APRIL 3, 2020

Welcome to the MACRA MIPS/APM Update eNewsletter
Editor: Philip L. Ronning
This issue is sponsored by the National ACO Summit, the National Bundled Payment Summit,
the National Medical Home Summit, the National MACRA MIPS/APM Summit,
and the National Medicare Advantage Summit

CMS Postpones MIPS Deadline in Light of COVID-19
The CMS extended the 2019 Merit-based Incentive Payment System data submission deadline to April 30, 2020, to help facilitate the health care system's response to the COVID-19 pandemic. Doctors of optometry participating in MIPS will get a 30-day reprieve from some Quality Payment Program (QPP) deadlines and requirements. ODs can attest through the American Optometric Association Measures and Outcomes Registry for Eyecare (MORE) or by using the QPP website, according to information provided by the AOA. Specifically, practices that wish to report through AOA MORE must complete the attestation steps by 5 p.m. EST to meet the CMS April 30, 8 p.m., deadline. The AOA MORE resources include a web portal, contact through a hotline or department email and a step-by-step instructional webinar. MIPS-eligible clinicians who have not submitted any data by the deadline will qualify for the automatic extreme and uncontrollable circumstances policy and will not be penalized for the 2021 MIPS payment year. "This latest decision to extend MIPS deadlines and requirements comes after the AOA sought an extension from CMS on March 16," the AOA reported. "The CMS notes it continues to evaluate options for providing relief around participation and data submission for 2020." Finally, doctors who have already submitted MIPS data or submit before the new deadline will be scored and receive a payment adjustment based on those data. (Healio, March 26, 2020

Telehealth Beyond the Hospital
The industry of telehealth is expanding for many reasons, including increased access to technology, a demand for more affordable health services and the desire for convenient care. Research findings projected a compound annual growth rate between 2014 and 2020 of 18.4% for telehealth services.

Telehealth can reduce initial hospital admissions, readmissions, length of stay and mortality rates. By expanding telehealth services to the outpatient industry, emergency department visits are reduced, patient engagement and health management are encouraged, and the overall cost of chronic disease management is lowered. While telehealth has been primarily limited to hospitals in the past, that's changing with the expansion of telecommunications and the introduction of new policies. Both the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 and the CMS's Patient-Driven Groupings Model are prompting outpatient healthcare clinicians to increasingly adopt telehealth. The CMS's final rule is also expanding Medicare Advantage telehealth benefits as of the 2020 health plan year. With increased access to preventative and medical care outside a hospital setting, we can expect to see decreased costs for both providers and patients along with more positive patient outcomes. Virtual physician-patient visits may become the norm for senior-aged patients residing in rural areas and/or those who have a history of noncompliance with prescribed medication. That said, Medicare coverage is still limited in terms of home healthcare and tends to be directed toward rehabilitation centers and nursing homes. (Forbes, March 6, 2020)

CMS Lays Out Regulatory Relief for Value-Based Care Programs Amid COVID-19 Pandemic
The Trump administration has extended the deadlines for quality reporting and applications for providers in value-based care programs. The Centers for Medicare & Medicaid Services (CMS) released Sunday relief for regulatory requirements as providers face the growing tide of COVID-19 patients. CMS also announced it will not use any quality data on services from January 1 through June 30 in the agency's calculations for quality reporting and value-based purchasing programs. "This is being done to reduce the data collection and reporting burden on providers responding to the COVID-19 pandemic," CMS said in a release Sunday. "CMS recognizes that quality measure data collection and reporting for services furnished during this time period may not be reflective of their true level of performance on measures such as cost, readmissions and patient experience during this time of emergency." Provider groups had asked for CMS to waive any performance results or quality scores for the entirety of 2020. CMS extended the deadline for the Merit-based Incentive Payment System (MIPS) and accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) to submit 2019 data. The original deadline was March 31, but they now have until April 30 to submit quality data from 2019. However, CMS said it is still evaluating its options for "providing relief around participation and data submission for 2020" for the MIPS and MSSP programs. (FierceHealthcare, March 22, 2020)

