TMGMA works closely with both the MGMA and TMA Government Affairs staff to provide our members with the latest legislative & regulatory information. TMGMA members are encouraged to participate in grassroots activities, anecdotal surveys, and contacting your elected officials on issues of importance to medical practices. For more information on how you can get involved or questions on any legislative issue, contact your TMGMA Legislative Liaison DeAnna Brown, FACMPE, CPC at email@example.com.
TMGMA, Tennessee Hospital Association and the Tennessee Medical Association have partnered to develop an online portal for gathering feedback from healthcare providers about the state’s payment reform initiative.
The Tennessee Healthcare Innovation Initiative is the state’s plan to reduce the costs of healthcare and increase quality for TennCare and state employees. Commonly referred to as “payment reform,” the initiative includes shifting from traditional fee-for-service reimbursements to retrospective payments based on episodes of care. Providers may be able to share in cost savings when total costs for an episode fall below a pre-determined commendable threshold, or face financial penalties if total costs exceed an acceptable threshold.
Because of the complexity of managing episodes of care and the limited data reporting and sharing that currently exists, TMGMA, THA and TMA are offering the online portal Tennessee Innovation Inform or “Ti2” as a way for physicians, practice managers and others to share their concerns[JG1] and recommendations. Then, the organizations will:
The Ti2 website is live and ready to accept feedback. Submitting feedback through the portal is a simple process that requires only a few clicks. Users can share feedback as often as they’d like and/or as an issue or concern arises.For more information about the state’s payment reform initiatives and a breakdown of episodes of care, click here.
As a new Administration and Congress come into power, MGMA Government Affairs has identified the following legislative and regulatory issues as top priorities for medical group practices in the coming year. MGMA will keep members apprised of key developments in these areas, and will be calling on the Trump Administration and Congress to work in a bipartisan manner to pursue legislative and regulatory changes that will enable practices to thrive in their mission to furnish high-quality, cost-effective patient care. Members are encouraged to maximize their Association benefits, which include expert guidance from government affairs staff on federal legislative and regulatory requirements. Email or call 877.275.6462 with your questions. We also regularly add new information and resources to the government affairs webpage and as always, stay tuned to the Washington Connection for weekly and breaking news updates.
1. New Congress tackles repeal and replacement of the Affordable Care Act
When President-Elect Trump is inaugurated on Jan. 20, Republicans will control both the legislative and executive branches of the federal government for the first time in more than ten years. The two branches are expected to address deregulation, tax cuts, entitlement programs and repeal and replacement of the Affordable Care Act (ACA). Last week, Congress took the first step by introducing a budget resolution instructing key congressional committees to develop ACA repeal legislation, but this resolution is a statement of priorities and does not have the force of law. Practical implications for medical group practices will remain unclear until a specific replacement plan emerges. MGMA is closely tracking this issue and will engage Congress to ensure any resulting legislation supports policies that reduce the excessive administrative burden faced by practices in our healthcare system today.
2. Trump Administration priorities include reducing government's role in healthcare
President-Elect Trump’s pick for the top position at the Department of Health and Human Services (HHS), Rep. Tom Price, MD (R-GA), is no newcomer to the field. If confirmed, he would be the first physician Secretary of HHS since the first Bush Administration. Price has been a frequent and outspoken critic of government involvement in the patient-physician relationship and a vocal opponent of the ACA since its inception, authoring several legislative alternatives to the Act. Trump has also nominated Seema Verma, the president of a national health policy consulting practice, to head the Centers for Medicare & Medicaid Services (CMS).
Trump has indicated price transparency and reducing drug costs will be a priority for his incoming Administration. What remains unclear are the details for how Trump will implement these policy priorities and how these would intersect with his and Price’s goal to provide regulatory relief and reduce the federal government’s influence in how healthcare services are delivered and paid.
3. Physician practices test the waters in MIPS
A sweeping new quality reporting and value-based payment initiative stemming from the Medicare Access and CHIP Reauthorization Act (MACRA), known as the Medicare Quality Payment Program (QPP), took effect on Jan. 1. In 2017, most physician practices will participate in the new quality reporting track of the QPP known as the Merit-Based Incentive Payment System (MIPS), which replaces PQRS, the Value-Based Payment Modifier, and Meaningful Use and potentially adjusts payment of Medicare Part B claims accordingly. In this first year of MIPS, physician performance will be compared in three categories: quality, advancing care information and practice improvement activities. Following MGMA’s concerted advocacy efforts, CMS established a flexible transition-year policy allowing group practices to potentially receive an incentive payment for reporting data for any 90 consecutive day period in 2017, or avoid a penalty by reporting a small amount of data, such as one quality measure for one patient. MGMA recommends group practices report more than the absolute minimum required data as added insurance against a penalty in the event of data submission issues or inaccuracies. Access resources to help your group succeed in MIPS at MGMA’s MACRA/QPP Resource Center.
4. Will alternative payment models (APMs) flourish under the new Administration?
In late December, CMS unveiled a flurry of new Advanced APMs, which by the agency’s calculations are expected to increase the overall number of clinicians participating in an Advanced APM from 70,000 to 200,000 by 2018. CMS has notably placed an emphasis on developing specialty-focused Advanced APMs, which now feature a number of cardiac, orthopedic, oncology, and nephrology-focused models. With MACRA passing with broad, bipartisan support in Congress, its enduring legacy featuring APMs as a focal point is expected to continue. The incoming Congress and Administration, however, have been heavily critical of mandatory demonstration projects and have repeatedly chastised the CMS Innovation Center, the entity charged with developing APMs. These factors raise a question about whether the APM infrastructure sculpted largely by the Obama Administration will proceed in its current form or a new system under the Trump Administration. MGMA will continue to be vigilant in advocating for group practice-friendly APM options.
