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CMS May Delay MACRA Start Date Print E-mail
Written by Rajiv Leventhal | Healthcare Informatics   
Thursday, 14 July 2016 00:00

During a July 13 U.S. Senate Committee on Finance hearing on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Centers for Medicare & Medicaid Services (CMS) Acting Administrator Andy Slavitt left open the possibility that the new sweeping changes set to overhaul physician payment could be pushed back from the intended start date of Jan. 1, 2017.

The Congressional hearing, led by Committee Chairman Orrin Hatch (R-UT) and Ranking Member Ron Wyden (D-OR), set out to give Slavitt a chance to describe MACRA's implementation efforts and give members of Congress a chance to address issues and concerns towards the CMS head. Hatch opened his statement by noting that physicians are greatly concerned about the timeline of MACRA, which as currently scheduled, calls for implementation to begin in 2017 with bonuses being paid out to eligible Medicare doctors in 2019. Indeed, as comments from healthcare stakeholders poured in since the release of the proposed MACRA rule in April, various physician groups have called for a host of greater flexibilities, many which center around pushing the start date back at least six months.

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Last Updated on Saturday, 16 July 2016 10:19
The Strategic Implications of MACRA Print E-mail
Written by   
Saturday, 09 July 2016 16:18

On April 27, the Centers for Medicare and Medicaid Services (CMS) unveiled the much-anticipated (and, for some, feared) proposal to implement the physician payment reforms required under the Medicare Access to Care and CHIP Reauthorization Act of 2015 (MACRA).  These reforms, once implemented, will profoundly change how and how much Medicare pays physicians for services furnished to program beneficiaries by substantially linking such payments to performance and incentivizing physicians to participate in alternative payment models. Moreover, while not expressly intended by Congress or CMS, these changes also are likely to cause a dramatic increase in physician-physician consolidation and physician-hospital consolidation and alignment.
Under the Merit-Based Incentive Payment System (MIPS) established in MACRA, and now described in detail by CMS in draft regulations, Medicare payments to physicians will be adjusted based on each physician's performance in four performance categories...

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Last Updated on Tuesday, 26 July 2016 17:12
Is MACRA All It's Cracked Up to Be? Print E-mail
Written by FHI's Week in Review   
Tuesday, 28 June 2016 16:54

'Payment gap' for docs may grow over time, analyst warns
Joyce Frieden, News Editor for MedPage Today reports on 6.23.16:

Physicians are likely to be hurt by the legislation passed to repeal Medicare's sustainable growth rate reimbursement formula, several experts said at a briefing here <Washington, D.C.> Thursday on the Medicare trustees' report sponsored by the Brookings Institution and the American Enterprise Institute (AEI).

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Last Updated on Saturday, 09 July 2016 16:12
OIG Issues Report on Provider-Based Facilities Print E-mail
Written by Emily J. Cook, Christine Parkins Johnson & Monica Wallace |   
Monday, 27 June 2016 00:00

Urges CMS to Make Changes

On June 16, 2016, the US Department of Health and Human Services Office of Inspector General (OIG) posted a report examining the Centers for Medicare & Medicaid Services' (CMS's) oversight of billing by provider-based facilities. The OIG concluded that although CMS is taking steps to improve its oversight of provider-based facilities, CMS is unable to adequately monitor provider-based facilities and ensure appropriate billing and payment.

The OIG continues to recommend elimination of the provider-based designation or implementation of equal payment for physician services, regardless of the setting where the services are provided. Alternatively, the OIG recommends that CMS (1) implement systems to monitor all provider-based facility billing, (2) make provider-based attestations mandatory, (3) ensure that CMS regional offices and Medicare Administrative Contractors (MACs) appropriately apply provider-based requirements when reviewing attestations, and (4) take appropriate action against hospitals and their off-campus provider-based facilities that do not meet the provider-based requirements.

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Last Updated on Tuesday, 28 June 2016 17:22
Medicare's Drug-Pricing Experiment Stirs Opposition Print E-mail
Written by Julie Appleby | KHN   
Monday, 30 May 2016 00:00

khn logo black A broad proposal by Medicare to change the way it pays for some drugs has drawn intense reaction and lobbying, with much of the debate centering on whether the plan gives too much power over drug prices to government regulators.
One of most controversial sections would set up a nationwide experiment, scheduled to start in 2017, to test a handful of ways to slow spending on drugs provided in doctor's offices, clinics, hospitals and cancer infusion centers. The proposal would not affect most prescriptions patients get through their pharmacies.
The aim, the government says, is to maintain quality while slowing spending in Medicare Part B by more closely tying payments to how well drugs work, using methods drugmakers, insurers and benefit managers are already trying in the private sector.
One of the approaches included in the proposal would allow Medicare to earmark "therapeutically similar" drugs and set a benchmark, or "reference price," that it would pay for all drugs in that category. That amount might be the cost of the drug the agency considers the most effective in the group, or some other measure. It's aimed at narrowing the wide variability - often hundreds or thousands of dollars a year - in what is paid for similar drugs.
Such an approach is seen by some as government price setting, a method common in Europe that draws support in the U.S. from the left but has longstanding opposition from conservatives, many economists and pharmaceutical companies.
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