Medicare Compliance & Reimbursement

Plus: New offerings from the ONC help providers address health IT issues

With MACRA’s Quality Payment Program (QPP) set to begin Jan. 1, 2017, Medicare providers are in for a complete overhaul of a system they’ve become accustomed to. Despite the hints, releases, and now mandates that have been gradually coming on since MACRA’s inception in 2015, many providers find themselves bewildered and unready to move from a fee-for-service, one-size-fits-all structure to a pay-for-performance, tailor-made, tiered system.

The American Medical Association (AMA) has been working hand-in-hand with CMS to assist providers with the transfer from one ideology to another. Enlisting leaders in the health care industry as well as physicians on the frontline who service Medicare beneficiaries daily, the AMA has compiled and designed three resources specifically for physicians to figure out how to adapt to the new payment plan. 

“MACRA represents the most significant change to Medicare’s physician payment system in a generation, and the AMA is working to help physicians navigate this change and make sure they are prepared for it,” said Andrew Gurman MD, AMA president, in an Oct. 5, 2016 press release.

In addition to extending its STEPS Forward program—which has been updated to now include 42 learning modules devoted to educating physicians and their staffs on MACRA and other health care-related issues—the AMA has also introduced two other innovations targeting the worried practitioner. The other offerings that complete the trio of resources are:

• The AMA Payment Model Evaluator is a creative online tool that compiles a practice’s data through a questionnaire then makes a suggestion based on the detailed information on which MACRA payment plan would be best for that particular practice.
• The AMA’s ReachMD series called Inside Medicare’s New Payment System is an informative podcast that explains the changes coming through talks with AMA elite and CMS leaders like head honcho, Andy Slavitt.

“We know there are challenges under the new system, but the recent announcement of the ‘Pick Your Pace’ reporting options indicates not only that the Centers for Medicare and Medicaid Services is responsive to the AMA’s advocacy on behalf of physicians,” Gurman said. “But, that it is working to give physicians a fair chance to be successful in the new payment framework.”

Resource. For more information on the three AMA initiatives and a complete read of the press release, visit http://www.ama-assn.org/ama/pub/news/news/2016/2016-10-05-ama-introduces-new-tools-macra.page.

In other news...

Health IT continues to be a catalyst for change and innovation in the health care industry, pushing care forward with patient engagement and telehealth options while connecting providers and patients like never before.

This year, the ONC’s annual celebration of health IT brought Medicare providers, suppliers, and vendors together to blend ideas and unveil up-and-coming tools to make accessing health care easier and more efficient. The HHS’ technology hub never fails to impress, offering up some handy online gadgets to aid providers with their digital livelihoods.

The two initiatives target problem areas in the industry. The first addresses provider missteps and management of acquiring and implementing EHRs and is called the EHR contract guide. The other program is an expansion of the already popular Patient Engagement Playbook. The add-on—The Health IT Playbook—aims to increase patient and provider discourse, making the EHR process and delivery of information more user-friendly and HIPAA-safe.

“I know from my experiences practicing emergency medicine and managing information technology for a health system how helpful practical tools can be for clinicians and health care administrators as they navigate the purchase and use of health IT,” said B. Vindell Washington, MD, MHCM, national coordinator for health information technology, in a Sept. 28, 2016 press release from the ONC. “The EHR contract guide and the Health IT Playbook incorporate feedback we have heard from the provider community about the need for clear, reliable information about EHR contracts and user-friendly, specific tools for how to get the most out of health IT to better manage patient health and care.”

Resource. To review the news release with links to the new ONC products, visit http://www.hhs.gov/about/news/2016/09/26/ehr-contract-guide-and-health-it-playbook-help-clinicians-and-hospitals-get-most-out-health.html.