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The Strategic Implications of MACRA Print E-mail
Written by   
Saturday, 09 July 2016 16:18

On April 27, the Centers for Medicare and Medicaid Services (CMS) unveiled the much-anticipated (and, for some, feared) proposal to implement the physician payment reforms required under the Medicare Access to Care and CHIP Reauthorization Act of 2015 (MACRA).  These reforms, once implemented, will profoundly change how and how much Medicare pays physicians for services furnished to program beneficiaries by substantially linking such payments to performance and incentivizing physicians to participate in alternative payment models. Moreover, while not expressly intended by Congress or CMS, these changes also are likely to cause a dramatic increase in physician-physician consolidation and physician-hospital consolidation and alignment.
Under the Merit-Based Incentive Payment System (MIPS) established in MACRA, and now described in detail by CMS in draft regulations, Medicare payments to physicians will be adjusted based on each physician's performance in four performance categories...

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Last Updated on Tuesday, 26 July 2016 17:12
Is MACRA All It's Cracked Up to Be? Print E-mail
Written by FHI's Week in Review   
Tuesday, 28 June 2016 16:54

'Payment gap' for docs may grow over time, analyst warns
Joyce Frieden, News Editor for MedPage Today reports on 6.23.16:

Physicians are likely to be hurt by the legislation passed to repeal Medicare's sustainable growth rate reimbursement formula, several experts said at a briefing here <Washington, D.C.> Thursday on the Medicare trustees' report sponsored by the Brookings Institution and the American Enterprise Institute (AEI).

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Last Updated on Saturday, 09 July 2016 16:12
OIG Issues Report on Provider-Based Facilities Print E-mail
Written by Emily J. Cook, Christine Parkins Johnson & Monica Wallace |   
Monday, 27 June 2016 00:00

Urges CMS to Make Changes

On June 16, 2016, the US Department of Health and Human Services Office of Inspector General (OIG) posted a report examining the Centers for Medicare & Medicaid Services' (CMS's) oversight of billing by provider-based facilities. The OIG concluded that although CMS is taking steps to improve its oversight of provider-based facilities, CMS is unable to adequately monitor provider-based facilities and ensure appropriate billing and payment.

The OIG continues to recommend elimination of the provider-based designation or implementation of equal payment for physician services, regardless of the setting where the services are provided. Alternatively, the OIG recommends that CMS (1) implement systems to monitor all provider-based facility billing, (2) make provider-based attestations mandatory, (3) ensure that CMS regional offices and Medicare Administrative Contractors (MACs) appropriately apply provider-based requirements when reviewing attestations, and (4) take appropriate action against hospitals and their off-campus provider-based facilities that do not meet the provider-based requirements.

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Last Updated on Tuesday, 28 June 2016 17:22
Medicare's Drug-Pricing Experiment Stirs Opposition Print E-mail
Written by Julie Appleby | KHN   
Monday, 30 May 2016 00:00

khn logo black A broad proposal by Medicare to change the way it pays for some drugs has drawn intense reaction and lobbying, with much of the debate centering on whether the plan gives too much power over drug prices to government regulators.
One of most controversial sections would set up a nationwide experiment, scheduled to start in 2017, to test a handful of ways to slow spending on drugs provided in doctor's offices, clinics, hospitals and cancer infusion centers. The proposal would not affect most prescriptions patients get through their pharmacies.
The aim, the government says, is to maintain quality while slowing spending in Medicare Part B by more closely tying payments to how well drugs work, using methods drugmakers, insurers and benefit managers are already trying in the private sector.
One of the approaches included in the proposal would allow Medicare to earmark "therapeutically similar" drugs and set a benchmark, or "reference price," that it would pay for all drugs in that category. That amount might be the cost of the drug the agency considers the most effective in the group, or some other measure. It's aimed at narrowing the wide variability - often hundreds or thousands of dollars a year - in what is paid for similar drugs.
Such an approach is seen by some as government price setting, a method common in Europe that draws support in the U.S. from the left but has longstanding opposition from conservatives, many economists and pharmaceutical companies.
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MACRA rules for physician payments stacked against small practices, critics say Print E-mail
Written by Jeff Lagasse | Healthcare Finance   
Wednesday, 04 May 2016 00:00

About 346,000 physicians, mostly in practices that have between one and 24 members, could see penalties.
Proposed regulations released last week by the Centers for Medicare and Medicaid Services are raising concerns that the playing field is uneven, with 87 percent of solo practitioners getting penalized and 81 percent of clinicians in large groups earning bonuses, according to some estimates.
The new proposal includes a compensation formula for Medicare that gives performance bonuses as high as 4 percent to about 412,000 physicians and other clinicians in 2019, according to published reports. But there will also be penalties on an additional 346,000, mostly in practices that have between one and 24 members.
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Last Updated on Tuesday, 10 May 2016 11:25
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