VOLUME 4 - ISSUE 37
MARCH 19, 2019



Welcome to the MACRA MIPS/APM Update eNewsletter
Editor: Philip L. Ronning
This issue sponsored by the National MACRA Summit, National ACO Summit,
and the National Bundled Payment Summit.




5 Ways 2020 Medigap Changes Are Driving States Wild
Congress wants users of Medicare supplement insurance policies, or "Medigap" policies, to feel at least a small financial pinch when they get care. A federal law -- the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) -- is pushing state insurance regulators to set a minimum deductible requirement for Medigap policies starting in 2020. One message the task force is trying to communicate is that, under current federal law, states that fail to adopt the new minimum Medigap deductible requirements by 2020 may lose the right to regulate Medigap coverage. Here are five things the task force is saying about the MACRA changes.

  1. The federal government is on top here.
  2. Congress eliminated some Medigap program flexibility.
  3. Issuers that sell Medigap Plan C or Medigap Plan F after Jan. 1, 2020, could face compliance nightmares.
  4. The MACRA Medigap deductible requirements have holes
  5. Many agents are confused.

Links to information about the Medicare supplement insurance regulation shift and other topics of interest to the Senior Issues Task Force are available here. The new MACRA "frequently asked questions" document for regulator, and the new MACRA consumer bulletin, and the new MACRA producer bulletin are posted under the "Related Documents" tab. (Think Advisor, March 6, 2019)

MedPAC: Docs Don't Need Raise in Base Medicare Pay: Commission Agrees with Update Set by MACRA Law
Physicians' current fee-for-service Medicare reimbursement rates can stay as they are in 2020, the Medicare Payment Advisory Commission (MedPAC) said Friday in its annual March report to Congress. Under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Congress set a number of updates to the Medicare fee-for-service payment schedule in advance. In that schedule, physicians received a 0.5% increase each year from 2015 to 2019; no further increases are scheduled for 2020 to 2025. However, apart from those updates in individual fee-for-service payments, physicians can also earn bonuses of up to 12% -- or penalties of as much as -4% -- based on their performance in Medicare's new pay-for-performance program. "Overall, access to clinician services for Medicare beneficiaries appears stable and comparable with that for privately insured individuals," the report authors wrote. "Other measures of payment adequacy are stable and consistent with prior years. Therefore, the Commission does not see a reason to diverge from the current-law policy of no update for 2020." MedPAC also had agreed with the 0.5% increase for 2019. (MedPage Today, March 15, 2019)

Next Generation ACO Providers on PatientPing's Network Achieve More than $100 Million in Shared Savings
PatientPing, the nation's most comprehensive care coordination network, recently announced that its national network of Accountable Care Organizations (ACOs) generated over $100 million in shared savings for 2017 under the Centers for Medicare and Medicaid Innovation (CMMI) Next Generation ACO Program. Launched in 2016, the Next Generation ACO Model is an Advanced Alternative Payment Model (APM) under the Quality Payment Program established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). "PatientPing has allowed us to take action on care events by providing real-time information when our patients seek care outside of our four walls," said Chris Elfner, vice president of accountable care strategy at Bellin Health in Wisconsin. "Having this insight allows us to coordinate their care across the entire continuum, whereas in the past we could only see what happened if they came through our doors. We've been able to increase the number of patient follow-ups after discharge, allowing us to reduce readmissions and improve follow-ups with patients post-discharge. PatientPing also keeps us connected with our patients in skilled nursing facilities, allowing us to closely monitor length of stay. Finally, we are now able to see patients who are frequently utilizing the emergency department and direct them to a more appropriate setting to get the care they need." PatientPing currently partners with over 25% of the ACOs participating in the Next Generation ACO Program. Additionally, four of the top five NextGen ACOs to achieve shared savings in 2017 are within the PatientPing network. The platform allows providers across the nation to collaborate on their shared patients through Pings--real-time notifications when patients receive care--and Stories--clinical information that delivers important patient context at the point of care. Through these solutions, ACOs, hospitals, post-acute-care providers, community physicians, health plans and others are reducing costs while improving quality of care for the patients they are serving. (PRNewswire, March 7, 2019)



