Podcasts about chip reauthorization act macra

Six years after the Medicare Access and CHIP Reauthorization Act (MACRA 2015), Vynamic's Mindy, Ryan, and Jen discuss where we are today in the transition from Fee-For-Service (FFS) reimbursement to Value-Based Care (VBC). The episode opens with an acknowledgment that VBC is at a crossroads – the transition has been bumpy, VBC models have been “consistently inconsistent” (2:10), and the misalignment of payer and provider compensation models continues to be an ongoing challenge (3:18). The conversation then moves to what is needed for this transition to VBC to be successful; it requires operational overhaul (5:10), robust analytics, appropriate engagement of providers, and health system transparency. Innovation takes time and transitioning to VBC requires a shift in cultural mindset and a detailed strategy for change and adoption (8:10). The episode then explores what VBC means for Life Sciences companies, as the industry starts to reckon with the development of more expensive products with higher intrinsic value (14:50), including curative one-time treatments and gene therapies. From a market access perspective, Life Sciences companies should be creative with contracting and how they approach payers and providers about the products they bring to the market (15:18). Ultimately, these stakeholders will need to reach a middle ground to make products accessible to the right patients (20:04). As an industry, we should strive for “the art of the possible” (21:33) and engage in cross-sector thinking to make VBC models successful. Podcast Tags: healthcare, MACRA, fee-for-service, value-based care, reimbursement, innovation, Life Sciences, strategy, market access, value-based payment over time (VBPOT) Source Links - Below, we've listed links to some of the facts and resources discussed on this show. - https://revcycleintelligence.com/features/entering-the-next-phase-of-value-based-care-payment-reform - https://www.fiercehealthcare.com/payer/new-cmmi-director-says-value-based-care-models-at-crossroads?mkt_tok=Mjk0LU1RRi0wNTYAAAF8k4XqnunZZyMo3p_xn3tEs3yH708uXgCNuApAFnJQHSR0EYcv1E2LCt6NlhnrwdH2JyVf-V_pxlSfU24GHKz3P3xDIZMa8jQIoLXYaPdibJyNaBh1Cc4&mrkid=152778267 - https://www.fiercehealthcare.com/payer/verma-says-value-based-care-models-haven-t-made-good-return-investment - https://www.fiercehealthcare.com/payer/providers-call-for-another-chance-to-sign-up-for-direct-contracting-model?mkt_tok=Mjk0LU1RRi0wNTYAAAF8dKGQQGD5eCW9fP3QjJTt2D336_V8b5iB8tDE7JqOsFLKdsRpvjVAlrQMysKq4T7UamDcOD1mve6rocLCDDeRVC2cdYdiQ8iLjpaC6J0UFZyS_CaD5xk&mrkid=152778267 - https://www.fiercehealthcare.com/practices/medical-groups-urge-cms-to-walk-back-aco-quality-overhaul-citing-potential-negative?mkt_tok=Mjk0LU1RRi0wNTYAAAF824GfFyUI8FL_gS064nifCYSR3Zuk0KLpuNBZaeS1tB3UYGjMu883L-Dr2vtKP2pn19XwOcAZW-KlyrW9Zq1P7IUionDrt-hi739yRxkSO6YfNeiaYl4&mrkid=152778267 - https://revcycleintelligence.com/news/a-new-administration-value-based-payment-to-dictate-2021-success - https://www.fiercehealthcare.com/practices/industry-voices-3-questions-providers-need-to-prioritize-as-they-look-to-take-more-risk?mkt_tok=eyJpIjoiWW1JeFpESmlPRFEwWkRsaSIsInQiOiJ2dlcwTkRqUUVsUUpUVm94T2h3cTd5UzNYcWp0cUJwZHpKVWUxZUxZVXRFVTFWamx4Ykh1NDJXckptYVIxZitFQzBDM1VvcncrWGRsQ1JNUzdDK2lOTURPOVQ2RVAzQmNib0dsWDVIOUhhMmlqOEpGc01aUGd4dktrU1RXNmVnWHpqaGFSb3RBYWdBZ3hOWXMzZnpzWkE9PSJ9&mrkid=152778267 - https://digitally.cognizant.com/value-based-care-in-life-sciences-whats-it-worth-to-you-third-of-a-multipart-series-codex5396/ - https://www.zs.com/insights/new-era-value-based-contracts - https://www.bakertilly.com/insights/implications-of-value-based-care-for-the-life-sciences For additional discussion, please contact us at TrendingHealth.com or share a voicemail at 1-888-VYNAMIC. Mindy McGrath, Healthcare Industry Learning Lead mmcgrath@vynamic.com Ryan Hummel, Executive rhummel@vynamic.com Jen Burke, Healthcare Industry Strategist jburke@vynamic.com

