ACP IM 2016

WASHINGTON – Now that the move to value-based care is in full swing, it’s time for physicians – especially those in small or solo practice – to get ready to change.

“This must be a completely overwhelming time for you. We get that,” Dr. Hoangmai Pham, director of Seamless Care Models Group at the Centers for Medicare & Medicaid Services’ Innovation Center, said at the annual meeting of the American College of Physicians. “We are trying to help you understand the landscape as much as possible.”

Merit Based Incentive Payments (MIPS) are one way the federal government is transitioning physician payments from volume-based to value-based medicine. The proposed rule to implement the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) indicates how Medicare officials intend for MIPS to streamline the three main quality metrics reporting systems currently in use – meaningful use, the patient quality reporting system, and value-based modifiers – along with clinical practice improvement activities, into one quality metrics reporting system to be used for reimbursements.

The CMS currently bases pay incentives on at least 90 different clinical practice improvement activities, Dr. Pham said in an interview. Practices that already incorporate these activities will find it easy to comply with MIPS, according to several analysts. Under the proposed rule, physician’s Medicare fees would be adjusted based on MIPS starting in 2019; adjustment are slated to range from a 3.5% cut to as much as a 4.5% increase. By 2024, Medicare pay may be cut – or increased – by as much as 9%.

Because Congress set up MIPS to be budget neutral, it is not intended to help physicians grow their bottom line, but to provide a bridge to the Brave New World of value-based care.

“MIPS helps to link fee-for-service payments with quality and value,” Dr. Pham said.

The ultimate goal of the Quality Performance Program – the name CMS has selected for the MACRA-mandated reforms – is for physicians to deliver higher quality care over volume of care. Carrots (potential rewards for high quality) and sticks (financial risk for low quality) will be employed.

APMs, ACOs, CPC+, oh my!

Once physicians get over the bridge to value-based medicine, alternative payment models (APMs) are one way to start reaping the rewards.

APMs offer an avenue to increased revenue (shared savings) but also require physicians to share risk with the government.

Another option is the recently announced Comprehensive Primary Care Plus (CPC+) accountable care organization under which physicians will be paid prospectively for meeting a variety of criteria.

The CMS is now soliciting bids from other insurers to participate in CPC+. Once the CMS knows which third party payers are willing to participate, and at what level and in which regions, practices will be able to apply. The CMS expects selected practices to begin participating by January 2017, Dr. Pham said in the interview.

These and other forms of patient-centered medical home-type ACOs, offered by the CMS or by private insurers, are intended to help practices develop payment structures that can be tailored to fit the unique characteristics of a given practice, including the specific types of populations served.

The proposed rule also notes that the CMS would like to offer what is known as Physician Focused Payment Models. These organizations might be included in the final rule if they meet three criteria: a clear plan for setting and meeting quality goals; an enumeration of the type of population that will be served; and what resources will be necessary at what cost.

After the final rule is posted, all physician-focused proposals will be reviewed by an advisory committee to the CMS, known as the Physician Focused Payment Model Technical Advisory Committee (PTAC).

Practice managers interested in developing this kind of model should pay close attention to pages 562 and 624 of the proposed rule document for more specific instructions, according to Dr . Kavita Patel, a fellow and managing director of the Engelberg Center for Health Care Reform at the Brookings Institute in Washington, D.C.

When asked about the likelihood of such a plan being approved – particularly since the final rule is expected in November 2016, with metrics from 2017 to be collected for the first round of quality performance payments in 2019 – Dr. Patel emphasized that while she was not speaking on behalf of the CMS, “the phrase they use is that they ‘want to keep the door open.’ I think that as long as you honor these criteria, the desire is to move these proposals through.” Still, she acknowledged, “The timing is extremely tight.”

The problem, she added, is that the criteria still need to be defined by the law, so it is hard to know if and when such proposals will be evaluated and approved. Meanwhile, all practices have the option of switching back to MIPS annually, but since the goal is to push physicians away from that model, as evidenced by the steeper penalties each year the law is in effect, this becomes less attractive an option.

Calls for calm

In some ways, according to Dr. Patel, this evolution in health care delivery should be seen as a good thing since “the fee-for-service model is not viable.”

And yet, an impact analysis from the CMS Office of the Actuary that was included with the proposed rule predicts that based on measurements to be taken in 2017, 87% of all solo practices will be negatively adjusted in 2019, the year MACRA goes into full effect. Nearly 70% of practices with between 2 and 9 physicians are predicted to be penalized, while about 60% of those with between 10 and 24 practices will be hit. Larger practices also are expected to be severely affected. For those with between 25 and 99 member physicians, nearly 45% will face negative adjustments and groups with 100 or more physicians will face a nearly 20% negative incursion, according to the analysis.

But before you sell your practice to the local hospital system or drop out of Medicare altogether, some analysts and officials advise against panic.

Robert B. Doherty, ACP senior vice president for governmental affairs and public policy, disputed the notion that the analysis is proof of the coming death of small practices. “I disagree with that. Essentially, the actuary was projecting using relatively low rates of participation [in the new value-based programs],” he said.

To that end, on May 11, acting CMS Administrator Andy Slavitt testified before the House Ways and Means Committee’s Subcommittee on Health that because those actuarial projections were based on data collected in 2014, they were not reflective of what he said was an uptick in quality measure reporting for 2015. Before the rule is finalized later this year, the actuarial tables would be updated to reflect the new data, he said.

