Many people have asked me to review the Quality Payment Program final rule, released on October 14, 2016. Several summaries have already been written but your best bet is to rely on the CMS Quality Payment Program website at https://qpp.cms.gov. Yes, the rule is still complex - over 2400 pages, of which more than 50% is the mandated response to comments made on the proposed rule. The good news is that CMS has been very responsive to feedback, creating a transition plan for adoption, reducing the number of criteria and extending the timeline which enables iterative learning before large scale implementation. Under the Quality Payment Program, clinicians have two approaches to choose from for reimbursement: the Merit-based Incentive program (MIPS) and Advanced Alternative Payment Models (APMs)...
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Halamaka Takes a Deep Dive on the MACRA NPRM
As promised last week, I’ve read and taken detailed notes on the entire 962 page MACRA notice of proposed rulemaking (NPRM) so that you will not have to. Although this post is long, it is better than the 20 hours of reading I had to do! Here is everything you need to know from an IT perspective about the MACRA NPRM...What is the MACRA NPRM trying to achieve with regard to healthcare IT? The MACRA NPRM proposes to consolidate components of three existing programs, the Physician Quality Reporting System (PQRS), the Physician Value-based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program for eligible professionals (EPs), creating a single set of reporting requirements. The rule would sunset payment adjustments under the current PQRS, VM, and the Medicare EHR Incentive Program for eligible professionals...
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HIMSS18: Seema Verma - Making the patient the center of our health care system
I’ve always been struck by how seldom the patient is mentioned in discussions around value-based care. Let me be clear, we will not achieve value-based care until we put the patient at the center of our healthcare system. Until patients can make their own decisions based on quality and value health care costs will continue to grow at an unsustainable rate. This administration is dedicated to putting patients first, to be empowered consumers of health care that have the information they need to be engaged and active decision-makers in their care. Through this empowerment, there will be a competitive advantage for providers that deliver coordinated, quality care, at the best value, to attract patients who are shopping for value.
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How to Fix the EHR Mess
Computers, more specifically, electronic health records (EHRs), will someday revolutionize the practice of medicine. In fact, successful computerization of medical care is the most critical step necessary to transform the American health-care system from its current sorry state to the 21st century system of our dreams. It is ironic, then, that today EHRs represent one of the worst problems plaguing medical professionals. At this point, many physicians would say that EHRs have created more problems than they have fixed. The most important question is how do we get from where we are to where we need to be?...
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How to Fix the EHR Mess We’re In
Computers, more specifically, electronic health records (EHRs), will someday revolutionize the practice of medicine. In fact, successful computerization of medical care is the most critical step necessary to transform the American health care system from its current sorry state to the 21st-century system of our dreams. It is ironic, then, that today EHRs represent one of the worst problems plaguing medical professionals. At this point, many physicians would say that EHRs have created more problems than they have fixed. The most important question is how do we get from where we are to where we need to be?...
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MACRA: Big Fix or Big Problem?
In January 2017, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) took effect, ushering in a new system for physician payment in Medicare. With MACRA, policymakers ended the Sustainable Growth Rate (SGR) method for updating physician fees in Medicare and provided a permanent “doc fix,” relieving Congress of its annual duty to override substantial fee cuts that the SGR would have imposed. In place of the SGR, MACRA instituted the Merit-based Incentive Payment System (MIPS), which intends to reward clinicians for providing higher-quality and lower-cost care...
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Making Sense of MACRA: A Glossary of New Medicare Terms
As John Harvey, MD, FACS, past president of the Medical Association of Georgia, has toured his state to discuss the upcoming Medicare payment transition, he has noticed a trend. “More than half the physicians I have talked to … were not aware of the terms MACRA, MIPS and APMs.” Of course, there are also QPP, ACI and numerous non-initialisms that refer to crucial elements of the law that repeals the sustainable growth rate. Following is a short list of the terms every physician should know before the new payment rules take effect Jan. 1...
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The Quality Payment Program Final Rule
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