Roz Cordini, Brandt Jewell, and Alex Kirkland join Mark for a webinar to discuss the Medicare Quality Payment Program (QPP). The discussion was recorded live during its presentation on January 24, 2019. Contact Information Subscribe to our feed in Apple Podcasts, Google Podcasts, Spotify, or your preferred podcast provider. Like what you hear? Leave a review! Not there? Let us know! We welcome all feedback from our listeners. Please submit questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on topics for future episodes. Email us: feedback@cokergroup.com Connect with us on LinkedIn: Coker Group Company Page Follow us on Twitter: @cokergroup Follow us on Instagram: @cokergroup Webinar Description As part of the Medicare Access and CHIP Reauthorization Act (MACRA), the Medicare Quality Payment Program (QPP) was established and consists of two participation pathways for clinicians: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs). CMS has been gradually implementing the full scope of MACRA over the past three years, and January 1, 2019, marks the beginning of MIPS adjustments to Medicare Part B fee-for-service revenue. The panel discussion will focus on identifying potential pain points for healthcare organizations as a result of MACRA and review key changes for CY 2019 as outlined in the final rule. Learning Objectives Identify the potential pain points of full MACRA implementation and outline the first steps organizations should take to alleviate issues. Review the final rule for the quality payment program and how these changes impact APMs and MIPS. Discuss the impact E/M changes will have on reimbursement and physician compensation. Extras Webinar Recording Handout - Presentation Slides

Craig Hunter, Jeannie Cagle, Kay Stanley, and Max Reiboldt join Mark to share the history of Coker Group and how the firm was founded. The discussion was recorded live during its presentation to the company as part of the 2018 Coker Group annual meeting. Contact Information Subscribe to our feed in Apple Podcasts, Google Podcasts, Spotify, or your preferred podcast provider. Like what you hear? Leave a review! Not there? Let us know! We welcome all feedback from our listeners. Please submit questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on topics for future episodes.  Email us: feedback@cokergroup.com Connect with us on LinkedIn: Coker Group Company Page Follow us on Twitter: @cokergroup Follow us on Instagram: @cokergroup The History Established by Jackson C. Coker in 1987, Coker Group began as a physician relations firm whose purpose was to develop and enhance the relationships between hospitals and their medical staffs. The newly founded company moved into its first offices in 1988 with a small team from Atlanta and California. With extraordinary success and a growing list of hospital clients, Coker strengthened its footing through a focus on building hospital and physician relations through educating physicians and their staffs to improve their operational processes and enhance their business models. Delivering educational programs and assistance with medical practice management became the business model for this young company. Coker began to memorialize its expertise in the mid-‘90s through the publication of materials to enhance practice operations and financial management. Through the years, Coker has worked with national associations and other healthcare societies and entities to complement the work of its consultants with hospitals and physicians. Under the strong leadership of Max Reiboldt, upon Jack Coker’s retirement in the mid-1990s, Coker Group continued to respond to the needs of hospitals and physicians as healthcare transitioned from one reimbursement paradigm to another through the late 1990s and beyond. During this period, the firm shifted its emphasis from the original physician relations’ services to become a full-fledged healthcare advisory firm. Through its history, the firm has met the complexity and expansion in healthcare that has occurred into the 21st Century. Coker Group holds a notable position as leading business advisors to the healthcare industry, assisting with complex negotiations between hospitals and physicians. Through five main services areas--strategy, operations, finance, technology, and compliance--the firm’s mission is still to provide healthcare organizations with innovative, principled solutions to achieve their optimum level of productivity. Join us on January 24, 2019, at 2:00 pm, for the live panel discussion, One Month into MACRA! As part of the Medicare Access and CHIP Reauthorization Act (MACRA), the Medicare Quality Payment Program (QPP) was established and consists of two participation pathways for clinicians: Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs). CMS has gradually implemented the full scope of MACRA over the past three years, and January 1, 2019, marks the beginning of MIPS adjustments to Medicare Part B fee-for-service revenue. The panel discussion will focus on identifying potential pain points for healthcare organizations as a result of MACRA and review key changes for CY2019 as outlined in the final rule. Learning Objectives Identify the potential pain points of full MACRA implementation and outline the first steps organizations should take to alleviate issues. Review the final rule for the quality payment program and how these changes impact APMs and MIPS. Discuss the impact E/M changes will have on reimbursement and physician compensation. Sign-Up for the Live Event today! Extras Pictures and Tweets from #CokerLive2018 Follow Craig on Twitter Follow Max on Twitter Connect with Craig on LinkedIn Connect with Jeannie on LinkedIn Connect with Kay on LinkedIn Connect with Max on LinkedIn

