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The Department of Health and Human Services (HHS) released long-awaited proposals that modify the physician self-referral (Stark) and anti-kickback laws. The intent of the proposed rules is to create new exceptions that encourage value-based arrangements and allow for increased patient engagement.

MGMA is evaluating these two proposed rules and will develop comments in the coming weeks. For more information, see HHS' press release.

The 2019 MIPS performance year is in its final months and there are important steps participants can take to ensure successful data reporting. For participants utilizing EHR vendors to submit MIPS data, make time to check-in with those vendors to ensure they are on track to submit data during the submission period early next year. In the past, MGMA members have reported vendors experiencing glitches and computing issues when calculating scores. This is an issue MGMA Government Affairs tracks closely and members are encouraged to reach out to us if they encounter issues. As a reminder, Dec. 31 is the last day MIPS participants can apply for a Promoting Interoperability hardship exception and an extreme and uncontrollable circumstances application. Those that qualify will receive re-weighting of one or more MIPS performance categories.

MGMA joined organizations representing clinicians, hospitals, health systems, and others in encouraging congressional leaders to ensure that the interoperability provisions of the 21st Century Cures Act of 2016 are implemented in a manner that best meets the needs of patients and those who deliver their care. The letter raised concerns that provisions of the recently-proposed Office of the National Coordinator for Health Information Technology interoperability rule, especially prohibitions against information blocking, could increase administrative burdens for practices and jeopardize the security of patient information. The letter called on the government to: 

·     Enhance the privacy and security of patient data being exchanged electronically; 

·     Ensure that appropriate implementation timelines are established, giving practices and their vendor partners sufficient time to deploy and test technology and take into account competing regulatory mandates; and

·     Use discretion in its initial enforcement of the data blocking provisions of the regulation, prioritizing education and corrective action plans over monetary penalties.

The Department of Health and Human Services Office of the Inspector General (OIG) released a report finding that Medicare Part D beneficiaries face avoidable steps that can delay or prevent access to prescribed drugs. Based on 2017 data, the report found that Part D insurers rejected millions of prescriptions presented at pharmacies, yet overturned 73 percent of drug-coverage denials when beneficiaries appealed. The OIG signaled that some of these rejections could have been avoided if the prescribed drugs were on the approved lists, met requirements, or received any required preapprovals. OIG recommends that CMS:

·     Improve electronic communication between Part D insurers and prescribers to reduce avoidable pharmacy rejections and coverage denials; 

·     Reduce inappropriate pharmacy rejections; 

·     Reduce inappropriate coverage denials; and

·     Provide beneficiaries with clear, easily accessible information about Part D insurer performance problems, including those related to inappropriate pharmacy rejections and coverage denials.

MGMA's Annual Regulatory Burden Survey is closing soon. This is your opportunity to provide critical feedback on the impact that federal programs have on your practice. The findings of this research will greatly assist MGMA's advocacy efforts in Washington to reduce burdensome regulations on group practices. Click here to participate in this 5-7 minute survey!

MGMA submitted comments to the Centers for Medicare & Medicaid Services (CMS) on the proposed 2020 Medicare Physician Fee Schedule. MGMA recommended that CMS:

·     Finalize the proposal to maintain separate payment rates for E/M visit levels;

·     Develop the Merit-based Incentive Payment System (MIPS) Value Pathways proposal through continued stakeholder input;

·     Stabilize the MIPS quality performance category by maintaining current data completeness thresholds for longer than a single performance year;

·     Prioritize improvements to the MIPS cost performance category before increasing its weight; and

·     Increase opportunities to participate in Advanced Alternative Payment Models.

In recent months, Congress introduced a number of bills that address the issue of surprise billing. There is widespread agreement that patients should be protected from surprise medical bills and taken out of the middle of payment disputes. However, the current legislative “solutions” give too much power to health plans. Instead of the discounted in-network benchmark rate solution proposed by many of these bills, MGMA advocates for out-of-network payments to be set by leveraging commercial data from independent sources. When this payment rate is insufficient, an independent dispute resolution process should be utilized to determine fair payment for the physician.

Please take a moment to submit a letter to Congress through our Contact Congress portal and ask your representatives to hold health plans accountable.

As part of CMS’s continued phased-in approach to public reporting on Physician Compare, the agency recently published a subset of 2017 QPP information submitted under MIPS and APMs. The information added on profile pages for MIPS eligible clinicians and groups includes select quality measure and CAHPS survey data.

CMS announced the creation of two voluntary and two mandatory Medicare APMs for CY2020. The voluntary models are Kidney Care First and Comprehensive Kidney Care Contracting. CMS also proposed a regulation that would create two mandatory models – End-Stage Renal Disease Treatment Choices (ETC) and Radiation Oncology. 

CMS anticipates that all models will open for participation in CY 2020 and that each model, except for the proposed ETC model, will qualify as an Advanced APM starting in performance year CY 2021. While MGMA strongly supports the creation of new voluntary APM opportunities, we oppose mandatory models that subject group practices to untested payment structures that lack evidentiary support. To learn more about these new opportunities, visit MGMA’s APM landing page.

CMS has released data outlining preliminary, high-level results of participation data in the 2018 Quality Payment Program (QPP). A key takeaway from 2018 performance is that a higher percentage of participants in MIPS avoided a negative adjustment compared to 2017 performance (almost 98% versus 93%). Additional details of 2018 QPP participation include:

·     The total number of clinicians who participated in MIPS in 2018 was 559,230, down from 716,603 in 2017;

·     Small practice participation in MIPS increased to 89.2% in 2018, up from 81% in 2017; and

·     The number of Advanced Payment Model Qualifying Participants (QPs) rose to 183,306 in 2018, up from 99,076 in 2017.

MGMA members who believe an error has been made to their 2018 performance final scores can request a targeted review through the QPP website until September 30, 2019.