5 health policy predictions

Healthcare is a major topic of discussion in the news, in politics, and among physicians and their patients. Debate continues around the future of the Affordable Care Act (ACA), whether it will be replaced with any version of a new plan, and when any changes might occur. Issues of coverage, premiums, taxes, and the state of Medicaid are points of contention that have made healthcare and its policies uncertain. Still, experts can make health policy predictions, based on the current healthcare IT environment and how it is moving forward. John Halamka, MD, CIO of Boston-based Beth Israel Deaconess Medical Center, is optimistic about healthcare IT and has offered five predictions about its future: Stakeholders need to “focus on enhancing interoperability technology and policy in support of care coordination, population health, precision medicine, patient/family engagement, and research.” Care coordination, in particular, will become more important as the patient population ages. In regard to electronic health records (EHRs), “usability of the IT tools in the marketplace needs to be enhanced.” Independent physicians can take advantage of these technology tools to streamline their practices and focus more on patient care, but the tool itself must become more user-friendly. EHR vendors are progressing in this area, as they are working on usability improvements. A number of organizations “in industry, government, and academic are thinking about patient identity strategies.” Whether that identifier is biometrics, a voluntary national identifier, or an innovative software solution, the focus will be on building a “consensus on a framework that accelerates the availability of such an identifier for multiple purposes.” To simplify patient privacy protections, organizations are researching “how best to converge our heterogeneous state privacy policies, specifically focusing on the role of the patient as data steward.” In a move toward improved patient outcomes and a value-based payment structure, there will be “an overwhelming sentiment that the concept of certification and prescriptive IT policy should be replaced by an outcomes focus.” Dr. Halamka predicts the future of healthcare will be a “great time” for patients, as IT systems improve through market-driven innovations and low-cost, cloud-based systems help physicians focus more on quality outcomes for their patients.

Dante Capozzola

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Are independent physicians prepared for MACRA?

The Medicare Access and CHIP Reauthorization Act (MACRA) focuses on value-based reimbursement, moving providers away from the traditional fee-for-service payments. The MACRA Quality Payment Program (QPP) offers two tracks for independent physicians: Advanced Alternative Payment Models (APMs) or The Merit-based Incentive Payment System (MIPS) A majority of the independent physicians participating in a recent survey conducted by the American Medical Association (AMA) and KPMG, Inc., an audit, tax, and advisory firm, indicated they were not prepared for MACRA requirements. The survey, involving 1,000 practicing physicians, also revealed that: 56 percent plan to participate in the Merit-based Incentive Payment System (MIPS) in 2017, a payment system with variable incentive payments or penalties based on certain quality and efficiency measures, while 18 percent are expecting to qualify for higher and more stable payment as an Advanced Alternative Payment Model (APM) participant. In regard to their knowledge level, 51 percent of the survey participants indicated they were “somewhat knowledgeable about MACRA and the QPP” and only 8 percent were “deeply knowledgeable” about the program requirements. Those independent physicians responding to the survey who were in very small practices and those who did not have experience with value-based reporting systems stated they were “significantly more likely to view requirements as ‘very’ burdensome” and that they “feel less well prepared for long-term financial success.” Just as significantly, 90 percent of the physicians participating in the survey stated they felt that the “reporting requirements were ‘somewhat’ or ’very’ burdensome, with the time required to report performance being the most significant challenge.” MACRA recently released a new proposed rule designed to ease some of those restrictions on independent physicians. Elation Health understands the needs of independent physicians and will continue to work to help providers as they work to improve the quality of healthcare services they provide their patients while also managing their practices effectively. Our team of experts will stay on top of the latest regulations and guidelines provided by the Centers for Medicare & Medicaid Services (CMS) to keep our providers well informed!

Nick Dealtry

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What are the health policy priorities for the ONC in 2017?