Jessica Combs joins Mark to in a Q&A style discussion to address recent questions on healthcare trends. Mark addresses each question on various topics including private equity interest in healthcare, the opioid crisis, neutral site payments, healthcare technology, and revenue cycle management. Questions We have heard much discussion in the media and throughout this election season on the opioid crisis, but I’m curious if this is something of a significant impact yet on physicians and medical groups or hospitals. Have you observed any specific instances where the talk in the media and Washington has resulted in major changes – positive or negative – for healthcare entities?  We have been monitoring the issue of “neutral site payments” all year, as this could have a significant impact on hospital payments for those entities that have spent a lot of time and dollars investing in outpatient services. Can you comment on what has happened with this matter and perhaps make any predictions for how the results of the midterm elections could influence the outcome on this issue? In listening to your episode on what hospital boards should be thinking about concerning healthcare technology, we have been paying a lot of attention to the frequent stories that emerge about fines and legal issues (not to mention PR concerns) that many hospitals are dealing with in protecting records, maintaining security in the information systems, and lacking appropriate documentation. However, there are so many facets of protecting data that an organization like a hospital – even a relatively small, rural community hospital – must consider that it’s challenging to think about where to start. How would you suggest a leadership team begin to confront this issue to ensure we have as much protection as possible from some of those risks? Our organization has been struggling from revenue stagnation (and even drops in some cases) that we know are not tied to negative changes in payer contracts, fee schedule changes, expense management, or even the billing and collections component of the revenue cycle. So, we think the issue could be related to coding; however, in the past, our focus on coding has mainly been to ensure our providers are not up-coding. How could coding issues play into the broader revenue cycle management procedures? As it has become commonplace to see hospitals buying physician groups, some local markets have seen significant shifts as a result of larger groups selling to hospitals. Meanwhile, new players, such as large corporate systems or groups backed by private equity investors are entering markets and competing with the hospitals for acquiring major physician groups, which can significantly shake up the dynamic between the physicians within those groups and the hospitals they interact with on a regular basis at a local level. My question is twofold: 1) Have you seen this take place; and, 2) how might this trend potentially shake up local healthcare markets more in the future? Can hospitals compete with outside players that bring significant financial resources to invest in such deals?  Extras The Next Stage of Evolution in Physician Practice Transactions Coffee with Coker Episode 17: Executives Beware: Five Questions Astute Boards are Asking about Healthcare IT Follow Mark on Twitter Connect with Mark on LinkedIn Connect with Jessica on LinkedIn   Join us on January 24, 2019, at 2:00 pm for the live panel discussion One Month into MACRA! As part of the Medicare Access and CHIP Reauthorization Act (MACRA), the Medicare Quality Payment Program (QPP) was established and consists of two participation pathways for clinicians: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs). CMS has been gradually implementing the full scope of MACRA over the past three years, and January 1, 2019, marks the beginning of MIPS adjustments to Medicare Part B fee-for-service revenue. The panel discussion will focus on identifying potential pain points for healthcare organizations as a result of MACRA and review key changes for CY 2019 as outlined in the final rule. Learning Objectives Identify the potential pain points of full MACRA implementation and outline the first steps organizations should take to alleviate issues. Review the final rule for the quality payment program and how these changes impact APMs and MIPS. Discuss the impact E/M changes will have on reimbursement and physician compensation. Sign-Up for the Live Event today!   Contact Information Subscribe to our feed in Apple Podcasts, Google Podcasts, Spotify, or your preferred podcast provider. Like what you hear? Leave a review! Not there? Let us know! We welcome all feedback from our listeners. Please submit questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on topics for future episodes.  Email us: feedback@cokergroup.com Connect with us on LinkedIn: Coker Group Company Page Follow us on Twitter: @cokergroup Follow us on Instagram: @cokergroup