AMGA Seeks End of MIPS Exclusions to Promote Value-Based Care
AMGA is calling on Congress to implement MACRA and the Quality Payment Program it introduced fully, beginning with the elimination of exclusions from the Merit-based Incentive Payment System (MIPS) that exempted more than half of eligible clinicians. "MIPS was designed as a viable transition tool to value-based payment in the Medicare program, where providers would be rewarded for their investments in health information technology (IT), care management processes, and people," wrote American Medical Group Association (AMGA) President & CEO Jerry Penso, MD, MBA. "However, the Centers for Medicare & Medicaid Services (CMS) has not implemented MIPS as Congress intended." he organization representing medical groups drew special attention to the budget-neutral provision of the Medicare Access and CHIP Reauthorization Act (MACRA) that means negative payment adjustments for some become positive payment adjustments for others. "Under the MIPS program, providers have the opportunity to earn an annual adjustment to their Medicare Part B payments based on their performance starting in 2019, with a positive or negative adjustment range of 4%. That range eventually increases to 9% in 2023," Penso reiterated. By excluding nearly 60 percent of eligible providers from the pool, the gains for high-performing medical groups were not as significant as planned. (EHR Intelligence, February 5, 2019)

MACRA Tidbit for the Week: ACG Member Checklist: What Are the Steps I Need to Take?
Member Checklist: What are the steps I need to take? As discussed in previous tidbits, ACG members must meet certain criteria before being eligible for the "QPP."

Your first step: Check eligibility
First you need to find out whether you must participate in the QPP. Visit the Medicare Quality Payment Program website to check your participation status by entering your national provider identifier (NPI) number.

Your next step (if you must participate): Pick your QPP payment track
Your next step requires you to decide what reimbursement system or "track" you can participate in for your Medicare fee-for-services patients. This participation look-up will help you. The options:

  1. A modified fee-for-service reimbursement system called the Merit-Based Incentive payment System (MIPS); or
  2. A CMS-approved alternative payment model (APM), like participating in a bundled payment or accountable care organization (ACO) payment model. These CMS-approved payment mechanisms are called "advanced alterative payment models (APMs)."

Go to the article for more steps.

(ACG Blog, March 8th, 2019)

Make Value-Based Reimbursement Implementation Easier, AMGA Says
Promoting the implementation of risk- and value-based reimbursement models is key to reducing healthcare costs in the US, AMGA recently told policymakers. "The rising cost of healthcare in this country is an unnecessary burden on all American families and especially impacts vulnerable patient populations. We need to find a way to lower costs while continuing to provide high-quality, value-based care," AMGA President and CEO Jerry Penso, MD, MBA, stated in response to a Senate Health, Education, Labor, and Pensions (HELP) Committee request. "Policymakers have made it clear they want to transform the way US healthcare is financed. Ensuring success in value-based arrangements, where providers are accountable for total cost of care, is the best way to accomplish that goal." Healthcare spending in the US is unsustainable, stakeholders have argued. CMS actuaries recently predicted national healthcare costs to total almost $6 trillion by 2027 and account for about 19 percent of gross domestic product (GDP). However, value-based reimbursement can help stakeholders bend the healthcare cost curve and improve outcomes for the aging population, AMGA contended in the March 1 letter. "A shift toward a value-based approach and away from the fee-for-service system is the most effective way to lower overall costs. We need to align payments with the goals of the healthcare system, and the best way to do this is to reduce the barriers to success in value-based care arrangements," the association representing approximately 17,000 physicians wrote. (RevCycle Intelligence, March 4, 2019)




The Knowledge Group Has Scheduled a Live Webcast on Navigating the CMS Quality Payment Program and Pathways to Success Sweeping MSSP Changes

(American Academy of Family Physicians, February 4, 2019)


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Advancing Value-based Care with Payment Reform

Mark McClellan
Director, Robert J. Margolis Center for Health Policy and Margolis Professor of Business, Medicine and Health Policy, Duke University