SEPTEMBER 10, 2019

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

How Providers Can Outperform Their Peers on MIPS Regardless of What CMS Changes
As MIPS and other performance-based payment programs evolve, providers eventually will be on the hook to cut checks if they can't perform. Individual providers must act now to stay on top of the distribution curve. On July 29th, the Centers for Medicare & Medicaid Services (CMS) proposed changes to improve the Quality Payment Program's Merit-based Incentive Payment System (MIPS). This is the latest CMS announcement in a series of value-based care-related policy changes, including Pathways to Success and Primary Cares Initiative. CMS continues to double down on value-based care programs (and rightly so), but the question must be asked: how are individual providers supposed to keep up? (MedCity News, September 2, 2019)

10 Considerations for Success in a Post-MACRA Value-Based Healthcare Reality
The first two years of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program (QPP) are in the books and many organizations are wondering if their strong performances will ever be met with a significant upside adjustment. Taken together, the MACRA QPP is enforcing a health care reimbursement model that is designed to promote better outcomes, encourage greater technology utilization and manage/reduce the per capita cost of care. Here are a few important considerations for success in a post-MACRA value-based healthcare reality.

  1. From CEO to part-time staff - MACRA impacts everyone
  2. Reporting as a group or individual
  3. Your best path forward
  4. Bonus points are available, get them wherever possible!
  5. Review your Quality Resource Use Report
  6. Transform "data" into actionable "intelligence"
  7. Utilize resources found on the QPP website
  8. Capture quality codes now so you won't have to backfill them later
  9. Remember that the proposed rule is NOT the final rule
  10. Show me the money!

Clinicians reading this article demonstrate that their heads are in the right place. The next step now is to ensure that your technology is sound and that development is underway for a business-wide MACRA education and value implementation strategy. (HIT Consultant, August 20, 2019)

MGMA Urges CMS to Implement Rules to Further Patients Over Paperwork
MGMA recently stated its opinion that CMS has collected more than enough information from healthcare industry stakeholders to inform regulations that reduce administrative burden on providers, and should focus on implementing rules to further Patients Over Paperwork rather than gathering more information. "There is a tremendous amount the administration can do to reduce the regulatory burden on medical practices," said MGMA Senior Vice President of Government Affairs Anders Gilberg in a statement to EHRIntelligence.com. "CMS has gathered more than enough feedback from the physician community at this point and should focus on implementation over information," Gilberg continued. MS issued a request for information (RFI) in June looking for ways to further reduce administrative burden through the Patients Over Paperwork initiative. "We are doubling down on efforts to decrease healthcare costs by reducing administrative burden. In removing what doesn't add value, we're making room for what does," said CMS Administrator Seema Verma in the RFI. "Our goal is to ensure that doctors are spending more time with their patients and less time in administrative tasks." (EHR Intelligence, August 13, 2019)

Shift to Value-Based Payment Will Require New Staffing Mix for Primary Care, Analysis Finds
As they shift to value-based payment, primary care practices will need staff with a higher skill mix aimed at keeping patients healthy, according to a new analysis. Practices will need to add new staff such as behavioral health providers, social workers, nutritionists, and pharmacist support. While many primary care practices and clinics are still operating under fee-for-service payment models, those that want to transition to value-based care will need to adjust their operating models, including staffing, Chris Smedley, vice president of physician enterprise services at Premier, said in an interview with FierceHealthcare. Practices will need to add staff that support physicians in focusing on preventive care for patients, Smedley said. "It's really a mental switch between dealing with the recurring visit or the problem-of-the-day to more proactive and integrated care." Link to the White Paper in the Resource Section below. (FierceHealthcare, August 8, 2019)

AAFP Guides CMS on Administrative Simplification Efforts
The AAFP recently responded to a CMS request for information on how the agency should proceed in its efforts to reduce the crushing administrative burden that continues to overwhelm physicians in practice. Specifically, the agency singled out its Patients Over Paperwork (www.cms.gov) initiative in a request for public comment that was published in the June 11 Federal Register.(www.govinfo.gov). In an August 7 letter (6 page PDF) addressed to CMS Administrator Seema Verma, M.P.H, and signed by AAFP Board Chair Michael Munger, M.D., of Overland Park, Kan., the Academy noted that reducing administrative and regulatory tasks for family physicians is a top priority and referenced results of the 2019 AAFP Member Satisfaction Survey. "Fully 74% of respondents said the time spent on administrative tasks has increased in the past year," said the letter. Work associated with EHR documentation, prior authorizations for prescription drugs and quality measure reporting cause physicians the most consternation. The letter signaled the Academy's strong support for the initiative but added that more needs to be done so physicians "can devote more time to patient care." To that end, the AAFP urged CMS to "consult, adopt and adhere to" a list of joint principles (2 page PDF) on reducing administrative burden developed by the AAFP and five other medical organizations in 2018. (American Academy of Family Practice, August 13, 2019)

CMS Discontinues Demo that Waives MIPS Requirements for Clinicians
The Centers for Medicare and Medicaid Services says low participation is to blame for its decision to nix a demonstration designed to test if exempting qualifying clinicians from Merit-Based Incentive Payment System requirements would change the way in which they deliver care. The agency announced that "after careful consideration" it decided to discontinue the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration aimed at testing the concept of waiving MIPS requirements for clinicians who participate in certain MA plans that involve taking on risk. "CMS will not be accepting applications for MAQI for 2019," according to an announcement posted on its website. The first performance period for the demonstration was in 2018, and it is slated to last for five years in total. (Health Data Management, August 7, 2019)

Premier White Paper: Ready, Risk, Reward: Optimizing Primary Care Model Design to Improve Performance

MACRA MIPS/APM Update e-Newsletter is one of a family of free e-Newsletters providing a complimentary video presentation and regularly updated news and key resources on major health care issues such as ACOs, patient safety, pay for performance, bundled payment, readmissions, and Medicaid. To view and subscribe to other e-Newsletters go to healthcareeNewsletters.com.

Integrating the Social Determinants of Health into Value-based Care

Peter Long, PhD
President and CEO, Blue Shield of California Foundation; Former Senior Vice President, Henry J. Kaiser Family Foundation; Former Director of Research and Planning, The California Endowment, San Francisco, CA