Nearly 30 days ago, we posed the question “Are HIM Coding Professionals Qualified to Query for Clinical Validity?” leading up to the July 17 edition of Talk Ten Tuesdays, and the responses continue to roll in, nearly unabated. Specifically, we asked at that time, “are seasoned coding professionals competent or trained well enough to interpret clinical terms and concepts from the medical record?” And many of you responded with an unequivocal “yes.” As a consequence, we will proceed with Part II of this series, when we continue to explore reaction to this question – which, after decades, still remains contentious. Reporting our lead story during this edition of Talk Ten Tuesdays will be Anny Pang Yuen, author, consultant, and founder of AP Consulting Associates, LLC. Other segments to be featured on the broadcast include: News Desk: Larry Field, DO, anchors the Talk Ten Tuesdays News Desk with the very latest healthcare news. Field is the treasurer of the American College of Physician Advisors. Dateline Washington: Talk Ten Tuesdays legislative analyst Rhonda Taller has the latest news coming out of Washington, D.C. Rhonda is a member of the HIMSS professional development committee. Tuesday Focus: The Medicare Access and CHIP Reauthorization Act (MACRA) and the Merit-Based Incentive Payment System (MIPS) can be complicated and confusing for medical practices. Nationally recognized coding authority Terry Fletcher reports on the need for providers to balance regulatory compliance with efficiency. TalkBack: Talk Ten Tuesdays co-host Erica Remer, MD, FACEP, CCDS, founder and president of Erica Remer, MD, Inc., reports on the results of last Tuesday’s Talk Ten Tuesdays Listener Survey, asking if your facility has clinical documentation improvement (CDI) on the weekends. Talk Ten Tuesdays. More than just talk.™

Dr. Ellis “Mac” Knight joins Mark to discuss value-based healthcare and its impact on the healthcare industry. They cover financing as a driving force in the healthcare landscape and why it continues to become more complex with the shift from pay for service to value-based care. Episode Synopsis With budgetary pressures on Medicare and Medicaid, pay for performance and federal expectations for investment in technology without regard to costs, executives must continuously monitor the financing landscape. The most significant factor in healthcare reimbursement today is the industry-wide shift to value-based care. So, what is value-based care? One of the more common buzz phrases in the healthcare industry, value-based care, is a shift in focus. For the past two decades, healthcare providers have focused their efforts on the volume of services they are providing, not on the quality of services they are delivering. The reason is simple: physicians were paid only for the volume of professional services. In 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) was passed and ushered in a dramatic change in the way CMS will pay healthcare professionals. MACRA consolidated multiple pay-for-performance initiatives (PQRS, VPM, and MU) into two quality payment programs (QPPs), the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).  Dr. Knight and Mark provide their views on the move toward value-based reimbursement and the reality of healthcare for the past 15 years. Extras MACRA, what IS it? White Paper on Value-Based Reimbursement White Paper on MACRA Connect with Dr. Knight on LinkedIn Follow Dr. Knight on Twitter Contact Information Subscribe to our feed in Apple Podcasts, Google Play, or your preferred podcast provider. Like what you hear? Leave a review! Not there? Let us know! We welcome all feedback from our listeners. Please submit questions on any of the topics we discuss or questions about issues in which you have an interest. You can also provide recommendations on topics for future episodes.  Email us: feedback@cokergroup.com Follow us on Twitter: https://twitter.com/cokergroup Connect with us on LinkedIn: https://www.linkedin.com/company/coker-group/

Host: Alicia A. Sutton Guest: Andrew Rosenberg, JD, MP Guest: Thomas Sullivan Join in as Andrew Rosenberg, JD, MP, Senior Advisor of CME Coalition and Thomas Sullivan, President, and Founder of Rockpointe, discuss how CE providers will be able to offer a PI-QI improvement activity under the Medicare Access and CHIP Reauthorization Act (MACRA). They will also address the MACRA law’s physician incentives for quality care under Medicare, a breakdown of the Quality Payment Program and CE Opportunities, the newly adopted QI CME Improvement Activity, and more!

