Administration takes first step to implement legislation modernizing how Medicare pays physicians for quality

The Department of Health and Human Services today issued a proposal to align and modernize how Medicare payments are tied to the cost and quality of patient care for hundreds of thousands of doctors and other clinicians. The Notice of Proposed Rulemaking is a first step in implementing certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This legislation – supported by a bipartisan majority and stakeholders such as patient groups and medical associations – ended more than a decade of last-minute fixes and potential payment cliffs for Medicare doctors and clinicians, while making numerous improvements to America’s health care system.

“The legislation Congress passed a little over a year ago was a milestone in our efforts to advance a health care system that rewards better care, smarter spending, and healthier people,” said HHS Secretary Sylvia M. Burwell. “We have more work to do, but we are committed to implementing this important legislation and creating a health care system that works better for doctors, patients, and taxpayers alike. We look forward to listening and learning from the public on our proposal for how to advance that goal.”

Currently, Medicare measures the value and quality of care provided by doctors and other clinicians through a patchwork of programs. Some clinicians are part of Alternative Payment Models such as the Accountable Care Organizations, the Comprehensive Primary Care Initiative, and the Medicare Shared Savings Program—and most participate in programs such as the Physician Quality Reporting System, the Value Modifier Program, and the Medicare Electronic Health Record (EHR) Incentive Program.

Congress streamlined these various programs into a single framework to help clinicians transition from payments based on volume to payments based on value. Today’s proposed rule would implement these changes through the unified framework called the Quality Payment Program, which includes two paths:

  • The Merit-based Incentive Payment System (MIPS)
  • Advanced Alternative Payment Models (APMs).

“We are working with the medical community to advance our collective vision for Medicare payment reform,” said Dr. Patrick Conway, CMS acting principal deputy administrator and chief medical officer. “By proposing a flexible, rather than a one-size-fits-all program, we are attempting to reflect how doctors and other clinicians deliver care and give them the opportunity to participate in a way that is best for them, their practice, and their patients. Reducing burden and improving how we measure performance supports clinicians in doing what they do best – caring for their patients.”

Merit-based Incentive Payment System (MIPS)

Most Medicare clinicians will initially participate in the Quality Payment Program through MIPS. The ACA moved many Medicare payment systems, including that for clinicians, towards value, and MACRA builds on that work. Consistent with the goals of the law, the proposed rule would improve the relevancy and depth Medicare’s quality-based payments and increase clinician flexibility by allowing clinicians to choose measures and activities appropriate to the type of care they provide. MIPS allows Medicare clinicians to be paid for providing high value care through success in four performance categories: Quality, Advancing Care Information, Clinical Practice Improvement Activities, and Cost.

  • Quality (50 percent of total score in year 1): For this category, clinicians would choose to report six measures from among a range of options that accommodate differences among specialties and practices.
  • Advancing Care Information (25 percent of total score in year 1): For this category, clinicians would choose to report customizable measures that reflect how they use technology in their day-to-day practice, with a particular emphasis on interoperability and information exchange. Unlike the existing reporting program, this category would not require all-or-nothing EHR measurement or redundant quality reporting.
  • Clinical Practice Improvement Activities (15 percent of total score in year 1): This category would reward clinical practice improvements, such as activities focused on care coordination, beneficiary engagement, and patient safety. Clinicians may select activities that match their practices’ goals from a list of more than 90 options.
  • Cost (10 percent of total score in year 1): For this category, the score would be based on Medicare claims, meaning no reporting requirements for clinicians. This category would use 40 episode-specific measures to account for differences among specialties.

The proposed rule seeks to streamline and reduce reporting burden across all four categories, while adding flexibility for physician practices. CMS would begin measuring performance for doctors and other clinicians through MIPS in 2017, with payments based on those measures beginning in 2019.

Advanced Alternative Payment Models

Thanks to new tools created by the Affordable Care Act, increasing numbers of Medicare clinicians are participating in alternative payment models, which are helping transform how our health care system delivers care. Building on the Affordable Care Act, the bipartisan MACRA legislation created additional rewards for clinicians who take this further step towards care transformation.  Medicare clinicians who participate to a sufficient extent in Advanced Alternative Payment Models – would be exempt from MIPS reporting requirements and qualify for financial bonuses. These models include the new Comprehensive Primary Care Plus (CPC+) model, the Next Generation ACO model, and other Alternative Payment Models under which clinicians accept both risk and reward for providing coordinated, high-quality care.

Many clinicians who participate to some extent in Alternative Payment Models may not meet the law’s requirements for sufficient participation in the most advanced models. The proposed rule is designed to provide these clinicians with financial rewards within MIPS, as well as to make it easy for clinicians to switch between the components of the Quality Payment Program based on what works best for them and their patients.

We expect that the number of clinicians who qualify as participating in Advanced Alternative Payment Models will grow as the program matures.

