CMS Releases MACRA/Quality Payment Program Final Rule
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MACRA/Quality Payment Program Final Rule On October 14, 2016, the U.S. Centers for Medicare & Medicaid Services (CMS) released the final rule for Medicare’s Quality Payment Program, which implements the Medicare Access and CHIP Reauthorization Act (MACRA) and replaces the Sustainable Growth Rate (SGR) formula. The American Association of Orthopaedic Surgeons (AAOS) in June submitted comments to CMS that outlined a number of areas of concern with the original proposal, including the implementation timeline, restrictive requirements for Advanced Alternative Payment Models (APMs), and the impact on smaller or solo practices. While it appears CMS has been responsive to some of these concerns, AAOS leadership and staff are closely reviewing the final rule and will be providing CMS with additional comments. AAOS will also be providing detailed analyses and updates to all AAOS members. Click here to read more.
CMS Talks Reducing Medical Record Review Prior to issuing the MACRA final rule, CMS announced an 18-month pilot that will test out ways to reduce medical record review for providers practicing within certain Advanced Alternative Payment Models (Advanced APMs). According to CMS, this effort will be part of an initiative to improve the clinician experience with the Medicare program. The pilot will involve the following Advanced APMs that share financial risk with Medicare, with resultant incentives for efficient delivery of care:

  • Next-generation Accountable Care Organizations (ACOs)
  • Medicare Shared Savings Programs Track 2 and 3 participants
  • Pioneer ACOs
  • Oncology Care Model 2-sided Track participants.

Click here to read more.

GAO Report on Health Care Quality Measures A report from the U.S. Government Accountability Office (GAO) recommends that the U.S. Department of Health & Human Services (HHS) take steps to address misalignment of health care quality measures. GAO conducted interviews with HHS officials and experts, which yielded suggestions that three interrelated factors drive misalignment of healthcare quality measures:

  • Dispersed decision making
  • Variation in data collection and reporting systems
  • Few meaningful measures adopted by payers, providers, and other stakeholders

Click here to read more.

Deadline to Review CMS Data – November 30 Last month, the Centers for Medicare & Medicaid Services (CMS) posted information online that allows physicians to view whether they will be subject to 2017 payment penalties associated with the Physician Quality Reporting System (PQRS) and the Value Modifier. Practices that have concerns have until November 30, 2016 to file for an informal review of their data. PQRS penalties are being communicated to physicians by mail as well as in the PQRS feedback reports posted on the CMS website. Value Modifier penalties and bonuses can be found in Quality and Resource Use Reports (QRURs) posted on the website only. Click here to read more.
State Corner: Labor Secretary Rings Alarm on Workers Compensation System Significant changes need to be made to the current workers compensation system, according to a recent study released by the Department of Labor (DOL). According to the report, most state workers compensation systems are neither adequate, prompt nor equitable for medical care.   State-based workers’ compensation programs provide critical support to workers who are injured or made sick by their jobs. The history of workers’ compensation in the U.S. spans over 100 years, beginning in the late 19th century and early 20th century with the Industrial Revolution. But it wasn’t until 1970 that Congress passed the Occupational Safety and Health Act (OSHA), which established the National Commission on State Workmen’s Compensation Laws. Even today, the goals set by the commission have not been met. Click here to read more.