Dr. Scott Speelziek interviews Dr. Pushpa Narayanaswami and Dr. Lyell K Jones about the article, The Value Transformation of Heath Care: Impact on Neuromuscular and Electrodiagnostic Medicine. Beginning in 2017, most physicians who participate in Medicare are subject to the Medicare Access and CHIP Reauthorization Act (MACRA), the milestone legislation that signals the US health care system's transition from volume-based to value-based care. Here we review emerging trends in development of value-based healthcare systems in the US. MACRA and the resulting Quality Payment Program create 2 participation pathways, the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (AAPM) pathway. Although there are several program incentives for AAPM participation, to date there have been few AAPM options for specialists. MIPS and its widening bonus and penalty window will likely be the primary participation pathway in the early years of the program. Value-based payment has the potential to reshape health care delivery in the United States, with implications for neuromuscular and electrodiagnostic (EDX) specialists. Meaningful quality measures are required for neuromuscular and EDX specialists. Muscle Nerve 56: 679-683, 2017.

Dr. Scott Speelziek interviews Dr. Pushpa Narayanaswami and Dr. Lyell K Jones about the article, The Value Transformation of Heath Care: Impact on Neuromuscular and Electrodiagnostic Medicine. Beginning in 2017, most physicians who participate in Medicare are subject to the Medicare Access and CHIP Reauthorization Act (MACRA), the milestone legislation that signals the US health care system's transition from volume-based to value-based care. Here we review emerging trends in development of value-based healthcare systems in the US. MACRA and the resulting Quality Payment Program create 2 participation pathways, the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (AAPM) pathway. Although there are several program incentives for AAPM participation, to date there have been few AAPM options for specialists. MIPS and its widening bonus and penalty window will likely be the primary participation pathway in the early years of the program. Value-based payment has the potential to reshape health care delivery in the United States, with implications for neuromuscular and electrodiagnostic (EDX) specialists. Meaningful quality measures are required for neuromuscular and EDX specialists. Muscle Nerve 56: 679-683, 2017.

Dr. Scott Speelziek interviews Dr. Pushpa Narayanaswami and Dr. Lyell K Jones about the article, The Value Transformation of Heath Care: Impact on Neuromuscular and Electrodiagnostic Medicine. Beginning in 2017, most physicians who participate in Medicare are subject to the Medicare Access and CHIP Reauthorization Act (MACRA), the milestone legislation that signals the US health care system's transition from volume-based to value-based care. Here we review emerging trends in development of value-based healthcare systems in the US. MACRA and the resulting Quality Payment Program create 2 participation pathways, the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (AAPM) pathway. Although there are several program incentives for AAPM participation, to date there have been few AAPM options for specialists. MIPS and its widening bonus and penalty window will likely be the primary participation pathway in the early years of the program. Value-based payment has the potential to reshape health care delivery in the United States, with implications for neuromuscular and electrodiagnostic (EDX) specialists. Meaningful quality measures are required for neuromuscular and EDX specialists. Muscle Nerve 56: 679-683, 2017.

Are you ready for the Medicare number change?  This podcast will help you to prepare your staff and your patients.  Billing Buddies strives to help healthcare providers in billing and compliancy issues.  Our hope is the healthcare providers will pass their knowledge to coworkers and patients.  If you have any questions, please feel free to call or text the author, Bonnie at 612.432.2366.  Thank you. Podcast Details: Authority:  https://www.cms.gov/medicare/ssnri/  Details:   The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, requires Medicare to remove Social Security Numbers (SSNs) The initiative will begin in April 2018 and will be complete April 2019.  New number called Medicare Beneficiary Identifier. (MBI) Approach:  Keep your patients informed of the change to come with their Medicare policy numbers and cards.  Be prepared to start collecting new cards and identification from your patients.    