The Office of the National Coordinator (ONC) for Health Information Technology (IT) wants to see more patient-provider interaction and wants providers to realize more benefits from their electronic health records (EHRs). The newly appointed National Coordinator, Donald Rucker, M.D., held a press conference recently to discuss the ONC’s priorities for independent physicians and health policy. Dr. Rucker expressed his empathy for very small practices, particularly in regard to reporting and documentation requirements. EHR usability is one of the ONC’s priorities. Realizing that the administrative requirements may be excessive for independent physicians, the ONC will work toward reducing the regulations and reporting requirements that keep physicians from being able to spend more time with their patients. The Office is focused on helping providers and their patients get the most from their EHRs. The ONC is also working with the Centers for Medicare & Medicaid Services (CMS) to ease some of the reporting burdens coming from that office. They will work on reducing reporting requirements and have already issued a proposed rule that will reduce the administrative strain on independent physicians. CMS has moved toward a value-based payment system that encourages physicians to spend more time with patients providing quality healthcare services. However, many small practices have found the reporting requirements for the new reimbursement system to be quite stringent, and they actually now have less time to spend with patients. A second ONC priority is interoperability. Ensuring that systems can talk to each other, to provide secure and seamless data exchange between providers, is crucial to the quality of a patient’s healthcare plan. To that end, Dr. Rucker stated that the ONC should have EHR efficiency and interoperability as a focus going forward. Interoperability is particularly important for independent physicians providing coordinated care for patients with multiple providers. EHRs that enable each provider to immediately input and then view data for a patient are much more beneficial and useful for those providers as well as their patients.

Sam Peirce

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Participating in an APM? Elation is perfect for you!

Medicare for more than $30,000 a year), have the option of selecting between Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APM) for receiving Medicare reimbursements. If you have decided to participate in an APM you also know that they reward practices who take on added risks when treating their patients; and to be qualified to participate in an Advanced APM there are three criteria, one of them being that the practice must use a certified EHR technology. Although there are many certified EHRs out there, you want your EHR to support you and your practice during this extensive reporting and reimbursement change. The success of MACRA depends on independent physicians and those on the frontlines of providing patient-centered, value-based care. Supporting these physicians is one of Elation's priorities. We’ve created online resources, live webinars, informative videos, email newsletters, detailed articles, and on-call health policy specialists to give specific guidance and support to help physicians maneuver MACRA. We’re committed to making the transition to value-based care as uncomplicated as possible for every type of practice. Elation is here to support you and is equipped with the resources to enable independent practices to participate in APMs stress-free.

Nick Dealtry

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Possibilities for passing a bipartisan healthcare bill

The plan designed to replace the Affordable Care Act (ACA) has faced numerous debates and delays. In the Republican-controlled Senate, there are not yet enough votes to pass a new healthcare plan. Even though Senate Majority Leader Mitch McConnell plans another vote on yet another version of the plan sometime during the week of July 17, many speculate that it will take bipartisan cooperation to see positive results. Many Republican Senators heard from their constituencies over the July 4 break and are now either expressing concerns or are noncommittal. A number of lawmakers have proposed securing bipartisan support for fixing certain parts of the ACA while leaving the basic structure intact. Dick Durbin, the second-ranking Senate Democrat agreed that there is “a bipartisan appetite to tackle this issue." In fact, Reuters reports that on Friday, July 14, the American Medical Association (AMA) “called the new bill inadequate and said more bipartisan collaboration is needed in the months ahead to improve the delivery and financing of healthcare.” At the heart of the debate is whether those covered by Medicaid and by health plan subsidies will be adversely affected. Another significant aspect of the growing resistance reflects on the Congressional Budget Office (CBO) prediction that 22 million people would lose their healthcare insurance coverage under the proposed new plan. The AMA, medical advocacy groups, and independent physicians are all concerned with the impact that the new healthcare plan will have on patients who will no longer seek care if they have no coverage. At Elation, we are committed to continuing our goal of helping independent physicians focus on their patients’ positive outcomes, regardless of the outcome of the possible bipartisan healthcare bill. We recognize that certain healthcare trends will move forward, including the use of electronic health records (EHRs) to simplify medical records, improve communication, and enable independent physicians to provide the quality care necessary for their patients. [ximagination] © 123RF.com

Dante Capozzola

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What is the MIPS-APM track?

