News and noteworthy information for September 2016:
On September 8, 2016, Acting CMS Administrator Andy Slavitt announced the Centers for Medicare and Medicaid Services’ (CMS) plans to allow flexibilities in participation in the Quality Payment Program for the first performance period that begins January 1, 2017. Slavitt acknowledged that the agency heard concerns expressed by physician organizations about the proposed start date for performance reporting by physicians under the new payment systems created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). In the proposed rule issued in April 2016, CMS proposed to require physicians to begin reporting under the Merit-based Incentive Payment System (MIPS) or through the advanced alternative payment model (APM) option on January 1, 2017, even though the final rule implementing MACRA’s sweeping payment system changes would not be issued until the fall of 2016.
On September 8, Slavitt announced that physicians can “pick their pace” and will be exempt from any risk of penalties if they choose one of four paths for participation in the first year:
Option 1: Test the Quality Payment Program
Under this option, physicians can avoid a negative payment adjustment as long as some data is submitted to the Quality Payment Program, including data from after January 1, 2017. This first option is designed to ensure that your system is working and that you are prepared for broader participation in 2018 and 2019 as you learn more.
Option 2: Participate for part of the calendar year
Under this option, physicians may choose to submit data to the Quality Payment Program for a reduced number of days. This means your first performance period could begin later than January 1, 2017 and your practice could still qualify for a small positive payment adjustment. For example, if you submit information for part of the calendar year for quality measures, how your practice uses technology, and what improvement activities your practice is undertaking, you could qualify for a small positive payment adjustment.
Option 3: Participate for the full calendar year
Under this option, physicians may choose to submit data to the Quality Payment program for a full calendar year. This option is designed for practices that have internal systems ready for data reporting on January 1, 2017. This means your first performance period would begin on January 1, 2017. For example, if you submit information for the entire year on quality measures, how your practice uses technology, and what improvement activities your practice is undertaking, you could qualify for a modest positive payment adjustment.
Option 4: Participate in an Advanced Alternative Payment Model in 2017
Instead of reporting quality data and other information, the law allows physicians to participate in the Quality Payment Program by joining an Advanced Alternative Payment Model in 2017. If you receive enough of your Medicare payments or see enough of your Medicare patients through the Advanced Alternative Payment Model in 2017, then you would qualify for a 5 percent incentive payment in 2019.
More details will be included in the final rulemaking scheduled for release on or before November 1, 2016. For more information on MACRA and the Quality Payment Program, visit the ISASS website.
On September 15, Novitas Solutions Inc., the Medicare Administrative Contractor covering Colorado, New Mexico, Oklahoma, Texas, Arkansas, Louisiana, Mississippi, Delaware, D.C., Maryland, New Jersey, and Pennsylvania released a draft Local Coverage Determination (LCD) for Percutaneous Vertebroplasty and Vertebral Augmentation (Kyphoplasty). Novitas is accepting public comments on the draft LCD until November 3, 2016. Click here to access the draft LCD.
On September 26, the U.S. Food And Drug Administration (FDA) announced a list of private payers and health technology assessment groups that have expressed interest in attending device Pre-Submission meetings to learn more about new devices and provide input to medical device sponsors on clinical trial design and other clinical evidence needed to support coverage decisions.
The FDA’s Center for Devices and Radiological Health has been exploring opportunities to improve patient access to safe and effective medical devices by shortening the time between FDA approval or clearance and device coverage. The clinical evidence required for FDA approval or clearance may be different than the evidence required to obtain coverage which may delay coverage decisions if the medical device sponsors are unaware of the coverage data requirements, and/or need to conduct another clinical trial or gather additional evidence. These potential delays in coverage decisions may ultimately delay patient access to innovative medical devices.
In February 2016, the FDA Center for Devices and Radiological Health’s Payer Communication Task Force announced a voluntary opportunity for collaboration among the FDA, device sponsors, private payers, and health technology assessment groups. The following private payers and health technology assessment groups expressed interest in participating: BlueCross BlueShield Association, Duke Evidence Synthesis Group, ECRI Institute Headquarters, Humana, Kaiser Permanente, National Institute for Health and Care Excellence, and SelectHealth/Intermountain Health.
The Centers for Medicare and Medicaid Services (CMS) will soon be distributing letters to physicians providing services at Critical Access Hospitals and group practices regarding the 2017 Physician Quality Reporting System (PQRS) negative payment adjustment. The letter indicates that the recipient did not satisfactorily report 2015 PQRS quality measures or satisfactorily participate in a qualified clinical data registry in order to avoid the 2017 PQRS negative payment adjustment and, therefore, all of their 2017 Medicare Part B Physician Fee Schedule payments will be subject to a 2.0% reduction.
If you believe that the 2017 PQRS negative payment adjustment is being applied in error, you can submit an informal review request within 60 days of the September 26 release date of the 2015 PQRS feedback reports. Informal review will open on September 26 and close on November 30, 2016. CMS will investigate the merits of your informal review request and issue a decision within 90 days of receipt. To request an informal review, all requests must be submitted via a web-based tool on the Quality Reporting Communication Support Page.
Physicians are encouraged to access and review their PQRS feedback reports and 2015 Annual Quality and Resource Use Reports (QRURs) prior to submitting an informal review request. These reports were released on September 26, 2016. The PQRS Feedback Reports show your program year 2015 PQRS reporting results, including payment adjustment assessment for calendar year 2017. The 2015 Annual QRURs show how physician groups and physician solo practitioners performed in 2015 on the quality and cost measures used to calculate the 2017 Value Modifier as well as their 2017 Value Modifier payment adjustment.
How to Access the Reports:
A recent study sponsored by the American Medical Association and published in the Annals of Internal Medicine shows that physicians spend 27% of their office day on direct clinical face time with patients and 49% of their time on electronic health records and desk work. While in the exam room with patients, physicians spend 52.9% of the time on direct clinical face time and 37% on EHR and desk for. In addition, outside of the office, physicians spend another one to two hours of personal time each night doing additional computer and other clerical work, the study found. The authors observed 57 U.S. physicians in family medicine, internal medicine, cardiology and orthopedics for 430 hours and measured proportions of time spent on direct clinical face time, EHR and desk work, administrative tasks, and other tasks in addition to self-reported after-hours work. These findings help quantify the immense regulatory burden physicians face on a daily basis.