Sydney Welch Does My Practice Still Need To Prepare For MACRA? Lawmakers changed the way Medicare physicians and other health care professionals are paid when they passed the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015. MACRA resulted in the Medicare Quality Payment Program (QPP), which is designed to move physicians from a fee-for- […] The post Does My Practice Still Need To Prepare For MACRA? appeared first on Business RadioX ®.

MediStrategy with Kip Piper Episode 10: Value-Based Purchasing with Healthcare Consultant Nancy Kohler of Sellers Dorsey Summary Savvy consumers seek the best value for their money, evaluating the benefits of a product prior to purchase. Elsewhere in the economy, it seems obvious that we should hold a manufacturer accountable for delivering a quality product. With health care reform, this concept has at last been applied to medical care via the value-based purchasing model. Rather than simply paying fee-for-service which rewards volume, health care consumers, health plans, and purchasers - state Medicaid programs, federal Medicare program, and employers - can hold providers responsible for outcomes. As a consultant with Sellers Dorsey, Nancy Kohler provides assistance in federal and state health policy issues, financial analysis, and project management. Before joining the firm, she played a key role in the implementation and operational aspects of the Statewide Quality Care Assessment for the Pennsylvania Department of Human Services. The initiative provided millions of dollars in revenue to the Commonwealth's many hospitals and modernized Pennsylvania Medicaid hospital reimbursement. Ms. Kohler's comprehensive portfolio of experience includes both large and small scale public health program operations, policy development and fiscal analysis. She spent 20-plus years at KePRO, dedicating the last six years of her tenure as the vice president of public programs. Nancy Kohler has her master’s degree in Health Services Administration and is a Registered Health Information Administrator and Certified Professional in Healthcare Quality. In this episode, she outlines the core characteristics of the value-based purchasing model, the challenges faced by Medicaid in transitioning to value-based purchasing, and the federal and state collaboration key to further reform efforts. Well-versed in how current legislative proposals might affect value-based purchasing, Kohler explores Congress' efforts to repeal and replace the ACA, the fate of MACRA, and HHA Secretary Price’s advocacy for relief from administrative burdens. Subscribe in iTunes | Stitcher | SoundCloud | Libsyn | RSS Feed Topics Covered [2:48] How Kohler got involved in value-based purchasing Working in healthcare for 25 years Managed large, complex federal and state projects in quality improvement Appreciates the diversity of a career in health care management Values the ability to make an impact on the health and well-being of populations served Welcomes the opportunities for innovation and learning Led TRICARE national quality monitoring contract, gained insight into how managed care organizations provide oversight Current role involves value-based purchasing initiatives for several state Medicaid programs [6:47] Goals of value-based purchasing model Control rising costs Improve outcomes Replace ineffective volume based fee-for-service model [7:36] Core characteristics of value-based purchasing Measures provider performance Assigns accountability (transparent, timely, actionable approaches) Uses reimbursement/incentive pay to achieve quality-related goals Aligns finances of reimbursement with patient outcomes Places providers at risk for their performance Drives care delivery reform [11:01] Challenges faced by Medicaid in transition to value-based purchasing Complying with fluid, highly complex federal regulations Limited experience with new payment models Complexity of implementation Limited resources Budget planning processes Collection, exchange, a and integrity of data [14:08] The role of the state with respect to value-based purchasing Hold providers and managed care organizations accountable for cost and quality of care Lead and grow innovations in VBP Implement alternative payment models (states as laboratories of reform) [20:38] The role of federal collaboration in furthering state level reforms in payment and care delivery Joint financing States design program within federal standards HHS can waive certain Medicaid requirements, provide funding for options not otherwise allowed Trump administration proposed changes (limit federal financing, increased flexibility for states) [27:03] Kohler’s work to further value-based purchasing initiatives Assist states in developing VBP strategy Draft proposals that ensure improved outcomes Design innovative solutions specific to the state’s needs [30:37] How proposed legislation to repeal and replace the ACA may affect value-based purchasing VBP models enjoy bipartisan support Transition to VBP in motion, likely to continue HHS Secretary Price advocates relief from administrative burdens of ACA Proposals make system more straightforward and less complex [35:54] The pace of value-based purchasing initiatives Delay in bundled payment programs Possible changes in the mechanics VBP will continue to gain momentum [42:27] The shift of risk to providers Unsustainable growth of healthcare costs Providers accountable for driving cost-effective care, improved quality and better patient outcomes Even if ACA repealed/replaced, move to alternative payment models likely to remain ACA replacement proposals seek to make APM participation easier for providers [44:56] How the Medicare Access and CHIP Reauthorization Act (MACRA) fits within payment reform Enacted two years ago Moves Medicare Part B physician reimbursement to value-based model Created a new quality payment program Drives providers to alternate payment models such as accountable care organizations (ACOs) and bundled payment No talk of MACRA repeal at present Connect with Nancy Kohler and Sellers Dorsey  Sellers Dorsey Website Twitter LinkedIn Connect with Kip Piper, MA, FACHE, Host of MediStrategy Website Twitter Piper Report Blog LinkedIn About MediStrategy and Kip Piper The MediStrategy podcast offers informative interviews with healthcare leaders and insights on hot business and policy issues in Medicare, Medicaid, and health reform.  Health executives, policymakers, entrepreneurs, authors, and other influencers share challenges and opportunities in America’s rapidly changing $3.2 trillion health care system. MediStrategy is hosted by Kip Piper, a top expert on Medicaid, Medicare, and health reform. A prominent consultant, speaker, and author, Kip Piper advises health plans, state Medicaid agencies, hospitals and health systems, provider associations, life sciences companies, and investment firms.  Subscribe in iTunes | Stitcher | SoundCloud | Libsyn | RSS Feed