As the Centers for Medicare and Medicaid Services (CMS) moves toward a value-based payment plan, many independent physicians are growing concerned about their practices’ financial risks. Under the Merit-based Incentive Payment System (MIPS), providers are penalized for poor performance scores.  With the shift towards value-based care, a portion of an independent physician practice’s Medicare payments are at risk and this share will grow over time. However, another option, known as the Advanced Alternative Payment Model (APM), may be available. The third track, the MIPS-APM track, is described in an article in Modern Healthcare, as being “available for physicians participating in Track 1 of the Medicare Shared Savings Program,” and as one that “doesn't punish physicians for low scores in MACRA performance categories.” This model is only available, though, to those physicians participating in an Accountable Care Organization (ACO). ACOs are formed by physicians who are concerned with providing coordinated care to their Medicare patients.  Modern Healthcare further explains that “establishing an ACO requires healthcare organizations to build data analytics tools, enhance information technology and hire care coordinators and additional staff to oversee the venture. “ CMS lists the following three criteria to determine whether a practice qualifies as an Advanced APM: 1)      Practice uses certified EHR technology. 2)      Practice employs quality measures similar to those used in the MIPS quality performance category to provide payments 3)      Practice takes on an increased financial risk for monetary losses, in forms such as reduced rates or withheld payments. The MIPS-APM track helps transition the independent physician into value-based care, particularly those who are concerned about the financial ramifications of the new reimbursement strategy. One of the MIPS-APM’s goals, according to CMS, is to “reduce eligible clinician reporting burden,” which will also, in turn, help reduce the financial burden on the independent provider.

Sam Peirce

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The bipartisan way lawmakers are trying to improve healthcare

Today’s healthcare environment has been referred to as a debate over money rather than a discussion of the actual quality of healthcare. In fact, many of the most contentious points of the Affordable Care Act (ACA) and its potential replacement focus on patient payments and insurance reimbursements. Author Adam Davidson, writing recently in The New Yorker, points out that there has long been a bipartisan solution that actually contributes to the improved quality of healthcare itself. Capitation is, in Davidson’s words, “an ungainly name for a system in which a medical provider is paid a fixed amount per patient.” The payment is typically made monthly or annually and covers all the services a patient would need over that period of time. The system of capitation payments has been around for many years and enjoys bipartisan support. Even though the cost of healthcare has not been a topic of much political discussion, the payment structure itself is changing. Today, there is bipartisan support for moving away from a fee-for-service system. The ACA created the Center for Medicare and Medicaid Innovation, which was charged with exploring alternative payment systems. Value-based payments have since been adopted by the Centers for Medicare and Medicaid Services (CMS) as an incentive for providers to focus on the quality of the healthcare they deliver rather than the frequency with which they see their patients. Whether payment for a patient’s healthcare services is made through a capitation system or reimbursed with value-based payments, lawmakers are recognizing that these types of payment structures do contribute to improved patient outcomes. There are incentives on the physician side, in particular, to focus more on healthcare quality and less on multiple visits and procedures. Physicians are also better able to manage their practices efficiently with known revenue streams. The costs of healthcare itself could potentially be reduced with value-based or capitation payments. Patient visits can become more effective and more efficient.  Most importantly, the quality of healthcare itself can certainly be improved with these bipartisan moves.

Sam Peirce

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The growth of ACOs and APMs in 2017

Quality care is the focus of accountable care organizations (ACOs), groups of physicians who voluntarily join together to more effectively coordinate care for their Medicare patients. Quality care is also the focus of alternative payment models (APMs), including ACOs, that provide incentive payments for high quality and cost-efficient care. The Accountable Care Learning Collaborative (ACLC), partnering with Leavitt Partners, has been tracking the growth of ACOs and APMs and has found a significant increase recently. ACLC counts an increase of 2.2 million lives covered by an ACO in the past year, for a current total of “923 active public and private ACOs across the United States, covering more than 32 million lives.” There have been some ACOs that have dropped their contracts in the past year, but there has been a net increase of 92 additional ACOs. According to ACLC’s numbers, “since the first quarter of 2016, 138 new ACOs began operation, and 46 ACOs dropped their accountable care contracts.” The organization adds that during the same timeframe, “the number of contracts has grown by 166, as many ACOs have expanded the number of accountable care contracts in which they participate.” ACLC reports that “other APMs with accountability for person- or episode-level outcomes and costs are also expanding.” The growth in APMs undoubtedly has been impacted by the Medicare Access and CHIP Reauthorization Act (MACRA), which provides incentives for physicians to become part of an APM. APMs, including APOs, focus on improving the quality of patient care through financial incentives. Elation Health is also focused on helping independent physicians provide the highest quality patient care. Our electronic health record (EHR) system gives primary care providers the tools they need to collaborate with other providers, communicate with patients, and spend more time with their patients. We bridge the gap between the worlds of policy and payers, so providers can focus on what they do best, for the benefit of their patients and their practices.

