Changes to MIPS announced in the 2019 QPP Proposed Rule

The proposed rule for the 2019 Quality Payment Program (QPP) includes several changes to the Merit-Based Incentive Payment System (MIPS) that aim to reduce the administrative burden for eligible clinicians and put more emphasis on the improving EHR interoperability. In 2017, 91% of MIPS eligible clinicians successfully participated, thus giving CMS the encouragement to continue increasing the program requirements. At the same time, CMS has maintained certain measures of flexibility, particularly for small practices. Enacted earlier this year, the Bipartisan Budget Act of 2018 provides additional authority to continue the gradual transition in MIPS for three more years, to help further reduce clinician burden. The 60-day comment period during which CMS will receive public comments and recommendations ends on September 10th, 2018, with the final rule expected to be published in fall.

Key Highlights from the Proposed ... read more

Care Management 3.0 : Increase Revenue & Improve Quality while providing the best care

The current healthcare environment has brought about a new unique set of challenges.  Patients are becoming more tech-savvy with their smartphones, tablets, and computers, they tend to demand “What they want when they want it, and how they want it!”.  This becomes especially difficult to balance with the Quality Programs like MIPS, MACRA, CPC+, etc. becoming more stringent every year.  It has become difficult for Providers to balance patients’ needs with providing a high quality of care all the while keeping an eye on rising healthcare costs.  This becomes even more challenging with Quality Programs like MIPS, MACRA, CPC+, etc. becoming more stringent every year.

 

In the past, ... read more

What healthcare can learn from the retail apocalypse

By: Dr.Mansoor Khan   The retail industry is going thru what can rightly be called an apocalypse. Almost 7,000 retail outlets shut down in the US in 2017! In the meanwhile, these retailers opened almost 1,500 new stores!
  • Dollar General: 900
  • Dollar Tree: 320
  • Aldi: 180
  • Target: 35
  • Walmart: 25
  • Costco: 3
This is true across all major retail verticals from home goods to grocery to fashion (source: CBInsights). With the recent seismic shifts in the healthcare industry, we anticipate that this sector will also face a similar shift in the not too distant future. So what do we do about it? As the retail success stories illustrate and as we started to talk about in the last blog, the answer lies in giving the customer what they want. Healthcare, fortunately, has a big advantage; 88% of patients give their ... read more

CPC+ 2018 updates you should know!

By Zaeema Ahmed I am excited to bring you the updates you need to know for 2018 and some of the lessons learned from 2017. To begin with, CMS has increased the number of eCQMS from 14 to 19 measures. The measure set contains 7 new measures and two measures have been retired. For 2018, you must successfully report 9 measures and (this is important) the two outcome measures (Controlling High Blood Pressure and Diabetes HbA1c) are mandatory. As eCQMS are at the heart of meeting CPC+ quality requirements, we are happy to report that CMS has kept the benchmarks at the 30th and 70th percentiles and the measure thresholds remain the same. To be able to retain your PBIP payment, you still need to meet the 30th percentile for all 9 and the 70th percentile for at least 7 of the 9 measures. One of the lessons learned is that to achieve an optimal performance start early on tracking and monitoring these measures. A follow-on lesson being: Pay ... read more

Patient Engagement – the Urgent Care killer?

By Dr. Mansoor Khan Last month, we started looking at the impact of Urgent Care centers on physician practices. I only started there because a news article had caught my eye. There are, however, multiple other reasons for the steadily declining revenues and squeezing profit margins of physicians. These include payer payment transformation and value-based purchasing initiatives, patient demand for more convenient care delivery modalities, quality incentives/penalties, unfilled practice calendars (27% of available slots go unfilled), losing patients to competitors, to name a few. The response to these conditions however, can’t be more of the same (remember what Einstein said, no not “The hardest thing to understand in the world is the income tax”, though he did say that, but rather “We can't solve problems by using the same kind of thinking we used when we created them.”). So, to survive and thrive practices ... read more

Urgent care is taking over Primary Care – how will you respond?

By Dr. Mansoor Khan
The business of health care is changing; faster than most of us would like. The Urgent Care sector is projected to grow to over $26 Billion per year by 2023. Between 2007 and 2016 the number of claim lines for Urgent Care grew by 1,725%. Interestingly from 2012 to 2017 the number of patients using non-face-to-face services grew by 600% and is expected to accelerate. You see the pattern(s)? There are actually 2 primary takeaways from this data: 1) Urgent care is taking business from traditional brick-and-mortar care (remember this term from the dot com days?), yes, it is finally happening to medicine! 2) The non-face-to-face visit is growing even faster. I very purposefully use the term non-face-to-face rather than e-visit or telemedicine because the later 2 terms have a lot of reimbursement limitations that make them of very marginal value for the average practice. However, the non-face-to-face visit encompasses ... read more

Laying the Groundwork for Implementing a Chronic Care Management Program

By Mansoor Khan, CEO, Persivia

First the numbers:

  • 45% of the world’s population is affected by chronic disease
  • 60% of worldwide deaths are caused by chronic disease
  • 4% of the global annual GDP represents the economic burden associated with chronic disease
  • 17% of the US GDP is spent on healthcare, and chronic disease makes up 75% of this expense
  • 80% of chronic disease can be prevented
The numbers are staggering, so what do we do about this? Well, as individuals we can exercise more, eat better and lose weight, but that is not what I am asking. I mean what do we do as a society? Fortunately, the healthcare industry as a whole is working on the problem. However, in this, and successive blogs, I will focus on the path that CMS is taking to address the issue of Chronic Disease Management.

What is CMS Doing About it?

As we all know now, CMS launched the now CPT ... read more

Population Health, Care Management & Clinical Surveillance at the Heart of HIMSS 2015 Buzz

CEO Mansoor Khan
CEO Mansoor Khan

CEO Dr. Mansoor Khan Provides His Observations from the Show Floor
Q: What did you take away as the biggest changes ahead for the healthcare industry in 2015?
A: Population health management and how providers and clinicians can more effectively manage patients, and their data, were some of the main issues that I had addressed at the show. In the past, we had focused on the provider data, which essentially was "dirty data" that needed better ways to be captured, normalized and then interoperate across healthcare systems and into clinical workflows. But on the horizon, the biggest challenge will be around ... read more