Dr. Miles Snowden, the Chief Medical Officer at TeamHealth, shares his personal insight on the Medicare Access and CHIP Reauthorization Act (MACRA), and what it means for physicians, hospitals, and consumers. Dr. Snowden has seen a lot of changes throughout his career, but none so impactful as the implementation of the Merit-based Incentive Payment System.

Listen NowSince the passage of the Affordable Care Act in 2010 CMS has been working to reform Medicare reimbursements from "fee for service" to "fee for value."  (Earlier this year Secretary Burwell noted 30% of traditional or "fee for service" Medicare reimbursements are now tied to quality or value.)  The Medicare Access and CHIP Reauthorization Act (MACRA) passed in 2015 accelerates this transition by incenting Medicare providers to participate in "fee of value" or pay for performance agreements, termed Alternative Payment Models (APMs) under MACRA, with a 5% annual bonus.  To date, commercial Medicare Advantage (MA) plans (Medicare Part D) have been immune from these reforms.   However, under MACRA beginning in performance year 2019 MA plan providers can potentially count their MA reimbursements and MA beneficiaries toward qualifying for the 5% MACRA APM bonus - if they meet the financial risk and other qualifying MACRA APM criteria.  To what extent MA plans, that now account for nearly one-third of all Medicare beneficiaries, will work with their provider partners to meet the MACRA APM qualifying criteria is unknown.      During this 23 minute conversation Ms. Turco discusses expectations for MA plan participation under MACRA as qualifying APMs, how MA stakeholders are thinking about moving the program outside of MACRA toward improved value or reduced spending growth, CMS's MA Value Based Insurance Design (VBID) demonstration scheduled to begin in January and anticipated MA reforms under a new White House administration next year.   Ms. Molly Turco is presently Director of Policy and Research at the Better Medicare.  Previously, Ms. Turco was a Senior Healthcare Policy Analyst with the Marwood Group.   Ms. Turco also worked as a Healthcare Policy Researcher in the State of Vermont Office of Health Reform, within the University of Pennsylvania Health System and at Dartmouth Hitchcock Medical Center and the Geisel School of Medicine at Dartmouth.  Ms. Turco holds a MPH from the Dartmouth Institute for Health Policy and Clinical Practice and a BA from Middlebury College.   This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Host: Matt Birnholz, MD Guest: Lawrence Kosinski, MD The advancement of the Medicare Access and CHIP Reauthorization Act (MACRA) has catapulted Alternative Payment Models into the spotlight for identifying new value-based approaches to care. But questions persist as to the roles that specialists can and should play in the design and implementation of APMs, how these models will cut healthcare costs, and which administrative partnerships are needed to make them successful. Dr. Lawrence Kosinski, a practicing gastroenterologist with The Illinois Gastroenterology Group, is pioneering one such APM that applies an innovative method for tracking patients between clinic visits. The model, called SonarMD, for which Dr. Kosinski is founder and Chief Medical Officer, provides a web-based platform that pings patients beyond practice settings to help get ahead of issues before they become emergencies.

