The Medicare Access and CHIP Reauthorization Act (MACRA) /Merit-based Incentive Payment System (MIPS) final rule has been released unexpectedly this morning.

 

Now we can call it meaningful changes instead of meaningless use.

 

The Centers for Medicare and Medicaid Services (CMS) has made substantial changes. We are extremely pleased that they have accepted at least part of our recommendation in reference to a 90-day period reporting rather than full year.

 

We would like to thank all the ASIPP members who signed on the letter with 4,534 signatures and members of Congress who attempted to introduce the bill to obtain these changes, the Doc Caucus who sent the letter requesting a 90-day period, the group of pain organizations who worked together addressing various issues, and numerous other organizations working on this issue.

 

However, the 90-day period was ASIPP's idea. It really helped us to go to Washington and advocate for our positions.

 

Here is the summary of MIPS as we read it. We are very optimistic, but again, we are cautiously optimistic.

 

More good news is in the works for interventional pain physicians on MIPS registries, etc. We will keep you posted.

 

CMS will create a 90-day reporting period for clinicians reporting in MIPS, the final rule states. The agency is reducing the number of measures to be reported from 11 to five. Providers will have the option of reporting all the dropped measures.

 

Reporting to public health or clinical data registries will result in a bonus. CMS is also exploring whether to count managing referrals and consults as part of the MIPS reporting.

 

The final rule also outlines CMS's "pick-your-pace" route to MIPS reporting. Given the wide diversity of clinical practices, the initial development period of the Quality Payment Program implementation would allow physicians to pick their pace of participation for the first performance period that begins January 1, 2017.

 

(1) Clinicians can choose to report to MIPS for a full 90-day period or, ideally, the full year, and maximize the MIPS eligible clinician's chances to qualify for a positive adjustment. In addition, MIPS eligible clinicians who are exceptional performers in MIPS, as shown by the practice information that they submit, are eligible for an additional positive adjustment for each year of the first 6 years of the program.

 

(2) Clinicians can choose to report to MIPS for a period of time less than the full year performance period 2017 but for a full 90-day period at a minimum and report more than one quality measure, more than one improvement activity, or more than the required measures in the advancing care information performance category in order to avoid a negative MIPS payment adjustment and to possibly receive a positive MIPS payment adjustment.

 

(3) Clinicians can choose to report one measure in the quality performance category; one activity in the improvement activities performance category; or report the required measures of the advancing care information performance category and avoid a negative MIPS payment adjustment. Alternatively, if MIPS eligible clinicians choose to not report even one measure or activity, they will receive the full negative 4 percent adjustment.

 

(4) MIPS eligible clinicians can participate in Advanced Alternative Payment Models (APMs), and if they receive a sufficient portion of their Medicare payments or see a sufficient portion of their Medicare patients through the Advanced APM, they will qualify for a 5 percent bonus incentive payment in 2019.

 

(5) Other provisions:

 

-        Financial and technical assistance (100 million) to small and rural practices

-        Teases that more advanced APMs will be available by January 2017

-        Finalizes most of the APM portions of the proposed rule

-        New estimate is 200 million distributed under MIPS, down from 833 million

  

Docs lose patients when insurers move 65-year-olds to Medicare Advantage plans

  

Doctors say they're losing patients when commercial health plans automatically move consumers to a Medicare Advantage plan when they turn 65. The Medicare Advantage plans mean more revenue for insurers, but it often means patients' doctors will be considered out of network.

A policy known as seamless conversion allows insurance companies to move members of their commercial or Medicaid managed-care plans over to Medicare Advantage plans if they first ask permission from the CMS.

In an effort to ensure continuity of care, the CMS has been increasingly encouraging the practice. A recent memo reminded Medicare Advantage plans about seamless conversion as a way to transition enrollees in Medicaid managed-care plans to integrated dual special-needs plans once the enrollee is Medicare-eligible.

  

Modern Healthcare

   

Start Planning NOW!
ASIPP® Abstracts Submission for 2017 Annual Meeting OPEN

  

Registration will be open for Abstract Submissions is now available.