That leaves plenty of time to advocate for feasible payment structures for practices of all sizes, Mr. Doherty said. “If we succeed in doing that, and I think there is some progress ... then I think there will be opportunities for smaller practices to get positive updates.”

Advocacy is not enough

Dr. Patel, a practicing internist in Washington, said that she agrees with this approach.

In addition to making constructive, written comments on the proposed rule, which closes on June 27, 2016, at 5 p.m. EDT, Dr. Patel said that taking steps to optimize available resources now, such as reporting quality measures, or using the chronic care management fee, are ways to ensure higher revenues in the future. “Think about ways to leverage your practice now in order to actually get on one of the advanced payment care models so you avoid being in that track that gets all that downward pressure,” she added.

Still, she said that advocacy may not be enough for some practices to stay solvent. “If the actuaries and CMS really believe that small practices are going to face these steep penalties and not be able to survive, then how we address that, such as through how we define alternative models that are broader [in scope] for practices to follow, has to actually be written by CMS into the final rule.”

No matter the type of ark you choose to build, particularly if yours is a small practice, you’ll have to create some kind of watertight vessel or else, said Dr. Patel, it is “going to be extremely hard to participate in the Medicare program.”

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

WASHINGTON – Now that the move to value-based care is in full swing, it’s time for physicians – especially those in small or solo practice – to get ready to change.

“This must be a completely overwhelming time for you. We get that,” Dr. Hoangmai Pham, director of Seamless Care Models Group at the Centers for Medicare & Medicaid Services’ Innovation Center, said at the annual meeting of the American College of Physicians. “We are trying to help you understand the landscape as much as possible.”

Merit Based Incentive Payments (MIPS) are one way the federal government is transitioning physician payments from volume-based to value-based medicine. The proposed rule to implement the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) indicates how Medicare officials intend for MIPS to streamline the three main quality metrics reporting systems currently in use – meaningful use, the patient quality reporting system, and value-based modifiers – along with clinical practice improvement activities, into one quality metrics reporting system to be used for reimbursements.

The CMS currently bases pay incentives on at least 90 different clinical practice improvement activities, Dr. Pham said in an interview. Practices that already incorporate these activities will find it easy to comply with MIPS, according to several analysts. Under the proposed rule, physician’s Medicare fees would be adjusted based on MIPS starting in 2019; adjustment are slated to range from a 3.5% cut to as much as a 4.5% increase. By 2024, Medicare pay may be cut – or increased – by as much as 9%.

Because Congress set up MIPS to be budget neutral, it is not intended to help physicians grow their bottom line, but to provide a bridge to the Brave New World of value-based care.

“MIPS helps to link fee-for-service payments with quality and value,” Dr. Pham said.

The ultimate goal of the Quality Performance Program – the name CMS has selected for the MACRA-mandated reforms – is for physicians to deliver higher quality care over volume of care. Carrots (potential rewards for high quality) and sticks (financial risk for low quality) will be employed.

APMs, ACOs, CPC+, oh my!

Once physicians get over the bridge to value-based medicine, alternative payment models (APMs) are one way to start reaping the rewards.

APMs offer an avenue to increased revenue (shared savings) but also require physicians to share risk with the government.

Another option is the recently announced Comprehensive Primary Care Plus (CPC+) accountable care organization under which physicians will be paid prospectively for meeting a variety of criteria.

The CMS is now soliciting bids from other insurers to participate in CPC+. Once the CMS knows which third party payers are willing to participate, and at what level and in which regions, practices will be able to apply. The CMS expects selected practices to begin participating by January 2017, Dr. Pham said in the interview.

These and other forms of patient-centered medical home-type ACOs, offered by the CMS or by private insurers, are intended to help practices develop payment structures that can be tailored to fit the unique characteristics of a given practice, including the specific types of populations served.

The proposed rule also notes that the CMS would like to offer what is known as Physician Focused Payment Models. These organizations might be included in the final rule if they meet three criteria: a clear plan for setting and meeting quality goals; an enumeration of the type of population that will be served; and what resources will be necessary at what cost.

After the final rule is posted, all physician-focused proposals will be reviewed by an advisory committee to the CMS, known as the Physician Focused Payment Model Technical Advisory Committee (PTAC).

Practice managers interested in developing this kind of model should pay close attention to pages 562 and 624 of the proposed rule document for more specific instructions, according to Dr . Kavita Patel, a fellow and managing director of the Engelberg Center for Health Care Reform at the Brookings Institute in Washington, D.C.

When asked about the likelihood of such a plan being approved – particularly since the final rule is expected in November 2016, with metrics from 2017 to be collected for the first round of quality performance payments in 2019 – Dr. Patel emphasized that while she was not speaking on behalf of the CMS, “the phrase they use is that they ‘want to keep the door open.’ I think that as long as you honor these criteria, the desire is to move these proposals through.” Still, she acknowledged, “The timing is extremely tight.”

The problem, she added, is that the criteria still need to be defined by the law, so it is hard to know if and when such proposals will be evaluated and approved. Meanwhile, all practices have the option of switching back to MIPS annually, but since the goal is to push physicians away from that model, as evidenced by the steeper penalties each year the law is in effect, this becomes less attractive an option.

Calls for calm

In some ways, according to Dr. Patel, this evolution in health care delivery should be seen as a good thing since “the fee-for-service model is not viable.”

