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MedPAC votes 14-2 to junk MIPS, providers angered
http://www.modernhealthcare.com/article/20180111/NEWS/180119963
The Medicare Payment Advisory Commission voted 14-2 to repeal and replace a Medicare payment system that aims to improve the quality of patient care. Providers immediately slammed the move.
To avoid penalties under MACRA, physicians must follow one of two payment tracks: the Merit-based Incentive Payment System, or MIPS, or advanced alternative payment models like accountable care organizations.
On Thursday, the Commission voted to asks Congress to eliminate MIPS and establish a new voluntary value program in which clinicians join a group and are compared to each other on the quality of care for patients. Physicians who perform well would receive an incentive payment. The suggestion will be published in the advisory group’s annual March report to Congress.
MedPAC wants to junk MIPS because it believes the system is too burdensomefor physicians and won’t push them to improve care. Members have criticized the program’s design for primarily measuring how doctors perform, including whether they ordered appropriate tests or followed general clinical guidelines, rather than if patient care was ultimately improved by that provider’s actions.
The CMS estimates that up to 418,000 physicians will be submitting 2017 MIPS data.
Prior to the vote, the majority of the debate centered on whether or not MedPac had developed an adequate replacement for MIPS.
David Nerenz, one of the no votes, said he was against the replacement because he worried that only providers with healthy patients would ban together, while those with high risk patients would face difficulty finding anyone to partner with.
He also said evidence was lacking that the group reporting approach would be an effective way to hold providers accountable for quality.
Dr. Alice Coombs, a commissioner and critical-care specialist at Milton Hospital and South Shore Hospital in Weymouth, Mass., was the other no vote. She said she was against getting rid of MIPS as providers are just now getting used to it. Those concerns increased when MedPac staff noted that MIPS repeal likely wouldn’t take place until 2019 or 2020 depending when or if Congress accepted its recommendation.
Warner Thomas, a commissioner and CEO of the Ochsner Health System in New Orleans, LA voted yes, but said he did so with some trepidation as MedPac had not received comments from industry that they were supportive of what the Commission was doing in terms of repealing and replacing MIPS.
“There hasn’t been any support from the physician community around this, and we should be cautioned by that fact,” Thomas said.
Clinicians and providers criticized MedPac following the vote.
“I think they’re wrong,” Dr. Stephen Epstein, an emergency physician at Beth Israel Deaconess Medical Center in Boston said in a tweet. “MIPS could change practice patterns by aligning incentives with performance measures.”
The Medical Group Management Association said it did not support the Commission’s suggestion for a replacement to MIPS.
“It would conscript physician groups into virtual groups and evaluate them on broad claims-based measures which is inconsistent with the congressional intent in MACRA to put physicians in the driver seat of Medicare’s transition from volume to value,” Anders Gilberg, senior vice president of government affairs at MGMA said in a statement.
Lawsuit filed against ObamaCare insurer over coverage
The insurance carrier Centene misled enrollees about the benefits of its ObamaCare exchange plans and offered far skimpier coverage than promised, according to a class-action lawsuit filed Thursday.
The lawsuit, filed in federal court in Washington state, claims customers who bought Centene’s ObamaCare plans had trouble finding in-network doctors or hospitals and often found that doctors who were advertised as in-network actually were not.
ObamaCare requires plans to meet certain minimum requirements.
Centene covers about 10 percent of the ObamaCare individual market and is one of the largest insurance carriers that participates on the exchanges.
As many other insurers have pared back their ObamaCare exchange plans, or completely left the market, Centene has expanded. In some areas of the country, Centene is the only insurer offering plans for ObamaCare customers.
Centene markets its signature product — its three-tiered Ambetter plans — in at least 15 states, and covers more than 1.4 million customers.
According to the lawsuit, Centene targets low-income customers who qualify for substantial government subsidies “while simultaneously providing coverage well below what is required by law and by its policies.”
A spokeswoman for the company told The Hill they have not been served papers and only learned of the lawsuit Thursday morning.
“We believe our networks are adequate. We work in partnership with our states to ensure our networks are adequate and our members have access to high quality health care,” Marcela Manjarrez Hawn said in an email.
Narrow networks — insurance plans that limit which doctors and hospitals customers can use — are not uncommon, as they are cheaper than more expansive plans. But the lawsuit says Centene went far beyond the norm.
“Centene misrepresents the number, location and existence of purported providers by listing physicians, medical groups and other providers — some of whom have specifically asked to be removed — as participants in their networks and by listing nurses and other non-physicians as primary care providers,” the lawsuit claims.
According to the lawsuit, customers found the provider network Centene said was available was “largely fictitious. Members have difficulty finding — and in many cases cannot find — medical providers who will accept Ambetter insurance.”
The suit was filed on behalf of two Centene customers, but seeks class-action status to represent all customers who purchased Centene plans on the ObamaCare exchange.