  

The American Society of Interventional Pain Physicians will hold its 19th Annual Meeting April 20-22 in Las Vegas at Caesar's Palace.

  

This year, we will be making significant changes to the Abstract and Poster Sessions. Submissions will be in two categories: Resident/Fellow and Physician.  Selected posters will be on display forall meeting participants during all breaks and meal times.

  

The Abstract Committee will select the top 25 for publication in Pain Physician and of those 10 will be selected for Abstract presentation and judging during the Annual Meeting. The top 3 will receive cash prizes.

Submit and review this year's rules.

Humana, Cigna hit by lower 2017 Medicare star ratings

  

Humana and Cigna saw stock prices fall Wednesday after the CMS released its latest star ratings that showed declines in both insurers' Medicare quality measures. The companies said the lower ratings follow a recent CMS audit that resulted in sanctions for Cigna.

Overall, more Medicare Advantage programs received top quality ratings from the CMS for their 2017 plans than in previous years. The agency reported that nearly 70% of Medicare Advantage enrollees would be in plans that received at least four stars. However, the average star rating declined slightly, according to data released Wednesday.

Shares of Humana fell 5% Wednesday after CMS reported that the percentage of Medicare Advantage members in Humana plans with four stars or higher fell by half, from 78% a year ago to 37%. The insurer said it would appeal the ratings and raised its full-year guidance, arguing the scores do not reflect its current business.

Democratic Minnesota governor says Obamacare is 'no longer affordable'

  

Minnesota's Democratic governor said Wednesday that the Affordable Care Act is "no longer affordable," a stinging critique from a state leader who strongly embraced the law and proudly proclaimed health reform was working in Minnesota just a few years ago.

Gov. Mark Dayton made the comments while addressing questions about Minnesota's fragile health insurance market, where individual plans are facing double-digit increases after all insurers threatened to exit the market entirely in 2017. He's the only Democratic governor to publicly suggest the law isn't working as intended.

  

Modern Healthcare

 

On the September ASIPP Podcast we'll talk to Ashley Brenton, PhD of Proove Biosciences about genetic tests that can help you decide a patient's treatment plan; in the news segment we'll learn about a common NSAID that could be important in the fight against cancer, giving codeine to children, pain perception in patients with Alzheimer disease and more; and we'll end with a story about an elaborate cheating scheme during medical school exams.

 

Click to listen >>>

  

On the final day of June 2015, Colin LePage rode waves of hope and despair. It started when LePage found his 30-year-old son, Chris, at home after an apparent overdose. Paramedics rushed Chris by helicopter to one of Boston's flagship medical centers.

Doctors revived Chris's heart, but struggled to stabilize his temperature and blood pressure. At some point, a doctor or nurse mentioned to LePage that his son had agreed to be an organ donor.

"There was no urgency or, 'Hey, you need to do this.' I could see genuine concern and sadness," LePage said, his voice quavering.

  

  

Kaiser News

Bluffs doctor's license suspended for a year after investigation

  

It's important that other medical staff be present during a procedure on a sedated, unconscious patient, the Iowa Board of Medicine said Thursday in disciplining a Council Bluffs physician.

 

Dr. Michael Prescher, an anesthesiologist and pain-management specialist who lives in Omaha, initially was accused of engaging in "sexual misconduct and professional incompetency" while performing injection procedures for pain treatment on two female patients who were under sedation.

In an order suspending Prescher's medical license for a year, the board said Thursday that while it "did not find a preponderance of the evidence to support the sexual abuse charges, the board continues to question whether sexual abuse occurred. (Prescher) could have erased all questions as to what he did if he had had a chaperone present when he performed the procedures."

  

  

The Daily Nonpareil

What the Scheduling of Kratom by the DEA Means for Research

 

At the end of August 2016, the Drug Enforcement Administration (DEA) announced its intent to place the active components of kratom into Schedule I of the Controlled Substances Act, due to 15 known deaths related to kratom between 2014 and 2016, as well as its "high potential for abuse," and lack of an "accepted medical use... in the United States."

 

However, due to a widespread outcry, including a letter to the DEA from 51 members of Congress, questioning the decision and a lack of opportunity for public comment, the DEA is placing a hold on this decision.