And yet, an impact analysis from the CMS Office of the Actuary that was included with the proposed rule predicts that based on measurements to be taken in 2017, 87% of all solo practices will be negatively adjusted in 2019, the year MACRA goes into full effect. Nearly 70% of practices with between 2 and 9 physicians are predicted to be penalized, while about 60% of those with between 10 and 24 practices will be hit. Larger practices also are expected to be severely affected. For those with between 25 and 99 member physicians, nearly 45% will face negative adjustments and groups with 100 or more physicians will face a nearly 20% negative incursion, according to the analysis.

But before you sell your practice to the local hospital system or drop out of Medicare altogether, some analysts and officials advise against panic.

Robert B. Doherty, ACP senior vice president for governmental affairs and public policy, disputed the notion that the analysis is proof of the coming death of small practices. “I disagree with that. Essentially, the actuary was projecting using relatively low rates of participation [in the new value-based programs],” he said.

To that end, on May 11, acting CMS Administrator Andy Slavitt testified before the House Ways and Means Committee’s Subcommittee on Health that because those actuarial projections were based on data collected in 2014, they were not reflective of what he said was an uptick in quality measure reporting for 2015. Before the rule is finalized later this year, the actuarial tables would be updated to reflect the new data, he said.

That leaves plenty of time to advocate for feasible payment structures for practices of all sizes, Mr. Doherty said. “If we succeed in doing that, and I think there is some progress ... then I think there will be opportunities for smaller practices to get positive updates.”

Advocacy is not enough

Dr. Patel, a practicing internist in Washington, said that she agrees with this approach.

In addition to making constructive, written comments on the proposed rule, which closes on June 27, 2016, at 5 p.m. EDT, Dr. Patel said that taking steps to optimize available resources now, such as reporting quality measures, or using the chronic care management fee, are ways to ensure higher revenues in the future. “Think about ways to leverage your practice now in order to actually get on one of the advanced payment care models so you avoid being in that track that gets all that downward pressure,” she added.

Still, she said that advocacy may not be enough for some practices to stay solvent. “If the actuaries and CMS really believe that small practices are going to face these steep penalties and not be able to survive, then how we address that, such as through how we define alternative models that are broader [in scope] for practices to follow, has to actually be written by CMS into the final rule.”

No matter the type of ark you choose to build, particularly if yours is a small practice, you’ll have to create some kind of watertight vessel or else, said Dr. Patel, it is “going to be extremely hard to participate in the Medicare program.”

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

WASHINGTON – Now that the move to value-based care is in full swing, it’s time for physicians – especially those in small or solo practice – to get ready to change.

“This must be a completely overwhelming time for you. We get that,” Dr. Hoangmai Pham, director of Seamless Care Models Group at the Centers for Medicare & Medicaid Services’ Innovation Center, said at the annual meeting of the American College of Physicians. “We are trying to help you understand the landscape as much as possible.”

Merit Based Incentive Payments (MIPS) are one way the federal government is transitioning physician payments from volume-based to value-based medicine. The proposed rule to implement the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) indicates how Medicare officials intend for MIPS to streamline the three main quality metrics reporting systems currently in use – meaningful use, the patient quality reporting system, and value-based modifiers – along with clinical practice improvement activities, into one quality metrics reporting system to be used for reimbursements.

The CMS currently bases pay incentives on at least 90 different clinical practice improvement activities, Dr. Pham said in an interview. Practices that already incorporate these activities will find it easy to comply with MIPS, according to several analysts. Under the proposed rule, physician’s Medicare fees would be adjusted based on MIPS starting in 2019; adjustment are slated to range from a 3.5% cut to as much as a 4.5% increase. By 2024, Medicare pay may be cut – or increased – by as much as 9%.

Because Congress set up MIPS to be budget neutral, it is not intended to help physicians grow their bottom line, but to provide a bridge to the Brave New World of value-based care.

“MIPS helps to link fee-for-service payments with quality and value,” Dr. Pham said.

The ultimate goal of the Quality Performance Program – the name CMS has selected for the MACRA-mandated reforms – is for physicians to deliver higher quality care over volume of care. Carrots (potential rewards for high quality) and sticks (financial risk for low quality) will be employed.

APMs, ACOs, CPC+, oh my!

Once physicians get over the bridge to value-based medicine, alternative payment models (APMs) are one way to start reaping the rewards.

APMs offer an avenue to increased revenue (shared savings) but also require physicians to share risk with the government.

Another option is the recently announced Comprehensive Primary Care Plus (CPC+) accountable care organization under which physicians will be paid prospectively for meeting a variety of criteria.

The CMS is now soliciting bids from other insurers to participate in CPC+. Once the CMS knows which third party payers are willing to participate, and at what level and in which regions, practices will be able to apply. The CMS expects selected practices to begin participating by January 2017, Dr. Pham said in the interview.

These and other forms of patient-centered medical home-type ACOs, offered by the CMS or by private insurers, are intended to help practices develop payment structures that can be tailored to fit the unique characteristics of a given practice, including the specific types of populations served.

The proposed rule also notes that the CMS would like to offer what is known as Physician Focused Payment Models. These organizations might be included in the final rule if they meet three criteria: a clear plan for setting and meeting quality goals; an enumeration of the type of population that will be served; and what resources will be necessary at what cost.

After the final rule is posted, all physician-focused proposals will be reviewed by an advisory committee to the CMS, known as the Physician Focused Payment Model Technical Advisory Committee (PTAC).