Host: Matt Birnholz, MD Guest: Lawrence Kosinski, MD The advancement of the Medicare Access and CHIP Reauthorization Act (MACRA) has catapulted Alternative Payment Models into the spotlight for identifying new value-based approaches to care. But questions persist as to the roles that specialists can and should play in the design and implementation of APMs, how these models will cut healthcare costs, and which administrative partnerships are needed to make them successful. Dr. Lawrence Kosinski, a practicing gastroenterologist with The Illinois Gastroenterology Group, is pioneering one such APM that applies an innovative method for tracking patients between clinic visits. The model, called SonarMD, for which Dr. Kosinski is founder and Chief Medical Officer, provides a web-based platform that pings patients beyond practice settings to help get ahead of issues before they become emergencies.

Host: Matt Birnholz, MD Guest: Lawrence Kosinski, MD The advancement of the Medicare Access and CHIP Reauthorization Act (MACRA) has catapulted Alternative Payment Models into the spotlight for identifying new value-based approaches to care. But questions persist as to the roles that specialists can and should play in the design and implementation of APMs, how these models will cut healthcare costs, and which administrative partnerships are needed to make them successful. Dr. Lawrence Kosinski, a practicing gastroenterologist with The Illinois Gastroenterology Group, is pioneering one such APM that applies an innovative method for tracking patients between clinic visits. The model, called SonarMD, for which Dr. Kosinski is founder and Chief Medical Officer, provides a web-based platform that pings patients beyond practice settings to help get ahead of issues before they become emergencies.

Host: Matt Birnholz, MD Guest: Lawrence Kosinski, MD The advancement of the Medicare Access and CHIP Reauthorization Act (MACRA) has catapulted Alternative Payment Models into the spotlight for identifying new value-based approaches to care. But questions persist as to the roles that specialists can and should play in the design and implementation of APMs, how these models will cut healthcare costs, and which administrative partnerships are needed to make them successful. Dr. Lawrence Kosinski, a practicing gastroenterologist with The Illinois Gastroenterology Group, is pioneering one such APM that applies an innovative method for tracking patients between clinic visits. The model, called SonarMD, for which Dr. Kosinski is founder and Chief Medical Officer, provides a web-based platform that pings patients beyond practice settings to help get ahead of issues before they become emergencies.

Listen NowIn an extremely busy year for Medicare delivery and payment reform,  regulatory implementation of the 2015 Medicare Access and CHIP Reauthorization Act (MACRA) stands out.   This past April CMS published the agency's 960-page proposed rule to implement the law.  The proposed rule, that will go final this fall, will change the way Medicare physician payments (Medicare Part B) are annually updated beginning in payment year 2019.   Payment updates, either at the individual provider or at the group level, will be calculated either by the Merit-based Incentive Payment System (MIPS), a composite score based on four, differently weighted, component scores, or via provider participation in what CMS defines as an "advanced" Alternative Payment Model (APM) pathway, e.g., Track 2 and 3 ACOS and Patient Centered Medical Homes that meet certain financial risk criteria.During this 22-minute discussion Ms. Mara McDermott evaluates how CMS proposes to define APM nominal risk, how the agency has defined the MIPS composite score, the effect MACRA will have on small practices, how Medicare Advantage plans and physicians can be included in MACRA, and several inter-related issues.   (While the introduction to this discussion provides some brief explanatory information, our conversation assumes the listener has some familiarity with Title I of the MACRA law.)    Mara McDermott is the Vice President of CAPG (formerly the California Association of Physician Groups) where she leads the organization's federal legislative and regulatory activities in Washington, D.C.  Prior to joining CAPG, Mara was Counsel in the health industry practice of Akin Gump Strauss Hauer and Field.  Mara received her JD with high honors and her MPH from George Washington University School of Law in 2007.  She received her BA in 2003 from the University of California, Davis.The CMS MACRA proposed rule is at: https://www.federalregister.gov/articles/2016/05/09/2016-10032/medicare-program-merit-based-incentive-payment-system-mips-and-alternative-payment-model-apm Information concerning CAPG is at: http://www.capg.org/ This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com