Beginning a Dialogue

In implementing the law, we were guided by the same principles underlying the bipartisan legislation itself: streamlining and strengthening quality-based payments for all physicians; rewarding participation in Advanced Alternative Payment Models that create the strongest incentives for high-quality, efficient, and coordinated care; and giving doctors and other clinicians flexibility regarding how they participate in the new payment system. Today’s rule incorporates input from patients, caregivers, clinicians, health care professionals, and other stakeholders, but it represents only the first step in an iterative implementation process.

HHS looks forward to feedback on the proposal and will accept comments until June 27, 2016.



The Hidden Cost of Paper Charts

By Miles Buckley

Many office based practices are still using paper charts, with the assumption that it’s easier, more efficient, or saves their practice money.

This is simply not true.

Outlined below are just some of the hidden costs of paper.

Missing tasks

Delegating tasks with colored fluorescent sticky notes on top of patient charts, lab orders, medication refills, follow-up appointments and more is a completely unreliable task management system with no way of tracking if the tasks were actually completed.

How much revenue is lost when a referral is missed? Or when a follow-up appointment is never scheduled? Multiply that by the volume of your practice over a year and the result is thousands of dollars lost.

EHR’s allow you to streamline your workflow with task management, instant referrals, integrated lab ordering/results, and audit reports to ensure your practice is working as efficiently and accurately as possible.

Inefficient appointment booking

Whether you’re using a physical appointment book or the limited scheduling feature attached to your billing software, manual scheduling can cost your practice thousands of dollars every year.

For example, if your practice schedules 50 appointments a day, and your office staff is spending four minutes calling and confirming each patient, that’s over three hours a day dedicated to the appointment book. Multiply this by five days a week and you’re looking at an expense of over $11,000 each year.

With Practice Fusion, appointment reminders are sent automatically, allowing your office staff to focus more on patient care instead of the appointment book. You can also enable online scheduling from your EHR settings so patients can also schedule their own appointments online through your practice’s profile on,.

Lack of connectivity

Many providers rely on blood glucose reports to assess the needs of their diabetic patients. However, these reports are frequently recorded on paper in the waiting room prior to the exam and can easily be lost.

Integrated lab results provide instant access to all of your patient’s lab work. This can be reviewed, summarized, or even aggregated into trended results (without having to flip through pages of pixelated fax results).

Preventable errors

There are an estimated 210,000 preventable deaths a year due to inaccurate or unavailable medical records. That’s over 500 preventable deaths every single day. An EHR can help give every provider the full clinical picture of a patient’s health and deliver more accurate drug-drug and drug-allergy interaction checks.

An EHR can help improve the health of your practice

If you’re still holding onto paper charts, the hidden costs are adding up. You can start charting in an EHR from Practice Fusion and save your practice time and money




MACRA, MIPS and more: What healthcare advocates see for the year ahead

February 5, 2016 | By Katie Dvorak
Lobbyists and healthcare advocates spoke about where they see the industry going in the year to come, especially when it comes to health IT policy.

With an election year looming, questions remain about how many health IT programs and policies the government will tackle this year, panelist speaking at the eHealth Initiative’s annual conference in the District of Columbia noted.

However, they do see actions on Capitol Hill making a difference for healthcare this year, especially when it comes to programs like the Merit-Based Incentive Payment System (MIPS) and the Medicare Access and CHIP Reauthorization Act (MACRA).

Here’s what they see for 2016:

Erin Mackay, associate director of the National Partnership for Women and Families

“We’re hoping to see continued focus on policies to enhance not only patient access to health data, but also making sure that data is useful,” Mackay said at the event.

MACRA and MIPS also will play a major role. MIPS “is a huge bucket of activities that is yet to be defined but is likely to include a lot of HIT practices.”

Education on policies surrounding patient access to information also will be very important, she added. There’s a need for policy education on both the patient and provider sides of the aisle, she said.

Mark Segal, Ph.D., vice president of government and industry affairs at GE Healthcare IT

Segal agreed that the Centers for Medicare & Medicaid Services’ proposed regulations–“the alphabet soup,” as he called them–will gain the most attention this year, including MACRA, MIPS and Alternative Payment Models.

The MACRA rule “not only really is going to be an important pivot on how Medicare approaches payment delivery, but it’s also likely to have proposed changes for the Meaningful Use program,” he said at the event. “I think it will effect health IT at both macro and mirco levels.”

In addition, Segal said he sees the House and Senate continuing to push legislation on interoperability, patient safety and telemedicine.

Kristen O’Brien, Washington counsel for the American Medical Association

In her comments, O’Brien also addressed the importance of MIPS. “That is the big regulation we’re watching this entire year,” she said.

Other things she sees Congress looking to tackle before November include telemedicine, interoperability and, to an extent, privacy and security. President Barack Obama’s Precision Medicine Initiative also should get a good deal of attention, she added. “[Obama’s] really going to be promoting that this year.”