Practice managers interested in developing this kind of model should pay close attention to pages 562 and 624 of the proposed rule document for more specific instructions, according to Dr . Kavita Patel, a fellow and managing director of the Engelberg Center for Health Care Reform at the Brookings Institute in Washington, D.C.

When asked about the likelihood of such a plan being approved – particularly since the final rule is expected in November 2016, with metrics from 2017 to be collected for the first round of quality performance payments in 2019 – Dr. Patel emphasized that while she was not speaking on behalf of the CMS, “the phrase they use is that they ‘want to keep the door open.’ I think that as long as you honor these criteria, the desire is to move these proposals through.” Still, she acknowledged, “The timing is extremely tight.”

The problem, she added, is that the criteria still need to be defined by the law, so it is hard to know if and when such proposals will be evaluated and approved. Meanwhile, all practices have the option of switching back to MIPS annually, but since the goal is to push physicians away from that model, as evidenced by the steeper penalties each year the law is in effect, this becomes less attractive an option.

Calls for calm

In some ways, according to Dr. Patel, this evolution in health care delivery should be seen as a good thing since “the fee-for-service model is not viable.”

And yet, an impact analysis from the CMS Office of the Actuary that was included with the proposed rule predicts that based on measurements to be taken in 2017, 87% of all solo practices will be negatively adjusted in 2019, the year MACRA goes into full effect. Nearly 70% of practices with between 2 and 9 physicians are predicted to be penalized, while about 60% of those with between 10 and 24 practices will be hit. Larger practices also are expected to be severely affected. For those with between 25 and 99 member physicians, nearly 45% will face negative adjustments and groups with 100 or more physicians will face a nearly 20% negative incursion, according to the analysis.

But before you sell your practice to the local hospital system or drop out of Medicare altogether, some analysts and officials advise against panic.

Robert B. Doherty, ACP senior vice president for governmental affairs and public policy, disputed the notion that the analysis is proof of the coming death of small practices. “I disagree with that. Essentially, the actuary was projecting using relatively low rates of participation [in the new value-based programs],” he said.

To that end, on May 11, acting CMS Administrator Andy Slavitt testified before the House Ways and Means Committee’s Subcommittee on Health that because those actuarial projections were based on data collected in 2014, they were not reflective of what he said was an uptick in quality measure reporting for 2015. Before the rule is finalized later this year, the actuarial tables would be updated to reflect the new data, he said.

That leaves plenty of time to advocate for feasible payment structures for practices of all sizes, Mr. Doherty said. “If we succeed in doing that, and I think there is some progress ... then I think there will be opportunities for smaller practices to get positive updates.”

Advocacy is not enough

Dr. Patel, a practicing internist in Washington, said that she agrees with this approach.

In addition to making constructive, written comments on the proposed rule, which closes on June 27, 2016, at 5 p.m. EDT, Dr. Patel said that taking steps to optimize available resources now, such as reporting quality measures, or using the chronic care management fee, are ways to ensure higher revenues in the future. “Think about ways to leverage your practice now in order to actually get on one of the advanced payment care models so you avoid being in that track that gets all that downward pressure,” she added.

Still, she said that advocacy may not be enough for some practices to stay solvent. “If the actuaries and CMS really believe that small practices are going to face these steep penalties and not be able to survive, then how we address that, such as through how we define alternative models that are broader [in scope] for practices to follow, has to actually be written by CMS into the final rule.”

No matter the type of ark you choose to build, particularly if yours is a small practice, you’ll have to create some kind of watertight vessel or else, said Dr. Patel, it is “going to be extremely hard to participate in the Medicare program.”

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

WASHINGTON – Simple steps can be taken now in fee-for-service practices that can help predict performance in 2019, when the Medicare Access and CHIP Reauthorization Act (MACRA) goes into effect. The first key is to complete all necessary metrics for 2016, according to an American College of Physicians official.

For example, although meaningful use will no longer exist after this year, many aspects of it will continue to be applied and reported under the MACRA rules, Shari Erickson, vice president of governmental and medical practice at the American College of Physicians, said during the Hot Topics session at the annual meeting of the American College of Physicians.

“It will take some time for how things are measured to be reimagined, so we are advising members to try to test meaningful use, because what you’ve learned by doing that will be very helpful as you move” into the Merit-Based Incentive Payment System (MIPS), Ms. Erickson said.

Another way reporting can help is to participate in the Physician Quality Reporting System (PQRS) this year. The measures in this program will be streamlined under the new law, but the flavor will be the same, according to Ms. Erickson. Additionally, not taking the time to report this year not only will set physicians back in their ability to gauge readiness for what’s to come but also could cost considerable money.

“The 2018 adjustments based on 2016 reporting can be as much as [negative] 9% if you’re not doing any reporting at all,” she said in an interview.

Another step is to begin implementing quality improvement programs now. Doing so not only will improve PQRS measures while the program still exists, but also could help earn credit for clinical practice improvement activities that will account for 15% of MIPS scores in the first year under the new law.

Because the new law requires the Centers for Medicare & Medicaid Services to provide feedback to physicians on overall performance on MIPS scores, Ms. Erickson said that reviewing physician feedback reports as they already exist can help determine current ratings. Another way to determine performance ratings is to survey patients directly, she said.

Under the new law, practices have the option each year of choosing to be paid under the MIPS program or an alternative payment model, Ms. Erickson said, so even gradual shifts toward putting in place patient-centered-medical-home sorts of protocols will help MIPS-based performance ratings and increase the chances of earning more under an alternative model in the future.To facilitate those efforts, physicians can conduct a risk stratification of current patient panels and access how care is being delivered by learning about what the ACP calls “high value care.” The ACP has developed a resource center featuring documents addressing these questions for members.

