Monthly Archives: April 2016

How to Navigate MU, MACRA and MIPS: It’s All About Interoperability, Stupide

Ok, so I borrowed a line from Bill Clinton for the title. Please don’t sue me, Bill…

If you are confused by comments previously made by Andy Slavitt (Acting Administrator for CMS) regarding the end of the Meaningful Use program, you are not alone! The link below will take you to an excellent blog post which clarifies those comments and links you further to a streamlined application for exception.

Fear not! Meaningful Use is still the law of the land today! Things will change, but with any luck we will have plenty of notice and be able to transition to provisions of MACRA and MIPS without too much trouble. One thing to be aware of is the government’s focus is going to be on interoperability and new open application programming interfaces (APIs) using plug-ins, apps, etc. Ready, set, go!

Here is the link to the CMS blog post mentioned above. Really worth a read if this affects you or your organization. Again, I’ll try to keep posting about this as we walk through the next chapter in federal regulatory requirements.

EHR Incentive Programs: Where We Go Next

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Nothin’ don’t mean nothin’ if it ain’t free..

These iconic lyrics from Janice Joplin convey a sense of the powerful nature of freedom spiritually, politically, and economically. A recent post from Kaiser Health News explores the phenomenon of the newly-insured and free clinics. Despite being able to purchase health insurance, many people have high deductibles and elect to continue to utilize free clinics for primary care. The pragmatic and logical nature of this practice is upheld by Sarah Rosenbaum,professor of health law and policy at George Washington University. Why is this important? Because it clearly illustrates what policy makers need to understand which is for some people, health care in this country is absolutely unavailable unless it’s free.

To access the full article, click here

Free Clinics Expanding Mission To Help Insured Patients With High Expenses



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The “new math” – Updated Clinical Quality Measures for 2014 EHR Incentive Programs

CMS has just released updated clinical quality measures (CQM), and the way in which they should be calculated. A link to the update is provided below. So…even though Meaningful Use will be discontinued or is discontinued, the need to utilize these CQMs is ongoing. Perhaps there is a phasing out period which we are entering, which will transition us gently into new reporting specifications. For 2017, here they are!


Click to access eCQM_2016EP_MeasuresTable.pdf


Click to access eCQM_2016EH_MeasuresTable.pdf

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Merit-Based Incentive Payment (MIPS) and the Episode of Care Conceptual Model

The first foray into a new payment system involves expansion of current value based purchasing methodology. Documentation of quality measures has moved from the Meaningful Use program into a new iteration with the adoption of the Medicare Access and CHIP reauthorization Act (MACRA) of 2015. A new Merit-Based Payment Incentive System (MIPS) is being phased in, requiring the identification of Episodes of Care. Claims will be assigned to episode groups, analyzed for risk and severity, resource utilization, opportunities for improvement and deviation from patient care pathways. Episode costs will be developed for use in and alignment with Medicare value based purchasing programs and physician fee for service reimbursement. New codes and modifiers will be required, defining the relationship between each provider (clinician) and the patient, in an attempt to attribute that practitioner’s responsibility for all or a specific portion of the patient’s episode of care. The critical portion of this change is in the attribution of responsibility for care or relationship to the patient.  As section 101(f) of the MACRA also requires the Centers for Medicare and Medicaid Services (CMS) to develop patient relationship categories and codes, CMS expects to post a draft list of these categories and codes separately by April 16, 2016.

For more information, please visit the link below.

Click to access Episode-groups-summary.pdf

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MACRA and MIPS…are you ready?

Earlier this year, the Office of the National Coordinator (ONC) surprised a good part of the health care industry by announcing the early end of the Meaningful Use program and associated incentive payments. Seeing that most large entities were able to switch to Electronic Health Records (EHR), their focus now shifts to modification of reimbursement methodologies. As the government is generally the driver of policy change, hospitals and providers need to understand where the future of health care is headed.

For an in-depth look at MACRA and MIPS, you can go to the CMS website here:

Granted this is a bit overwhelming, so in very general terms here is what is happening.

MACRA stands for Medicare Access and CHIP Reauthorization Act of 2015. It modifies the existing mechanism for Medicare payments by eliminating the Sustainable Growth Rate (SGR) formula, rewarding quality vs quantity of care, and unifying quality reporting systems.

MIPS stands for Merit-Based Incentive Payment System. MIPS and Alternative Payment Models (APM) will be phased in starting now through 2021 (unless supplanted by new legislation…). CMS is reviewing comments on the drafted Quality Measure Development Plan (MDP), with a final version to be posted on May 2.

Why is this important? Because payment methodologies are about to change a whole lot, and providers need to be prepared. It is also important because all of the current textbooks which guide budding nurse informaticians / informaticists reference the Meaningful Use program, now obsolete. WE HAVE A LOT TO LEARN IN A SHORT TIME!

If you have the time to check out the CMS link above, you can learn a great deal from it. Otherwise I will attempt to break it down in a series of posts so…stay tuned! Nothing happens overnight, so as with all of the changes in health care, we will survive this as well. But to be forewarned is to be forearmed.

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