CMS Offers Relief for Promoting Interoperability Program, MIPS
Due to the COVID-19 outbreak, Centers for Medicare & Medicaid Services (CMS) announced relief and an extension of data submission deadlines for providers, facilities, and clinicians participating in Medicare quality reporting programs and the Quality Payment Program. CMS and the Trump Administration stated it is now allowing for reporting requirements and data submission requirements to either be delayed or optional. "In granting these exceptions and extensions, CMS is supporting clinicians fighting Coronavirus on the front lines," said Seema Verma, CMS administrator. "The Trump Administration is cutting bureaucratic red tape so the healthcare delivery system can direct its time and resources toward caring for patients." CMS is deploying additional extreme and uncontrollable circumstances policy exceptions and extensions for the Merit-based Incentive Payment System (MIPS) and the Promoting Interoperability Program. The deadline has been extended from March 31 to April 30 for the MIPS program. CMS noted that clinicians who have not submitted data by April 30, will qualify for the policy and will receive a neutral payment adjustment for the 2021 MIPS payment year. CMS also stated it is evaluating options for providing relief around participation and data submission for 2020. (EHR Intelligence, March 23, 2020)

Declining Use of Primary Care Among Commercially Insured Adults in the United States, 2008--2016


Primary care is known to improve outcomes and lower health care costs, prompting recent U.S. policy efforts to expand its role. Nonetheless, there is early evidence of a decline in per capita primary care visit rates, and little is understood about what is contributing to the decline.

To describe primary care provider (PCP) visit trends among adults enrolled with a large, national, commercial insurer and assess factors underlying a potential decline in PCP visits.

Descriptive repeated cross-sectional study using 100% deidentified claims data from the insurer, 2008-2016. A 5% claims sample was used for Poisson regression models to quantify visit trends.

National, population-based.

Adult health plan members aged 18 to 64 years.

PCP visit rates per 100 member-years.

In total, 142 million primary care visits among 94 million member-years were examined. Visits to PCPs declined by 24.2%, from 169.5 to 134.3 visits per 100 member-years, while the proportion of adults with no PCP visits in a given year rose from 38.1% to 46.4%. Rates of visits addressing low-acuity conditions decreased by 47.7% (95% CI, -48.1% to -47.3%). The decline was largest among the youngest adults (-27.6% [CI, -28.2% to -27.1%]), those without chronic conditions (-26.4% [CI, -26.7% to -26.1%]), and those living in the lowest-income areas (-31.4% [CI, -31.8% to -30.9%]). Out-of-pocket cost per problem-based visit rose by $9.4 (31.5%). Visit rates to specialists remained stable (-0.08% [CI, -0.56% to 0.40%]), and visits to alternative venues, such as urgent care clinics, increased by 46.9% (CI, 45.8% to 48.1%).

Data were limited to a single commercial insurer and did not capture non-billed clinician--patient interactions.

Commercially insured adults have been visiting PCPs less often, and nearly one half had no PCP visits in a given year by 2016. Our results suggest that this decline may be explained by decreased real or perceived visit needs, financial deterrents, and use of alternative sources of care.

(Annals of Internal Medicine, February 2020)

iPatientCare Expands Its Telehealth Services to Help Doctors Combat the COVID-19
In this time of crisis, telemedicine has a big role in fighting coronavirus. Increasing the telehealth services across the nation would limit the potential for exposure and will ease the burden healthcare providers are facing during the pandemic. iPatientCare telehealth solution offers an easy-to-use video conferencing tools making it easier for doctors and patients to connect online. Providers can also send digital patient forms, charts, take notes, and e-prescribe--all though a HIPAA compliant telehealth platform. "During these challenging times, every provider needs a streamlined telehealth solution to deal with the widespread coronavirus outbreak. iPatientCare's goal is to arm its providers with technology and support necessary to respond to the current healthcare crisis posed by COVID-19. We believe that we can help stop the spread of the virus by empowering providers, and hospitals with cloud-based care management systems and telehealth solutions to meet the rising demand for virtual care" said Udayan Mandavia, Chief Growth Officer, iPatientCare/AssureCare. (Benzinga, March 28, 2020)

MACRA 2020 from the American Academy of Professional Coders

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