But most importantly, Ms. Erickson said, is to learn about the law and to contribute to the comments section on the proposed rule before the comment period closes at 5 p.m. on June 27, 2016.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

WASHINGTON – Simple steps can be taken now in fee-for-service practices that can help predict performance in 2019, when the Medicare Access and CHIP Reauthorization Act (MACRA) goes into effect. The first key is to complete all necessary metrics for 2016, according to an American College of Physicians official.

For example, although meaningful use will no longer exist after this year, many aspects of it will continue to be applied and reported under the MACRA rules, Shari Erickson, vice president of governmental and medical practice at the American College of Physicians, said during the Hot Topics session at the annual meeting of the American College of Physicians.

“It will take some time for how things are measured to be reimagined, so we are advising members to try to test meaningful use, because what you’ve learned by doing that will be very helpful as you move” into the Merit-Based Incentive Payment System (MIPS), Ms. Erickson said.

Another way reporting can help is to participate in the Physician Quality Reporting System (PQRS) this year. The measures in this program will be streamlined under the new law, but the flavor will be the same, according to Ms. Erickson. Additionally, not taking the time to report this year not only will set physicians back in their ability to gauge readiness for what’s to come but also could cost considerable money.

“The 2018 adjustments based on 2016 reporting can be as much as [negative] 9% if you’re not doing any reporting at all,” she said in an interview.

Another step is to begin implementing quality improvement programs now. Doing so not only will improve PQRS measures while the program still exists, but also could help earn credit for clinical practice improvement activities that will account for 15% of MIPS scores in the first year under the new law.

Because the new law requires the Centers for Medicare & Medicaid Services to provide feedback to physicians on overall performance on MIPS scores, Ms. Erickson said that reviewing physician feedback reports as they already exist can help determine current ratings. Another way to determine performance ratings is to survey patients directly, she said.

Under the new law, practices have the option each year of choosing to be paid under the MIPS program or an alternative payment model, Ms. Erickson said, so even gradual shifts toward putting in place patient-centered-medical-home sorts of protocols will help MIPS-based performance ratings and increase the chances of earning more under an alternative model in the future.To facilitate those efforts, physicians can conduct a risk stratification of current patient panels and access how care is being delivered by learning about what the ACP calls “high value care.” The ACP has developed a resource center featuring documents addressing these questions for members.

But most importantly, Ms. Erickson said, is to learn about the law and to contribute to the comments section on the proposed rule before the comment period closes at 5 p.m. on June 27, 2016.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

WASHINGTON – Simple steps can be taken now in fee-for-service practices that can help predict performance in 2019, when the Medicare Access and CHIP Reauthorization Act (MACRA) goes into effect. The first key is to complete all necessary metrics for 2016, according to an American College of Physicians official.

For example, although meaningful use will no longer exist after this year, many aspects of it will continue to be applied and reported under the MACRA rules, Shari Erickson, vice president of governmental and medical practice at the American College of Physicians, said during the Hot Topics session at the annual meeting of the American College of Physicians.

“It will take some time for how things are measured to be reimagined, so we are advising members to try to test meaningful use, because what you’ve learned by doing that will be very helpful as you move” into the Merit-Based Incentive Payment System (MIPS), Ms. Erickson said.

Another way reporting can help is to participate in the Physician Quality Reporting System (PQRS) this year. The measures in this program will be streamlined under the new law, but the flavor will be the same, according to Ms. Erickson. Additionally, not taking the time to report this year not only will set physicians back in their ability to gauge readiness for what’s to come but also could cost considerable money.

“The 2018 adjustments based on 2016 reporting can be as much as [negative] 9% if you’re not doing any reporting at all,” she said in an interview.

Another step is to begin implementing quality improvement programs now. Doing so not only will improve PQRS measures while the program still exists, but also could help earn credit for clinical practice improvement activities that will account for 15% of MIPS scores in the first year under the new law.

Because the new law requires the Centers for Medicare & Medicaid Services to provide feedback to physicians on overall performance on MIPS scores, Ms. Erickson said that reviewing physician feedback reports as they already exist can help determine current ratings. Another way to determine performance ratings is to survey patients directly, she said.

Under the new law, practices have the option each year of choosing to be paid under the MIPS program or an alternative payment model, Ms. Erickson said, so even gradual shifts toward putting in place patient-centered-medical-home sorts of protocols will help MIPS-based performance ratings and increase the chances of earning more under an alternative model in the future.To facilitate those efforts, physicians can conduct a risk stratification of current patient panels and access how care is being delivered by learning about what the ACP calls “high value care.” The ACP has developed a resource center featuring documents addressing these questions for members.

But most importantly, Ms. Erickson said, is to learn about the law and to contribute to the comments section on the proposed rule before the comment period closes at 5 p.m. on June 27, 2016.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

WASHINGTON – Determining how to integrate and deliver quality mental and behavioral health care has emerged as a top priority for internists, American College of Physicians officials have announced.

“We’re making our presence known in this field,” Richard Trachtman, director of legislative affairs at the ACP, said at a Hot Topics session at the annual meeting of the American College of Physicians.