Nick Dealtry

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Healthcare costs will grow in 2018 according to new report

The state of healthcare is in flux, as the Affordable Care Act (ACA) is potentially being replaced and reimbursement is moving away from fee-for-service to value-based payments. Even the cost of healthcare delivery has been fluctuating for the past several years and is predicted to once again be on the increase for 2018. PwC’s Health Research Institute (HRI) has released its annual report on the cost of healthcare that also identifies factors impacting the increase. The report includes three key points: HRI projects 2018’s medical cost trend to be 6.5%—the first uptick in growth in three years. Price continues to be a major driver of healthcare costs. Businesses will have to tackle the price of services as well as the rate of utilization to reduce medical cost trend in the future. According to the report, healthcare costs were at 11.9% in 2007 and steadily decreased from there, reaching 6.5% in 2014. In the years since, however, the percentage has risen and fallen several times and is expected to rise again in 2018. The report indicates that “structural changes such as the push toward paying for value, greater emphasis on care management and increased cost sharing with consumers are taking a stronger hold, pulling back against rapid healthcare spending growth.” Independent physicians, in particular, will need to find a way to streamline their practice management, to provide more value to their patients at a lower cost. Optimizing patient care will become an integral piece in healthcare delivery going forward. Patients will look toward their providers to utilize technology such as electronic health records (EHR) to reduce their overhead costs and become more efficient with their coordinated care, particularly for those with chronic conditions. As the costs of healthcare continue to rise, independent physicians will need to be more focused on providing quality care management to manage costs more effectively for their practices and their patients.

Dante Capozzola

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Organizations encourage HHS Secretary to adopt equitable incentives for Medicare Advantage advanced APMs under MACRA

As of now, the Centers for Medicare & Medicaid Services (CMS) has determined that MACRA will include traditional Medicare, but not Medicare Advantage as part of its APM track. However, starting in 2021, Medicare Advantage plans could qualify under the APM option. The delay in having Medicare Advantage plans qualify as an advanced APM has created a plea from ten organizations asking HHS Secretary Tom Price to expand the options under MACRA for physicians and physician groups. The organizations, which include both physicians and payers, sent a letter to Price asking him to accelerate the movement from volume to value-based payment, by accepting reasonable incentives for the physicians that are taking risks in Medicare Advantage contracts with health plans. The final rule released last October that excluded the Medicare Advantage plans to qualify as advanced APMs for multiple years was not happily accepted by the insurance industry. “Recognizing the advantages of alternative payment models in MA, we call on the administration to level the playing field and afford risk arrangements in MA the same credit under MACRA as risk arrangements in traditional Medicare,” the letter said. The main objective of the letter and the organized plea is to get more physicians away from the Merit-Based Incentive Payment System (MIPS) and into advanced APMs. “Providing APM credits for doctors participating in advanced payment models under Medicare Advantage will encourage value-based arrangements and advance the nationwide movement to reward clinicians for the value of the care they provide, rather than the volume of care,” said National Committee for Quality Assurance (NCQA) President Margaret E. O’Kane. This petition, if granted, can help speed up the process of transforming the way physicians get reimbursed for the care they provide, taking a larger step into value-based payment models. Along with the NCQA, other groups that signed the letter were: CAPG, Healthcare Leadership Council, America’s Health Insurance Plans, Health Care Transformation Task Force, Pacific Business Group on Health, Direct Primary Care, Alliance of Community Health Plans, National Coalition on Health Care and the Blue Cross Blue Shield Association.

Sam Peirce

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CMS Reviews PQRS reporting from 2015

The Physician Quality Reporting System (PQRS) was initiated by the Centers for Medicare and Medicaid Services (CMS) to encourage “individual eligible professionals (EPs) and group practices to report information on the quality of care to Medicare.” The last program year for PQRS was 2016. CMS has since transitioned to the Merit-based Incentive Payment System (MIPS) under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). CMS recently released their findings on participating providers’ reporting experience for the 2015 PQRS. In their report CMS “assessed existing quality programs, provider participation, and rates of satisfactory reporting to gain insight into aspects of PQRS proving most challenging for providers,” according to a summary published in EHR Intelligence. Their report provided data on the number of providers who were satisfactorily able to participate in PQRS, to determine which reporting methods were most effective. In their study, CMS found that “for registry, EHR and QCDR, 100% of eligible professionals who participated were able to satisfactorily report at least one measure while only 80% of eligible professionals who participated through claims were able to do so.” In addition, “eligible professionals reporting via EHR and QCDR were most likely to report 9 or more measures (96 percent of those using EHR and 86 percent for QCDR), compared to only 38 percent of those participating via registry and 4 percent of those reporting via claims.” As the agency transitions to MIPS, part of the Quality Payment Program (QPP) under MACRA, their PQRS report may provide some insight into physicians’ ability to be successful with the new payment program. However, CMS did stress in their report that “program eligibility and quality measure requirements (are) areas where MIPS diverges significantly from the previous federal incentive program.” Quality reporting requirements should be “significantly less burdensome and complex” in MIPS. Elation’s EHR solution also helps reduce the burden of everyday practice management, billing, and reporting for independent physicians. At Elation, we are focused on bridging that enormous chasm between the world of policy and payers, and the world of the front-line physician, to enable physicians to focus on quality patient care.

