The Pulse is the bi-weekly e-newsletter from The Physician Alliance, one of Michigan's largest physician organizations serving more than 2,200 primary care and specialty physicians.
The Pulse of The Physician Alliance
Friday, Sept. 30, 2016
A path to payment - an overview of MACRA's Merit-Based Incentive Payment System (MIPS)

As a follow up to our first article on the Medicare Access and CHIP Reauthorization Act (MACRA), the Centers for Medicare and Medicaid Services (CMS) created this program to help reform Medicare payments. A goal of the MACRA Quality Payment Program (QPP) is to pay for value and better care, linking quality to payments. The two paths to payment are the Merit-Based Incentive Payment System (MIPS) and the Advanced Payment Models (APMs).
In breaking down the first link to payment, MIPS is a new program that consolidates the Medicare quality programs into one program incorporating elements from Meaningful Use (MU), Physician Quality Reporting System (PQRS) and Value-based Payment Modifier (VBPM).
MIPS will base payments on four categories:
  1. The quality measure accounts for 50% of the score and combines the PQRS and the VBPM. This category reduces the number of measures from nine to six measures that allow eligible professionals (EPs) more flexibility in choosing measures to report that are geared toward scope of practice and outcomes.
  2. Advancing care information accounts for 25% of the score and replaces the Medicare Electronic Health Records (EHR) "Meaningful Use" physician incentive program. This category will not require physicians to report the former all or nothing EHR measurement. Scoring includes a base score, performance score and bonus points. Clinicians will choose to report custom measures reflecting how they use EHR technology in their daily practice with regards to information exchange and interoperability.
  3. Clinical practice improvement activities account for 15% of the score and include care coordination, beneficiary engagement and patient safety. Clinicians will be able to select activities from over 90 choices to match practice goals and be rewarded for practice improvements. PCMH designated practices receive full credit for this category.
  4. Resource use (cost) accounts for 10% of the score and involves smarter spending replacing the VBPM. This score is going to be based on Medicare claims, and according to the CMS fact sheet on cost, means no reporting requirements for clinicians. Cost will be risk adjusted and compared to benchmarks for treating similar care episodes and clinical condition groups.
EPs will be evaluated on these measures incorporated into the weighted score payment based on a 100-point scale. MIPS is aimed at improving physician accountability and reducing the amount of reporting among these four categories. CMS will begin measuring clinician performance in January 2017 with payments effective in 2019 based on MIPS measurements.

As a reminder, clinicians who will not be subjected to MIPS guidelines are 1st year Medicare part B participants, along with selected participants that are in Advanced Alternative Payment Models and also those that are below the low patient Medicare volume threshold.

**Be sure to check out the next newsletter article defining and exploring the Alternative Payment Models. For more information on MACRA visit the CMS website .
New provider tips available for pediatric measures

The Physician Alliance reached out to Blue Cross Blue Shield of Michigan for clarification and updated information regarding coding for physical activity for pediatric patients. A sports physical can be used/billed to satisfy the physical activity component of a well child visit. However, the sports physical documentation must include all necessary elements to be considered a well child visit.

An updated document for provider tips for pediatric HEDIS measures has been posted to TPA's website. The pediatric weight assessment and counseling tip sheet has also been updated.  
Two-step authorization required for e-prescribing
Four out of 10 teens think that prescription medications are much safer to abuse than illicit drugs, even if they're not prescribed by a doctor. At least half of all U.S. opioid overdose deaths involve a prescription opioid. Every 19 minutes someone dies from an unintentional drug overdose.*
Electronic prescribing of controlled substances (EPCS) has great potential to improve quality, safety and practice workflow and efficiency. EPCS combines traditional e-prescribing with security measures that allow physicians to also electronically order these regulated substances. EPCS provides opportunities for physicians and patients, including:
  • Prevent prescription fraud and abuse
  • Lower healthcare costs
  • Improve safety and efficiency
E-prescribing of controlled substances requires physicians to present a two-factor authentication to prove their identity as an approved provider. The Drug Enforcement Administration (DEA) requires two of three authentication options: something the provider knows, something the provider has, and something the provider is. Options for two-factor authentication include:
  • Hard token: A cryptographic password/key is sent to a hardware device (smartphone, key fob, etc.) that the physician enters into the EMR
  • Fingerprint scanner (this is the most common identifier for "something you are")
  • EMR login credentials/password
Practices should contact their EMR vendor for specific education and requirements on e-prescribing.

Click here for a list of EMR systems that use e-prescribing.
*Sources: Centers for Disease Control and Prevention, U.S. Drug Enforcement Administration, Blue Cross Blue Shield of Michigan
Protect your practice from cyber data breaches

With numerous patient data breaches occurring in healthcare, physicians need to consider cyber liability insurance policies to protect the assets of their practice. If a physician is subject to a data breach and their patients' personal information is compromised, the fines, penalties and expenses can be significant.
Here are some items to consider when purchasing a cyber liability policy:
  • Make sure the insurance carrier is financially stable and has the background and experience.
  • Ensure adequate coverage limits for patient notification and credit monitoring expenses in the event of a data breach. Average cost is $355 per patient file; $1,000,000 liability limit is recommended.
  • Consider First Party and Third Party Liability coverage. First Party protects and covers your direct costs of a data breach. Third Party coverage protects your practice from a potential liability claim.
  • Make sure your practice's crime and cyber liability policy provides coverage for computer fraud including theft, transfer of funds and business email compromise coverage.
Take advantage of the Cyber Liability Insurance program provided to The Physician Alliance members. Rates include $1,000,000 liability limit /$990 per physician.

Rick Loss at Huntington Insurance today - or (419) 461-0511.  
News you can use
Spectrum Health joins statewide network that also includes Henry Ford Health, others, Crain's Detroit
High Blood Pressure May Limit Children's Cognitive Skills, Study Suggests, New York Times
Setting the Body's ňúSerial Killers" Loose on Cancer, NY Times
Secrets to engagement: Start with the patient and work backward, Healthcare IT News
Ascension Michigan to rebrand hospitals, medical centers, Crain's Detroit
Reviving House Calls by Doctors, NY Times
Exchange EDI helps increase revenue and cash flow by providing convenient upfront patient responsibility payment tools that reduce patient bad debt and billing statement costs, and accelerates patient payments. TPA practices receive 15% discount on all services. 

   Learn more about these services.
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