Copyright thinkstockphotos.com

As part of its focus on mental health, the ACP is recommending that Congress approve a grant program that would fully fund the integration of primary, mental, and behavioral health care. “We would like to see it specifically stated that the team would include a primary care physician, and [that] the population treated would include patients with mental illness and co-occuring primary care conditions with chronic illness,” Mr. Trachtman said.

He cited a provision in the Senate’s Mental Health Reform Act calling for a chief medical officer to preside over the Substance Abuse and Mental Health Services Administration to facilitate the creation and dissemination of evidence-based practices that integrate mental health care services into primary care. Under the legislation, the chief medical officer also would provide guidance to insurers to comply with laws that mandate payment for such services. Mr. Trachtman said that he also expected similar legislation to be approved by the House of Representatives.

Among the concerns raised by several audience members during the question-and-answer period at the meeting were the growing workforce shortage of those trained to treat mental and behavioral illness, and best practices for coding and billing for those services. Some audience members also expressed concerns about what the recent proposed rule for value-based care assessment would mean in practical terms for integrating mental health care into practice, and how legal complications could be avoided should mental health outcomes turn out badly.

Shari Erickson, the ACP’s vice president for governmental and medical practice, said in an interview that she heard the concerns expressed by members about how they will be expected to deliver these services in a value-based care environment. “Based on the feedback I just heard here, I will be looking very closely at what [the Medicare Access and CHIP Reauthorization Act] means for them in terms of mental health care delivery,” Ms. Erickson said.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

WASHINGTON – Determining how to integrate and deliver quality mental and behavioral health care has emerged as a top priority for internists, American College of Physicians officials have announced.

“We’re making our presence known in this field,” Richard Trachtman, director of legislative affairs at the ACP, said at a Hot Topics session at the annual meeting of the American College of Physicians.

Copyright thinkstockphotos.com

As part of its focus on mental health, the ACP is recommending that Congress approve a grant program that would fully fund the integration of primary, mental, and behavioral health care. “We would like to see it specifically stated that the team would include a primary care physician, and [that] the population treated would include patients with mental illness and co-occuring primary care conditions with chronic illness,” Mr. Trachtman said.

He cited a provision in the Senate’s Mental Health Reform Act calling for a chief medical officer to preside over the Substance Abuse and Mental Health Services Administration to facilitate the creation and dissemination of evidence-based practices that integrate mental health care services into primary care. Under the legislation, the chief medical officer also would provide guidance to insurers to comply with laws that mandate payment for such services. Mr. Trachtman said that he also expected similar legislation to be approved by the House of Representatives.

Among the concerns raised by several audience members during the question-and-answer period at the meeting were the growing workforce shortage of those trained to treat mental and behavioral illness, and best practices for coding and billing for those services. Some audience members also expressed concerns about what the recent proposed rule for value-based care assessment would mean in practical terms for integrating mental health care into practice, and how legal complications could be avoided should mental health outcomes turn out badly.

Shari Erickson, the ACP’s vice president for governmental and medical practice, said in an interview that she heard the concerns expressed by members about how they will be expected to deliver these services in a value-based care environment. “Based on the feedback I just heard here, I will be looking very closely at what [the Medicare Access and CHIP Reauthorization Act] means for them in terms of mental health care delivery,” Ms. Erickson said.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

WASHINGTON – Determining how to integrate and deliver quality mental and behavioral health care has emerged as a top priority for internists, American College of Physicians officials have announced.

“We’re making our presence known in this field,” Richard Trachtman, director of legislative affairs at the ACP, said at a Hot Topics session at the annual meeting of the American College of Physicians.

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As part of its focus on mental health, the ACP is recommending that Congress approve a grant program that would fully fund the integration of primary, mental, and behavioral health care. “We would like to see it specifically stated that the team would include a primary care physician, and [that] the population treated would include patients with mental illness and co-occuring primary care conditions with chronic illness,” Mr. Trachtman said.

He cited a provision in the Senate’s Mental Health Reform Act calling for a chief medical officer to preside over the Substance Abuse and Mental Health Services Administration to facilitate the creation and dissemination of evidence-based practices that integrate mental health care services into primary care. Under the legislation, the chief medical officer also would provide guidance to insurers to comply with laws that mandate payment for such services. Mr. Trachtman said that he also expected similar legislation to be approved by the House of Representatives.

Among the concerns raised by several audience members during the question-and-answer period at the meeting were the growing workforce shortage of those trained to treat mental and behavioral illness, and best practices for coding and billing for those services. Some audience members also expressed concerns about what the recent proposed rule for value-based care assessment would mean in practical terms for integrating mental health care into practice, and how legal complications could be avoided should mental health outcomes turn out badly.

Shari Erickson, the ACP’s vice president for governmental and medical practice, said in an interview that she heard the concerns expressed by members about how they will be expected to deliver these services in a value-based care environment. “Based on the feedback I just heard here, I will be looking very closely at what [the Medicare Access and CHIP Reauthorization Act] means for them in terms of mental health care delivery,” Ms. Erickson said.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

WASHINGTON – Shorter, more frequent MOC assessments are coming to an office or home computer near you under a new American Board of Internal Medicine certification option announced May 5 at the annual meeting of the American College of Physicians.

The new option comes in response to outrage expressed in meetings and online by physicians affected by ABIM recertification protocols that many said were redundant and impractical.

“We know there has been a lot of frustration, and anger and concern,” said Dr. Yul Ejnes, who serves on the ABIM’s internal medicine specialty board.

Whitney McKnight/Frontline Medical News

“Already more than 9,000 ABIM board-certified physicians have shared their opinions with us through a survey and hundreds more are helping ABIM by participating in our [maintenance of certification] blueprint review and open book study,” said Dr. Richard J. Baron, president and CEO of ABIM.

Starting January 2018, the new option will mean that physicians who take shorter assessments on their personal or office computer – with properly authenticated security measures – can do so more frequently than every 10 years, but no more than annually. Physicians also will be able to participate in crafting assessments based on their actual practice experience, and eventually, if they perform well, test out of the longer assessments currently mandated every 10 years.

“By offering shorter assessments, that [can be taken] at home or at the office, we hope to lower the stress and burden that many physicians have told us the current 10-year exam generates,” Dr. Baron said. However, since 20% of diplomates surveyed said they preferred the 10-year exam, it will continue to be an option.

The shorter assessment may be available to some internal medicine subspecialties in 2018, Dr. Baron said.

Physicians maintaining certification in internal medicine whose certification expires before January 2018 will need to pass the current exam, although they will not need to assess again for 10 years.

A blueprint for a new exam has been created based on feedback from dozens of internal medicine professional organizations. The blueprint focuses on the most important things to know in daily practice, as well as the important things to know that aren’t encountered in daily practice, according to ABIM officials.

“The feedback we have so far on the new blueprint is that it is more relevant,” said Dr. Patricia M. Conolly, ABIM chair-elect. “We know it isn’t perfect, and we know we’ll never get it exactly right, but we will have an ongoing process to ensure the exam reflects what internists are doing.”

The ABIM is currently accepting comments on the proposed assessment, and expects to announce more specific details before the end of 2016.

Dr. Baron said ABIM is testing an “open book” assessment as well as ways to provide secure assessments at a physician’s home or office. ABIM also seeks to determine how to provide immediate feedback on assessments and learning activities and will work with societies to expand the number of continuing medical education activities available for MOC credit.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

WASHINGTON – Shorter, more frequent MOC assessments are coming to an office or home computer near you under a new American Board of Internal Medicine certification option announced May 5 at the annual meeting of the American College of Physicians.

The new option comes in response to outrage expressed in meetings and online by physicians affected by ABIM recertification protocols that many said were redundant and impractical.

“We know there has been a lot of frustration, and anger and concern,” said Dr. Yul Ejnes, who serves on the ABIM’s internal medicine specialty board.

Whitney McKnight/Frontline Medical News

“Already more than 9,000 ABIM board-certified physicians have shared their opinions with us through a survey and hundreds more are helping ABIM by participating in our [maintenance of certification] blueprint review and open book study,” said Dr. Richard J. Baron, president and CEO of ABIM.

Starting January 2018, the new option will mean that physicians who take shorter assessments on their personal or office computer – with properly authenticated security measures – can do so more frequently than every 10 years, but no more than annually. Physicians also will be able to participate in crafting assessments based on their actual practice experience, and eventually, if they perform well, test out of the longer assessments currently mandated every 10 years.

“By offering shorter assessments, that [can be taken] at home or at the office, we hope to lower the stress and burden that many physicians have told us the current 10-year exam generates,” Dr. Baron said. However, since 20% of diplomates surveyed said they preferred the 10-year exam, it will continue to be an option.

The shorter assessment may be available to some internal medicine subspecialties in 2018, Dr. Baron said.

Physicians maintaining certification in internal medicine whose certification expires before January 2018 will need to pass the current exam, although they will not need to assess again for 10 years.

A blueprint for a new exam has been created based on feedback from dozens of internal medicine professional organizations. The blueprint focuses on the most important things to know in daily practice, as well as the important things to know that aren’t encountered in daily practice, according to ABIM officials.

“The feedback we have so far on the new blueprint is that it is more relevant,” said Dr. Patricia M. Conolly, ABIM chair-elect. “We know it isn’t perfect, and we know we’ll never get it exactly right, but we will have an ongoing process to ensure the exam reflects what internists are doing.”

The ABIM is currently accepting comments on the proposed assessment, and expects to announce more specific details before the end of 2016.

Dr. Baron said ABIM is testing an “open book” assessment as well as ways to provide secure assessments at a physician’s home or office. ABIM also seeks to determine how to provide immediate feedback on assessments and learning activities and will work with societies to expand the number of continuing medical education activities available for MOC credit.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

WASHINGTON – Shorter, more frequent MOC assessments are coming to an office or home computer near you under a new American Board of Internal Medicine certification option announced May 5 at the annual meeting of the American College of Physicians.

The new option comes in response to outrage expressed in meetings and online by physicians affected by ABIM recertification protocols that many said were redundant and impractical.

“We know there has been a lot of frustration, and anger and concern,” said Dr. Yul Ejnes, who serves on the ABIM’s internal medicine specialty board.

Whitney McKnight/Frontline Medical News

“Already more than 9,000 ABIM board-certified physicians have shared their opinions with us through a survey and hundreds more are helping ABIM by participating in our [maintenance of certification] blueprint review and open book study,” said Dr. Richard J. Baron, president and CEO of ABIM.

Starting January 2018, the new option will mean that physicians who take shorter assessments on their personal or office computer – with properly authenticated security measures – can do so more frequently than every 10 years, but no more than annually. Physicians also will be able to participate in crafting assessments based on their actual practice experience, and eventually, if they perform well, test out of the longer assessments currently mandated every 10 years.