5. Focus on improving health information technology (HIT) usability, interoperability
One notable shortcoming of the Meaningful Use program was its lack of focus on EHR usability and effective and secure data sharing. 2017 will see implementation of legislation enacted late last year that could impact group practice adoption and use of HIT by reducing regulatory or administrative burdens relating to the use of EHRs (such as documentation requirements); prioritizing EHR usability and user-centered design, encouraging voluntary certification of EHRs for medical specialties (specifically pediatrics), requiring the development of a “trusted exchange framework,” and penalizing information “blocking” with fines of up to one million dollars.
6. Expanded payment for care management
CMS continues its trend of expanding Medicare payments for care management services by including in the 2017 physician fee schedule (PFS) complex chronic care management (CCM), care plan development, and non-face-to-face prolonged evaluation & management services. Additionally, in response to concerns raised by MGMA and other stakeholders, CMS mitigated the onerous billing requirements for CCM. For instance, beginning in 2017, CMS is limiting the face-to-face initiating visit requirement to CCM patients who are new or who have not been seen within the past year, rather than all beneficiaries receiving CCM services. For more information about the improvements to CCM and new billable services, read MGMA’s member-exclusive analysis of the 2017 PFS final rule.
7. New efforts promote revenue cycle automation
Despite the inclusion of numerous administrative simplification provisions in HIPAA and the ACA, industry adoption of automated administrative transactions is less than optimal. In 2017, both the public and private sectors are expected to move forward with new standards and initiatives aimed at increasing the use of electronic administrative transactions. It is anticipated that CMS will publish a long-awaited regulation establishing a standard for electronic attachments that could greatly simplify the process of supporting claim submission or other requests from health plans for patient medical records in addition to other expected regulations and guidance. Further, MGMA and other provider organizations are actively engaging the government, commercial health plans, vendors and others to join in working to reduce the burdens associated with revenue cycle tasks such as prior authorization, establishing patient insurance eligibility, and receiving payment for medical services.
8. Forecast unclear: Will health plan mergers continue under new Administration?
Mergers, acquisitions and consolidation among healthcare insurers have been on the rise, but the direction of these types of partnerships remains uncertain under a Trump Administration. The Department of Justice (DOJ) and Federal Trade Commission (FTC) continue to police these consolidations, most notably with the DOJ moving to block mergers between four of the five largest health insurance plans—Aetna’s acquisition of Humana and Anthem’s acquisition of Cigna. Complaints filed by the DOJ in July alleged the unions would restrict competition and potentially harm American consumers by increasing prices and reducing benefits. Decisions in both matters are imminent. While antitrust issues are somewhat insulated from political shifts, President-Elect Trump’s philosophy on anti-competition policy is largely unknown. Policy shakeups, such as ACA repeal, may also play a role in the race toward consolidation and whether the demise of the federal exchanges could lead to a significant shift in market power.
9. Unprecedented amount of Medicare quality and financial data slated to go public
In recent years, Medicare has been steadily increasing the amount of clinician data it discloses to the public related to performance on quality metrics and financial relationships with drug and device manufacturers through the Physician Compare and Open Payments websites. Provided the incoming Administration proceeds with these ongoing transparency initiatives, 2016 Open Payments data is scheduled to be released in mid-2017 and 2016 PQRS data is expected to be posted to the Physician Compare site in late 2017. For the first time, CMS will publish PQRS data submitted by individual clinicians, as well as PQRS data reported by group practices and ACOs. MGMA has raised concerns over the potential adverse consequences of publishing data that has a reputation for being outdated, inaccurate and subject to misinterpretation and will continue to work with the new Administration to ensure that any data reported is accurate and easily interpretable for consumers.
10. Patient data security at risk now more than ever—practices vulnerable to breaches, audits
The healthcare environment has witnessed a marked increase in the number of data breaches, both accidental and by unauthorized individuals. As more patient data is being stored and transmitted electronically, physician practices are increasingly vulnerable to internal and external security threats. Several federal agencies, including CMS, the Office for Civil Rights, and the Office of the Inspector General, are more actively enforcing HIPAA privacy and security regulations. Conducting a comprehensive risk analysis and review of your organization’s policies and procedures is your best defense against experiencing a data breach or failing a government audit, and is required under MIPS. Access MGMA’s HIPAA Resource Center for tools and guidance.
TMGMA monitors legislative/regulatory issues through our Legislative Committee, chaired by Sharon Cannon, CMPE. Members receive periodic Legislative Updates, including information provided by the Tennessee Medical Association (TMA) and the MGMA Government Affairs staff in Washington, DC.
With national legislative and regulatory issues constantly before our Congressional Leaders, it is critical that medical practice executives know their elected officials. Access the MGMA Legislative Action Center by Clicking HERE.
When members of MGMA (and TMGMA) voice their concerns to legislators at both the state and national level, they are taking one of the most important steps available to individuals and groups to influence the outcome of decisions affecting the medical practice industry, MGMA, its Government Affairs Department, and the TMGMA Legislative Committee are here to support member efforts with helpful tools and suggestions for successful grassroots advocacy.
MGMA provides a number of guides for effective communications with legislators:
Increase Your Effectiveness: