Roddy, MD Albany, NY Reason For Quality Measures Progressive increase in healthcare costs under the fee-for-service
More informationPURPOSE OF THE POLICY STATEMENT OF THE POLICY PROCEDURES
PURPOSE OF THE POLICY The purpose of this policy is to describe Health Alliance s process for transitions and ensure that continued drug coverage is provided to new and current Part D members. The transition
More informationUnderstanding and Facilitating Rural Health Transformation
Understanding and Facilitating Rural Health Transformation 2017 Center for Rural Health Annual Meeting St. Simons Island, Georgia August 16, 2017 A. Clinton MacKinney, MD, MS Clinical Associate Professor
More informationWhite Paper. AMGA Advocacy. Taking Risk, 3.0: Medical Groups Are Moving to Risk Is Anyone Else? AMGA s Third Annual Survey on Taking Risk
White Paper AMGA Advocacy Taking Risk, 3.0: Medical Groups Are Moving to Risk Is Anyone Else? AMGA s Third Annual Survey on Taking Risk AMGA Advocacy Taking Risk, 3.0: Medical Groups Are Moving to Risk
More informationReleased: November 16, Comments Due: January 16, 2018
AMCP Summary: Medicare Program; Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs,
More informationMedicare Payment Advisory Commission (MedPAC) January Meeting Summary
Medicare Payment Advisory Commission (MedPAC) January Meeting Summary The Medicare Payment Advisory Commission (MedPAC) is an independent Congressional agency established by the Balanced Budget Act of
More information2019 Merit-based Incentive Payment System (MIPS) Cost Performance Category Fact Sheet
2019 Merit-based Incentive Payment System (MIPS) Cost Performance Category Fact Sheet What is the Quality Payment Program? The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable
More information