“By offering shorter assessments, that [can be taken] at home or at the office, we hope to lower the stress and burden that many physicians have told us the current 10-year exam generates,” Dr. Baron said. However, since 20% of diplomates surveyed said they preferred the 10-year exam, it will continue to be an option.

The shorter assessment may be available to some internal medicine subspecialties in 2018, Dr. Baron said.

Physicians maintaining certification in internal medicine whose certification expires before January 2018 will need to pass the current exam, although they will not need to assess again for 10 years.

A blueprint for a new exam has been created based on feedback from dozens of internal medicine professional organizations. The blueprint focuses on the most important things to know in daily practice, as well as the important things to know that aren’t encountered in daily practice, according to ABIM officials.

“The feedback we have so far on the new blueprint is that it is more relevant,” said Dr. Patricia M. Conolly, ABIM chair-elect. “We know it isn’t perfect, and we know we’ll never get it exactly right, but we will have an ongoing process to ensure the exam reflects what internists are doing.”

The ABIM is currently accepting comments on the proposed assessment, and expects to announce more specific details before the end of 2016.

Dr. Baron said ABIM is testing an “open book” assessment as well as ways to provide secure assessments at a physician’s home or office. ABIM also seeks to determine how to provide immediate feedback on assessments and learning activities and will work with societies to expand the number of continuing medical education activities available for MOC credit.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

WASHINGTON – Doctors need to be more active in advocating for public policy, Rep. Ami Bera (D-Calif.) said at the annual meeting of the American College of Physicians.

“In medicine, this next decade is going to be transformative,” Rep. Bera, who is an internist, said May 5 during the opening general session. The foundation for enormous change was laid 6 years ago with the Affordable Care Act and refined last year with the Medicare Access and CHIP Reauthorization Act (MACRA). “This next decade will be how we implement and move forward.”

Rep. Bera called on his fellow physicians to play a larger role in shaping the policies.

“We are all busy taking care of our patients,” he said. “We are all busy practicing and teaching the next generation of physicians. But in truth, if we are not engaged with the policy makers, we don’t have a seat at the table.”

In particular, he noted that the focus of the conversation needs to be on keeping the patient at the center of policy changes going forward.

“Certainly while you are in Washington, D.C., you [should] try to stop by and visit your member of Congress,” he recommended. “But when you are back home in your districts, make sure that you are telling [your elected representatives] the stories of your patients, of what happens in the exam room or at the bed side or in the classroom. These are real issues that over the next decade we are going to have to grapple with.”

He said that while there are a lot of bright minds on Capitol Hill who are looking to move the country forward, “unless we bring our patients into that policy, the best policy may not always translate into practice, so that’s where those of us who have a unique perspective have to be part of the discussion.”

gtwachtman@frontlinemedcom.com

WASHINGTON – Doctors need to be more active in advocating for public policy, Rep. Ami Bera (D-Calif.) said at the annual meeting of the American College of Physicians.

“In medicine, this next decade is going to be transformative,” Rep. Bera, who is an internist, said May 5 during the opening general session. The foundation for enormous change was laid 6 years ago with the Affordable Care Act and refined last year with the Medicare Access and CHIP Reauthorization Act (MACRA). “This next decade will be how we implement and move forward.”

Rep. Bera called on his fellow physicians to play a larger role in shaping the policies.

“We are all busy taking care of our patients,” he said. “We are all busy practicing and teaching the next generation of physicians. But in truth, if we are not engaged with the policy makers, we don’t have a seat at the table.”

In particular, he noted that the focus of the conversation needs to be on keeping the patient at the center of policy changes going forward.

“Certainly while you are in Washington, D.C., you [should] try to stop by and visit your member of Congress,” he recommended. “But when you are back home in your districts, make sure that you are telling [your elected representatives] the stories of your patients, of what happens in the exam room or at the bed side or in the classroom. These are real issues that over the next decade we are going to have to grapple with.”

He said that while there are a lot of bright minds on Capitol Hill who are looking to move the country forward, “unless we bring our patients into that policy, the best policy may not always translate into practice, so that’s where those of us who have a unique perspective have to be part of the discussion.”

gtwachtman@frontlinemedcom.com

WASHINGTON – Doctors need to be more active in advocating for public policy, Rep. Ami Bera (D-Calif.) said at the annual meeting of the American College of Physicians.

“In medicine, this next decade is going to be transformative,” Rep. Bera, who is an internist, said May 5 during the opening general session. The foundation for enormous change was laid 6 years ago with the Affordable Care Act and refined last year with the Medicare Access and CHIP Reauthorization Act (MACRA). “This next decade will be how we implement and move forward.”

Rep. Bera called on his fellow physicians to play a larger role in shaping the policies.

“We are all busy taking care of our patients,” he said. “We are all busy practicing and teaching the next generation of physicians. But in truth, if we are not engaged with the policy makers, we don’t have a seat at the table.”

In particular, he noted that the focus of the conversation needs to be on keeping the patient at the center of policy changes going forward.

“Certainly while you are in Washington, D.C., you [should] try to stop by and visit your member of Congress,” he recommended. “But when you are back home in your districts, make sure that you are telling [your elected representatives] the stories of your patients, of what happens in the exam room or at the bed side or in the classroom. These are real issues that over the next decade we are going to have to grapple with.”

He said that while there are a lot of bright minds on Capitol Hill who are looking to move the country forward, “unless we bring our patients into that policy, the best policy may not always translate into practice, so that’s where those of us who have a unique perspective have to be part of the discussion.”

gtwachtman@frontlinemedcom.com