The Pulse of The Physician Alliance
Introducing the new CMS payment program
Starting in January 2017, The Centers for Medicare and Medicaid Services (CMS) is shifting to value based delivery and payment models through the creation of the Medicare Access and CHIP Reauthorization Act, or
, to help reform Medicare payments.
The launch of MACRA makes important changes to how CMS pays those who give care to Medicare beneficiaries. These changes create a Quality Payment Program (
QPP) that repeals the sustainable growth rate (SGR) formula for determining Medicare payments. It also creates a new payment framework to reward providers for giving better care to patients by combining several quality reporting systems into one new system.
MACRA has two paths that link quality to payments:
- Merit-Based Incentive Payment System (MIPS) bases payment on four categories:
- Quality (50%)
- Advancing care information (25%)
- Clinical practice improvement activities (15%)
- Resource (cost) use (10%)
MIPS composite weighted performance scores will utilize the above mentioned categories. MIPS is a new program that consolidates the below three existing Medicare quality programs into one program incorporating elements from:
- Advanced Alternative Payment Models (APMs) are new approaches for paying for medical care in which providers take responsibility for quality, cost and are paid to support high value care. Recognized APMs are:
- Medicare shared savings program ACO
- Health care quality demonstration program
- CMS innovation center models
- Demonstration required by federal law
Medicare providers must participate in one of these paths, unless exempt, to receive a payment adjustment. Exemptions include: 1st year as a Medicare provider, low Medicare volume or a participant in an advanced alternative payment model.
APM's offer greater financial risk and rewards than MIPs.
APM's require participants to use CEHRT EHR technology. Implementation is meant to streamline value and quality based payments for physicians and reward participation in advanced
APMs through incentives for high quality and efficient care.
MACRA does not change APM functioning, it adds extra incentives in APM participation.
Incentives and/or penalties
based on these measures will begin in 2019. For more information go to the
CMS MACRA Webinar Archive
-This is the first article in a multi-part series on this program.
Reminder: Community Resource Fairs provide linkage to community services
The Physician Alliance will be hosting two more community resource fairs for physicians and practice staff to meet and gather information from multiple nonprofits and organizations that serve patients in the metro Detroit area.
East Region - Wednesday, Sept. 28, 2016, 8-10:30am
Attendance at the fair satisfies the BCBSM's Physician Group Incentive Program (PGIP) capabilities in "linkage to community services." For a list of participating organizations, download the specific regional flyer (see below).*
Our first event was a success with much valuable information gathered by practices! Don't miss out on this opportunity to provide resources and support to patients.
St. John Hospital & Medical Center, 22101 Moross, Detroit
West Region - Tuesday, Oct. 4, 2016, 8-10:30am
Providence Hospital - Fisher Auditorium, 16001 W. Nine Mile, Southfield
with your name, practice and the regional fair you are attending.
*Not all organizations will be at every event. Please see flyers for details.
Catch up on the latest news
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Current and past issues of our printed quarterly newsletter, The Pulse, are also available on the website.
Electronic prescribing of controlled substances improves patient safety and practice workflow
The statistics are sobering: Every 19 minutes someone dies from an unintentional drug overdose. Three out of four of these deaths are caused by prescription pain killers. More Americans abuse prescription drugs than the number of cocaine, methamphetamine and heroin abusers combined.*
By August 2015,
all 50 states legalized electronic prescribing of controlled substances (EPCS). Some states are enacting laws to require electronic prescribing of all controlled substances. It's important for practices to begin using this procedure for submitting prescriptions.
Some benefits of e-prescribing include:
- Improve office efficiency by managing all prescriptions from one electronic workflow process
- Helps prevent errors related to legibility/clarity of faxed or phone prescriptions
- Improves monitoring of controlled substance prescriptions
- Aligns with Meaningful Use criteria
- Increases patient satisfaction and compliance (patients are more likely to fill prescriptions if they are electronically sent to a pharmacy
- Improve management of medications when there is a drug shortage or dose change
Blue Cross Blue Shield of Michigan reports that more than 60 percent of controlled substances are electronically prescribed. There is opportunity for growth and more states will begin requiring adoption of this process, including Michigan. The Physician Alliance is working with BCBSM and St. John Providence to educate and assist practices in initiating electronic prescriptions for controlled substances.
Most EMR systems are set up for e-prescribing. There is a two-step system to confirm the prescribing physician's identity. This may include a text code sent via smartphone or key fob, or a fingerprint scanner for the physician (connected to the EMR). 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.
--This is the first article on a multi-part series on e-prescribing of controlled substances. Stay tuned for more news and education.
*Centers for Disease Control and Prevention, U.S. Drug Enforcement Administration, Blue Cross Blue Shield of Michigan
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