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Featured Content

Payment Innovation: Regulation

CMS Releases CY 2019 MPFS/QPP Final Rule

November 01, 2018

CMS has posted the CY 2019 MPFS/QPP Final Rule.

Resource Centers

Dedicated resource libraries for clients and partner organizations.

Payment Innovation
Resource Center

A library of content about Medicare payment transformation initiatives. Includes original analysis, major regulations, agency guidance, program announcements and other primary source documents.

Diagnostics
Resource Center

A collection of primary source materials about laboratory diagnostics regulation and payment, including original analysis, Medicare rates, rulemakings, final determinations and other items of interest.

Health Reform 2.0
Resource Center

A collection of primary source content about the Affordable Care Act and efforts to repeal and replace the law.

The Latest from our Resource Centers

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CMS Announces Medicaid Demonstration to Expand Mental Health Treatment Services

Payment Innovation: Other , Quality Payment Program

CMS Announces Medicaid Demonstration to Expand Mental Health Treatment Services

November 13, 2018

CMS announces Medicaid demonstration to expand mental health treatment services.

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Innovation Center Posts New Resources

Payment Innovation: Innovation Center

Innovation Center Posts New Resources

November 13, 2018

CMS has updated it’s Innovation Center resources.

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CMS Updates QPP Participation Status Tool with APM QP Snapshot Data

Payment Innovation: Quality Payment Program

CMS Updates QPP Participation Status Tool with APM QP Snapshot Data

November 13, 2018

CMS Updates QPP participation tool.

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CMS Hosts Webinar on 2019 Medicare PFS Final Rule on Nov. 19

Payment Innovation: Quality Payment Program

CMS Hosts Webinar on 2019 Medicare PFS Final Rule on Nov. 19

November 13, 2018

CMS to host webinar covering the 2019 MPFS final rule on November 19.

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

November 13, 2018

CMS has added additional resources to the QPP Resource Center.

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93% of MIPS Eligible Clinicians Will Receive a Positive MIPS Payment Adjustment in 2019

Payment Innovation: MIPS

93% of MIPS Eligible Clinicians Will Receive a Positive MIPS Payment Adjustment in 2019

November 13, 2018

CMS has announced that 93 percent of MIPS eligible clinicians will receive a positive MIPS payment adjustment in 2019 based on their performance in 2017. Overall, 95 percent of eligible clinicians avoided a negative payment adjustment. The chart below summarizes the results.

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Top 10 Takeaways: 2019 Medicare Physician Fee Schedule

Insight: original analysis

Top 10 Takeaways: 2019 Medicare Physician Fee Schedule

November 06, 2018

On November 1, 2018, the Centers for Medicare & Medicaid Services released the CY 2019 Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Medicare Part B [CMS-1693F] Final Rule, which includes policies related to Medicare physician payment and the Quality Payment Program (QPP). The regulations will be published in the…

ORIGINAL ANALYSIS

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CMS Hosts Webinar on the 2019 Quality Payment Program Final Rule

Payment Innovation: Quality Payment Program

CMS Hosts Webinar on the 2019 Quality Payment Program Final Rule

November 06, 2018

CMS will host a webinar on Thursday, November 15, 2018 on the 2019 Quality Payment Program Final Rule.

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

November 06, 2018

CMS has posted new QPP resources.

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PTAC Update: PTAC Submits Four Reports to the Secretary and One New Proposal Open for Comment

Payment Innovation: PTAC

PTAC Update: PTAC Submits Four Reports to the Secretary and One New Proposal Open for Comment

November 06, 2018

The PTAC is soliciting comments on a proposal for a new physician-focused payment model.

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MedPAC Discuss Advanced APMs and Other Value-based Issues at November 2018 Meeting

Payment Innovation: Other

MedPAC Discuss Advanced APMs and Other Value-based Issues at November 2018 Meeting

November 06, 2018

MedPAC discussed a number of topics at its November meeting, including Advanced APMS.

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Institute for Medicaid Innovation Survey Finds Medicaid MCOs Are Increasingly Using Value-based Payment Models

Payment Innovation: Other

Institute for Medicaid Innovation Survey Finds Medicaid MCOs Are Increasingly Using Value-based Payment Models

October 30, 2018

Survey results released by the Institute for Medicaid Innovation find that around half of Medicaid managed care organizations launched population-specific value-based purchasing models last year, and around 10 percent of plans had extensive value-based purchasing arrangements in place.

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CMS Releases Proposed Rule on Medicare Advantage, Medicare Part D, PAC and Medicaid

Payment Innovation: Other

CMS Releases Proposed Rule on Medicare Advantage, Medicare Part D, PAC and Medicaid

October 30, 2018

CMS releases proposed rule implementing certain provisions of the Bipartisan Budget Act of 2018.  Under this proposed rule, MA plans would be able to offer telehealth benefits beyond what is currently allowable under the traditional Medicare telehealth benefit.