Sam Peirce

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AAFP recommends CMS simplify MACRA for primary care physicians

MACRA, a reporting program that streamlines current fee-for-service Medicare programs (Meaningful Use, Physician Quality Reporting System, and Value-Based Payment Modifier) into a single program, went into effect January of this year. However, now that MACRA is underway, one of the biggest physicians groups is calling for more streamlined rules for primary care physicians. The American Academy of Family Physicians (AAFP) has submitted a letter to CMS suggesting ways they can simplify MACRA implementation requirements for providers. They raised concerns regarding severe MACRA requirements and the negative effect current policy could have on patient care. “The AAFP sees a strong and definite need for CMS to step back and reconsider the current approaches to MACRA, which we view as overly complex and burdensome to physicians.” AAFP even included ways to simplify current requirements and improve MACRA implementation for both CMS and physicians: Remove the financial risk standards from regulatory definitions of Medical Home Model. Remove arbitrary size restrictions limiting AAPM participation on Medical Home Models. Eliminate all documentation guidelines for evaluation and management codes for primary care physicians in both the MIPS and AAPM pathways. Jettison the complicated and entirely uncalled-for MIPS APM category. Eliminate administrative claims population health measures. Use consistent terms from proposed to final rulemaking to avoid confusion in the physician community. MACRA meant to reduce burdens on practices The final MACRA ruling was meant to greatly reduce the burden on small and independent practices. While drafting MACRA, CMS received a great deal of feedback from physicians on the potential impact of this new reimbursement program. They later announced changes in the final rule reflecting that the feedback was heard; one of these changes being the ability to join virtual groups. In the future (as early as 2018), solo and small practices of 10 or fewer clinicians will have the option to combine MIPS reporting by forming “virtual groups” Still, it wasn’t enough, AAFP pushes that the new changes may have done more harm to provider productivity than good. AAFP members argue that the current MACRA implementation policy only adds to the intricacy of Medicare payment, quality improvement, and performance measurement programs. Independent physicians that feel overwhelmed by the demands of MACRA can lean on partners like Elation to help them navigate payment reform. We are committed to equipping you with resources like our health policy blog, as well as providing 24/7 health policy support and personalized webinars to answer any of your questions along the way. With our clinical first EHR, you can always be sure that you have an EHR system equipped with powerful quality care measures and intuitive reporting tools. Combined with our health policy support, physicians can put all their attention on strengthening the physician-patient relationship and enabling phenomenal care for all. Contact us to learn more about Elation’s Clinical EHR and what it can do for your practice.

Nick Dealtry

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Bipartisan CHRONIC Care Act of 2017 aims to improve chronic care coordination

In April, new legislation was introduced in the Senate that seeks to streamline chronic care coordination and strengthen treatments for patients struggling with chronic illnesses. On Tuesday, the Senate Finance Committee passed the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017, a bipartisan bill to strengthen and improve the health outcomes of Medicare beneficiaries living with chronic conditions. Some of the bill's provisions include allowing Medicare Advantage plans to adjust chronic care coordination and coverage for specific types of patient like those with diabetes. It also would allow accountable care organizations (ACOs) make incentive payments to help patients with chronic conditions obtain primary care services. Another major provision widens use of telehealth among Medicare Advantage beneficiaries, ACOs and individuals with stroke. "Today's passage of the CHRONIC Care Act is an important step forward for people suffering from debilitating diseases in Colorado and across the country," said Colorado U.S. Senator Michael Bennet. "Chronic conditions strain families and increase healthcare costs. By modernizing the Medicare program, we can address both of these challenges. We'll work to advance this bill, so we can improve the health and well-being of families, reduce costs, and improve patient outcomes."

Sam Peirce

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