CMS launches voluntary bundled payments model, first since spiking mandatory bundles
The agency’s Innovation Center said the new Bundled Payments for Care Improvement Advanced model is the first APM that would qualify under MACRA.
The Centers for Medicare and Medicaid Innovation Center has launched a new voluntary bundled payment model called Bundled Payments for Care Improvement Advanced — which CMS Administrator Seema Verma said is the first Advanced APM.
The current Bundled Payments for Care Improvement Initiative, or BPCI, is scheduled to end on Sept. 30. BPCI Advanced starts on Oct. 1 and runs through Dec. 31, 2023.
The BPCI will qualify as an an advanced alternative payment model under the quality payment program for MACRA. With advanced APMs, providers take financial risk, but can also reap an incentive payment reward.
The model gives incentive payments if all expenditures for an episode of care are under a spending target that factors in quality.
“BPCI Advanced builds on the earlier success of bundled payment models and is an important step in the move away from fee-for-service and towards paying for value,” Verma said.
BPCI Advanced participants may receive payment for performance based on 32 different clinical episodes. The clinical episodes in BPCI Advanced add outpatient episodes to the inpatient episodes that were offered in the previous BPCI model, including percutaneous coronary intervention, cardiac defibrillator, and back and neck except spinal fusion.
Last year, the Centers for Medicare and Medicaid Services cancelled or scaled back on mandatory bundled models for joint replacement, hip fractures and cardiac care, but promised to release new voluntary models.
CMS cancelled the episode payment model and the cardiac rehabilitation incentive payment model, which were scheduled to begin on Jan. 1.
The agency also reduced the number of mandatory geographic areas participating in the comprehensive care for joint replacement model, from 67 to 34. Participants in the 33 remaining areas could take part on a voluntary basis.
In BPCI Advanced, participants will be expected to redesign care delivery to keep Medicare expenditures within a defined budget while maintaining or improving performance on specific quality measures. Participant bear financial risk, have payments tied to quality performance, and are required to use certified electronic health record technology.
Like all models tested by CMS, there will be a formal, independent evaluation to assess the quality of care and changes in spending under the model.
Remedy Partners, which works with providers in the current BPCI program, reported in June 2017 that bundles resulted in a $500 million reduction in the cost of unnecessary medical expense over that past year for more than 1,000 providers. In addition, hospital readmissions decreased by 6.1 percent and a patient’s length of stay at a skilled nursing facility decreased by 6.3 percent, Remedy said.
Cost reduction tops list of 5 top CFO priorities for 2018
CFOs rank cost reduction opportunities as most important for year ahead, though most expressed limited confidence in their ability to do it.
CFOs rated cost reduction as the most important performance management activity for 2018, according to a new Kaufman Hall survey of senior finance professionals.
Nearly 30 percent chose “identifying and managing cost-reduction initiatives” as the most important performance management function for their organizations, from a list of five choices, according to the 2018 CFO Outlook: Performance Management Trends and Priorities in Healthcare.
The other four priorities, in order, are improving performance reporting to operational leaders (25.8 percent); predicting and managing the impact of changing payment models (18.1 percent); developing more integrated and planning processes across financial planning and strategic capital allocation (16.3 percent); and leveraging rolling forecasting as part of a more continuous planning and financial performance monitoring process (10.7 percent).
Most CFOs, however, also said they have limited confidence in their organization’s ability to manage the financial impact of evolving business conditions. Only 15 percent said their organizations are “very prepared” to manage evolving payment and delivery models with current financial planning processes and tools.
Seventy-percent said they have cost measurement tools that are too simplistic or provide inaccurate data that can’t be trusted or have no tools in place at all, according to the survey of senior finance executives at 350-plus hospitals and health systems.
Fifty-six percent of CFOs and executives said their organizations lack
access to clean, consistent, and trusted data, while ninety-percent think their hospitals should be doing more to leverage financial and operational data to inform strategic decisions.
CFOs said long budgeting cycles are preventing value-added analysis by finance teams. Sixty-nine percent have a budget process that takes more than three months from initial rollout to board presentation. For 9 percent of these organizations, the process takes more than six months.
The survey addresses the rapidly changing healthcare business environment, and the growing role and importance of the CFO function to inform strategic business decisions that will impact long-term success, according to consulting firm Kaufman Hall.
The health care industry’s bubble
Health care companies at this year’s J.P. Morgan Healthcare Conference celebrated the Republican tax overhaul and trumpeted optimistic views of their future financial power. But as more Americans become unable to afford drug prices, hospital bills, deductibles and copays — and as they voice their anger — there is sentiment brewing in the industry that a day of reckoning will come.
Key quote: “We are in the middle of a bubble in all health care asset classes,” said Bijan Salehizadeh, a health care investor at NaviMed Capital. “Everyone knows it, but no one knows how it will end.”
HENRY KOTULA 