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
July 7, 2017


ONC chief discusses focus on interoperability

The Office of the National Coordinator (ONC) for Health Information Technology (IT) has emphasized the need to adopt the usage of electronic health records (EHR) for many years. In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act charged the ONC with promoting both the adoption and the meaningful use of EHRs.

At a recent meeting in Washington, new ONC chief Donald W. Rucker, MD, said that now “adoption is out and usability and interoperability are in as health IT becomes more fully developed and new healthcare laws take full effect,” according to an article in Healthcare IT News. The ONC chief is focused on ensuring that EHRs are usable for the physicians as well as for the patients.

Dr. Rucker also emphasized the need for interoperability, ensuring that EHR systems are able to talk to each other seamlessly and securely. In fact, the article states, the “ONC is considering incentives for both providers and patients to share medical records in order to boost interoperability.”

True interoperability involves a single patient record that can be shared by all providers, enabling independent primary care physicians to spend less time inputting data and more time with their patients. Elation’s Collaborative Health Record, for example, enables all providers involved in a patient’s care to take action based on that patient’s most up-to-date clinical information.

At Elation, we are committed to reducing the independent physician’s burden when it comes to maintaining and sharing patients’ healthcare records. Our EHR solution provides physicians the information they need at the touch of a finger.

As adoption numbers increase among independent physicians, the ONC has turned its focus to usability and interoperability. At Elation, our focus has always been on providing physicians the advanced technology they need to ensure they are working together seamlessly for better patient outcomes.

[Vasin Leenanuruksa] ©

Nick Dealtry
July 7, 2017


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
July 7, 2017


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
June 21, 2017


Why coordinated care is important for independent primary care physicians

Patient safety and quality of care are the highest priorities for any independent physician. Independent primary care physicians understand that patients see specialty physicians, have lab tests and screening tests done, and may even be seen in other healthcare facilities.

Coordinated care between all of these medical providers plays a large role for primary care physicians and can be a challenging task.

Why is coordinated care important? When providers do not communicate with each other about a patient’s care, it can lead to errors in medication doses or care plans, repetitive tests, and even more serious consequences.

Chronically ill patients, in particular, benefit from coordinated care between their providers. A recent study published in the Annals of Family Medicine found that patients under 65 years and patients with chronic conditions were the most likely to experience poor primary care coordination. The study also found that the “rate of poor primary care coordination” was highest in the United States, out of the 11 countries involved in the study.

Frustrations of poor care coordination

As an independent primary care physician, the task of coordinated care can be a frustrating challenge. You may struggle with receiving timely, accurate information from other providers regarding your patients. Too often, you may have to rely on the patients themselves for that communication piece.

Patients are not medical professionals and should not be expected to relay the necessary information between their providers. Given human nature, it is also quite probable that patients will not always remember everything they’ve been told by all of their medical providers, therefore would not be able to share it accurately. Even though your focus is on providing quality care, the lack of coordination can become an issue for your patients’ health as well as for the costs involved in providing that care.

At Elation Health, we understand your concerns. We are also focused on quality patient care. That’s why we introduced the Elation Provider Network (EPN), a smarter and more effortless way for providers to connect and share patient information with one another so they can provide better care for their patients.

Contact us today to learn more about providing quality coordinated care for your patients.

Roy Steiner
June 21, 2017


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
June 20, 2017


What is interoperability, and how can independent practices benefit from it?

For independent providers, providing coordinated care can be a huge challenge. When your patients see specialty providers, or have lab tests, or receive services at other healthcare facilities, the primary care provider can be left in the dark. For high quality, coordinated care, this information is essential in making the right decisions to care for patients.

So, can independent physicians count on this level of interoperability? It’s become a huge healthcare buzzword. But is it available, easy to do, and making a difference in your patient care?

True interoperability would give physicians the ability to actually use the information that is being shared. As an independent physician, you need to be able to interpret data quickly and easily to provide your patients with quality coordinated care.

There are some existing ways to provide information – so in some ways, interoperability is already happening every day. Faxes, emails, and even phone calls provide ways to share patient information. However, digital interoperability, where electronic systems are in sync, is more elusive.

Taking advantage of digital interoperability

Step 1 is using a cloud-based system of updating and maintaining your patient’s health records. This provides the building block of interoperability, putting your notes, the patient’s information, lab results, and other critical clinical data into digital format that can be shared with your patient’s care team.

Step 2 is to use a networked EHR.  Elation’s Collaborative Health Record provides connectivity between all of the providers on a patient’s care team, enabling autonomy for each provider over their own version of the patient chart along with the ability to pull in updates from collaborating physicians when applicable. This enables truly coordinated care among all of the providers caring for a patient.

In essence, interoperability means that different systems are talking to each other, and that helps to ensure that all providers involved have access and can actually use the information they are sharing. As an independent physician, you need access to information and effective technology to be able to focus on your patient’s care.

Aviel Ettin
June 15, 2017