WEBINAR FEE:  First MIPS Webinar: $185
Attendee of January MIPS Webinar: $ 150
ASIPP Member: $150    

WEBINAR DATE: February 22, 2017 TIME:   3:30pm-5:00pm

SPEAKER: Deborah H. Tracy, MD, MBA  

Final Rule of the CMS Merit-Based Incentive Payment System, MIPS, and Alternative Payment Models, APMs, was published on 10/14/16, and is ~ 2,300 pages.  Now identified as the Quality Payment Program, QPP, it is extensive in scope to reward or penalize providers for performing certain activities in four performance categories.  The four categories are: (1) Quality, which will replaces PQRS, (2) Cost, attributed to Medicare providers by a complex set of statistical formulas replacing the Value Modifier (3) Improvement Activities, a new category of 90+ undertakings and (4) Advancing Care Information, which replaces Meaningful Use.  The four categories result in a final score of between 0 to 100 points.  

Depending on the provider's final score, a penalty/reward is assessed, or the provider remains neutral.  For 2017 the penalty is 4%, but the bonus could be 3 to 4 times that amount. Physicians must educate themselves and their practice managers on how to understand and potentially achieve high scores in the new Quality Payment Program and avoid costly penalties in their Medicare Part B claims. Although Cost will have a weight of 0% for 2017 the Quality Resource Use Report, QRUR, will continue to be calculated for providers. This report emphasizes the cost of a providers care compared to his peers. An understanding of this report will enhance a provider's ability to understand how he can potentially improve decision making to increase quality and decrease cost.

Click HERE to Registration and for other information  

We have important updates to report to you about our work here at ASIPP.  CMS is currently reviewing our documents for approval of the National Interventional Pain Management Qualified Clinical Data Registry (NIPM-QCDR). We expect to get their response by the end of this month or early March. We have submitted 18 high-quality quality measures. We are hoping they will accept at least two-thirds of them.  

CMS does not confirm measures for new QCDRs until later in the first quarter so we will be able to share final measures then and will begin formal data collection by April 1. If you haven't done so, we urge you to begin the process of enrollment now, while ASIPP completes the approval process with CMS.  

If you are interested in signing up for the National IPM QCDR, you can send an email to ASIPPQCDR@arbormetrix.com. We will then send you registration forms to complete. There is no commitment or cost to you until we are approved for the QCDR for 2017 reporting

If you have already signed up, please pass along this information to anyone else who could benefit from this opportunity.     

As you are well aware, CMS has issued the final rule on its value-based care entitled, "Merit-Based Incentive Payment System Combining Quality Measures, Meaningful Use or Advancing Care Information, Clinical Improvement Activities and Costs." Because of our efforts, CMS has made substantial changes to enable us to avoid penalties. The QCDR reporting mechanism and specifically the NIPM-QCDR will complete the collection and submission of MIPS requirements.  

In addition to participating in the MIPS in the present format, we are also engaging with the new administration about removing numerous barriers to so-called meaningful use, now called advancing care information to make it easier into the future with very little value added to that part of the program with major focus on quality and clinical improvement activities rather than meaningless use and cost, which is inappropriately calculated.  

Please contact us if you have any questions or concerns.  

As you know, on July 1, 2016, the Oregon Health Authority eliminated coverage for epidural injections. Instead, they recommended acupuncture, manipulation, massage, and medications (excluding long-term opioid treatment, cognitive behavioral therapy, physical therapy/occupational therapy, and yoga) as the only viable treatments for back pain. Further, on November 8, 2016, the Health Evidence Review Commission (HERC) issued draft coverage guidance strongly recommending against coverage for epidural, facet joint, medial branch, and sacroiliac joint injections for low back pain regardless of etiology. 

On December 8, 2016, the American Society of Interventional Pain Physicians (ASIPP) in collaboration with state societies submitted a letter with nearly 2,000 signatures including membership representation from all states protesting these decisions and asking them for modifications. In addition, ASIPP also worked with local Oregon providers and United States Congress; consequently, we engaged Chairman of the Energy and Commerce Committee Greg Walden (R - Oregon) and Senator Ron Wyden (D - Oregon) to assist us in prevention of these draconian measures. 

ASIPP arranged conference calls with staff from Chairman Walden and Senator Wyden's office and local providers on December 5, 2016, to discuss concerns with the draft guidance. Subsequently, ASIPP also followed with Walden's office to have them engage and question the process and guidance.  

During these times, one of the main providers from Oregon had to close the doors because of these draconian cuts.  

On February 2, 2017, physicians from various groups from ASIPP, as well as other groups, patients, and experts presented evidence in support of coverage of these procedures. Consequently, with the presentations and requests from Chairman Walden and Senator Wyden, the Oregon Health Authorities evidence-based guidelines subcommittee has elected to reconsider its initial ruling, and requested additional research and consideration of pain as an outcome. They plan to continue their discussion in April.   

So while we have made progress, the fight is not over. We would like to thank the membership of the Oregon Society of Interventional Pain Physicians and members of ASIPP from various societies, specifically those who signed the comment letter. We ask for your continued support as we follow this issue and pursue our efforts for the preservation of interventional pain management that includes safe, effective, and evidence-based treatment for our patients.

Aetna and Humana said they have terminated their merger deal following a U.S. District Court judge's ruling against the $34 billion deal.

Aetna will not seek an appeal and instead will pay Humana $1 billion to terminate the agreement. Aetna will also pay a breakup fee to Molina Healthcare to end an agreement to sell some Medicare Advantage plans as part of a divestiture to help close the Humana deal.

A federal judge recently said the Aetna/Humana merger wasn't in the best interest of consumers, siding with the U.S. Justice Department allegations that the combined company would have too much control over the Medicare Advantage market. 

Modern Healthcare