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CMS Announces MOM Model

Payment Innovation: Innovation Center

CMS Announces MOM Model

October 30, 2018

CMS announces the Material Opioid Misuse (MOM) model as part of the agency’s strategy for combating the opioid crisis.

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

October 30, 2018

CMS has uploaded a number of new resources to the QPP resource center, including web-based training courses.

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CMS Extends Cost Measure Field Testing to Nov. 5

Payment Innovation: MIPS

CMS Extends Cost Measure Field Testing to Nov. 5

October 30, 2018

CMS is extending the timeframe for submitting feedback on the 2018 field testing of cost measures until Monday, November 5, 2018, at 12:00 pm EDT.

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MedPAC Scheduled to Discuss Modifying the Advanced APM Incentive on Nov 1

Payment Innovation: Advanced APMs

MedPAC Scheduled to Discuss Modifying the Advanced APM Incentive on Nov 1

October 30, 2018

MedPAC is scheduled to discuss a policy option for revising the Advanced APM incentive payment during their public meeting on Thursday, November 1.

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Administration Announces State Relief and Empowerment Waivers

Health Reform 2.0: Administration

Administration Announces State Relief and Empowerment Waivers

October 23, 2018

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Payment Innovation: Other

LAN Releases Updated Report on APM Adoption

October 23, 2018

Health Care Payment Learning and Action Network released a new report on alternative payment model adoption.

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ASPE’s Social Risk Request for Information

Payment Innovation: Other

ASPE’s Social Risk Request for Information

October 23, 2018

RFI released seeking provider and plan approaches to improve care for Medicare beneficiaries with social risk factors.

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GAO Makes PTAC Appointments

Payment Innovation: PTAC

GAO Makes PTAC Appointments

October 23, 2018

On October 18, 2018 the GAO announced the appointment of two new members to the Physician-Focused Payment Model Technical Advisory Committee (PTAC).

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Upcoming QPP Webinars

Payment Innovation: Quality Payment Program

Upcoming QPP Webinars

October 23, 2018

CMS has scheduled several QPP webinars geared towards Physicians Compare and the CMS Web Interface for ACOs and Groups

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CMS Releases Guidance on How 2019 Payment Adjustments Will Be Indicated on Claims

Payment Innovation: MIPS

CMS Releases Guidance on How 2019 Payment Adjustments Will Be Indicated on Claims

October 23, 2018

CMS has released guidance to help MIPS eligible clinicians understand how to identify and interpret the application of positive, neutral and/or negative MIPS payment adjustments to be applied to payments for certain claims submitted for services furnished in calendar year 2019 based on clinicians’ 2017 MIPS final scores.

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MedPAC Releases 2018 Payment Basics – A Series of Briefs on the Various Medicare Payment Systems

Payment Innovation: Other

MedPAC Releases 2018 Payment Basics – A Series of Briefs on the Various Medicare Payment Systems

October 16, 2018

MedPAC releases 2018 Payment Basics, a series of briefs on the various Medicare payment systems.

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CMS Announces Changes to the Oversight of Medicare Accrediting Organizations

Payment Innovation: Other

CMS Announces Changes to the Oversight of Medicare Accrediting Organizations

October 16, 2018

CMS announces a number of changes to the oversight of Medicare Accrediting Organizations. CMS believes these changes will improve quality and safety in healthcare facilities and empower patients with information to make decisions about where to receive care.

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Blueprint for the CMS Measures Management System Version 14.0 Released

Payment Innovation: Other

Blueprint for the CMS Measures Management System Version 14.0 Released

October 16, 2018

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CMS Releases 2019 Medicare Advantage and Part D Prescription Drug Quality Program Star Ratings

Payment Innovation: Other

CMS Releases 2019 Medicare Advantage and Part D Prescription Drug Quality Program Star Ratings

October 16, 2018

CMS has released Part C and Part D Star Ratings; providing information about the quality of plan choices.

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Updates to QPP Resource Library

Payment Innovation: Quality Payment Program

Updates to QPP Resource Library

October 16, 2018

CMS has uploaded a number of new resources to the Quality Payment Program (QPP) Resource Library.

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QPP Website Update: 2018 Performance Feedback for MIPS Quality Data Submitted via Claims Now Available

Payment Innovation: MIPS

QPP Website Update: 2018 Performance Feedback for MIPS Quality Data Submitted via Claims Now Available

October 16, 2018

CMS has updated the QPP website so individual eligible clinicians who choose to submit their Quality performance category data via claims can access performance feedback for the 2018 performance year on an ongoing basis.

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CMS Announces Field Testing of 13 Cost Measures through October 31, 2018

Payment Innovation: MIPS

CMS Announces Field Testing of 13 Cost Measures through October 31, 2018

October 16, 2018

CMSis conducting field testing for 13 cost measures before consideration of their potential use in the MIPS cost performance category in 2020 or beyond. Note: These are not the same measures currently in use for the 2017 and 2018 MIPS performance periods.

