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

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

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

Final rule for MIPS in Year 2, 2018 is out!

CMS has announced its final rule for the MIPS with comment period for year 2, 2018. With new provisions, CMA has built flexibility into MIPS policies to minimize burden of participation and gear up the clinicians for full implementation in the following year. Here are 7 key things to know that will change MIPS in 2018:
  • Cost gets a weightage
Currently, the performance category weights for the MIPS final score are: 60% quality, 0% cost, 15% performance activities, 25% Advancing Care Information. Next year, quality will be weighted at 50% while the cost at 10%. The cost performance category will be measured against Medicare Spending per Beneficiary and total per capita cost measures. The Improvement activities and advancing care information category weights remain at 15% and 25% respectively.
  • Extended performance period
The performance period for the quality ... read more