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CMS Hosts Webinar on Patient Relationship Categories and Codes

Payment Innovation: MIPS

CMS Hosts Webinar on Patient Relationship Categories and Codes

October 16, 2018

CMS to host webinar on patient relationship categories and codes on Wednesday, October 17, 2018.

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CMS Announces Participants in BPCI Advanced and Releases Evaluation Report for BPCI Initiative

Payment Innovation: Advanced APMs

CMS Announces Participants in BPCI Advanced and Releases Evaluation Report for BPCI Initiative

October 10, 2018

CMS announces BPCI participants and releases its 5th evaluation report on the initiative.

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Legislation Introduced to Address MA Benchmark Cap

Payment Innovation: Other

Legislation Introduced to Address MA Benchmark Cap

October 02, 2018

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CMS Announces Multi-Year eMedicare Initiative to Empower Beneficiaries

Payment Innovation: Other

CMS Announces Multi-Year eMedicare Initiative to Empower Beneficiaries

October 02, 2018

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CMS Releases CY 2019 Medicare Advantage Program Landscape Files

Payment Innovation: Other

CMS Releases CY 2019 Medicare Advantage Program Landscape Files

October 02, 2018

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MedPAC Considers Episode-based Payments for Post-Acute Care

Payment Innovation: Other

MedPAC Considers Episode-based Payments for Post-Acute Care

October 02, 2018

MedPAC will consider a staff analysis of two aspects of a stay-based unified prospective payment system (PPS) for post-acute care at its October meeting.

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CMS Opens Virtual Groups Election Period for MIPS 2019 Performance Year

Payment Innovation: MIPS

CMS Opens Virtual Groups Election Period for MIPS 2019 Performance Year

October 02, 2018

CMS recently opened the annual virtual group election period for the MIPS 2019 Performance Year.

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Save the Date: Physician Compare National Provider Call

Payment Innovation: MIPS

Save the Date: Physician Compare National Provider Call

October 02, 2018

Save the Date: Physician Compare National Provider Call October 3, 2018 1:30 – 3:00 PM ET

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QPP Developer Resource: CMS Open Sources Code for Developers that Calculates QPP Quality Measures from Claims Data

Payment Innovation: MIPS

QPP Developer Resource: CMS Open Sources Code for Developers that Calculates QPP Quality Measures from Claims Data

October 02, 2018

CMS open-sources QPP code responsible for calculating quality measures from Medicare claims data submitted by eligible clinicians via Quality Data Codes. This code is intended for developers interested in the calculation mechanism supporting QPP Claims to Quality.

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CMS Announces Field Testing of Cost Measures

Payment Innovation: MIPS

CMS Announces Field Testing of Cost Measures

October 02, 2018

CMS and its contractor, Acumen, will conduct field testing in October 2018 for 13 cost measures. These measures will be considered for use in the MIPS Cost Performance Category in 2020 or beyond.

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GAO Makes Appointments to PCORI Governing Board

Payment Innovation: Other

GAO Makes Appointments to PCORI Governing Board

September 25, 2018

GAO announces PCORI board member appointments.

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Representative DelBene Circulates Dear Colleague Letter on MIPS Low Volume Threshold

Payment Innovation: MIPS

Representative DelBene Circulates Dear Colleague Letter on MIPS Low Volume Threshold

September 25, 2018

Rep. DelBene (D-WA) requests support in asking CMS to adjust the MIPS low-volume threshold in order to include more providers in MIPS as part of the final 2019 physician fee schedule.

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CMS Awards Funding for Quality Measure Development

Payment Innovation: MIPS

CMS Awards Funding for Quality Measure Development

September 25, 2018

CMS announces the selection of seven applicants to receive cooperative agreement awards through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Funding Opportunity: Measure Development for the Quality Payment Program (QPP).

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Deputy Secretary Hargan Announces Collaboration to Accelerate Innovation and Investment in Healthcare – Call for Participants

Payment Innovation: Innovation Center

Deputy Secretary Hargan Announces Collaboration to Accelerate Innovation and Investment in Healthcare – Call for Participants

September 25, 2018

HHS accepting recommendations for participants in the  “Deputy Secretary’s Innovation and Investment Summit” working group.

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CMS Releases 2019 Preliminary CLFS Payment Determinations

Diagnostics: Payment Rates

CMS Releases 2019 Preliminary CLFS Payment Determinations

September 21, 2018

CMS releases CY 2019 preliminary recommendations for codes reviewed during summer the 2018 Lab Public Meeting.

EXTERNAL LINK

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Medicare Payments for Clinical Diagnostic Laboratory Tests in 2017: Year 4 of Baseline Data

Diagnostics: OIG

Medicare Payments for Clinical Diagnostic Laboratory Tests in 2017: Year 4 of Baseline Data

September 20, 2018

OIG releases the fourth in a series of data briefs looking at Medicare spending under the Clinical Laboratory Fee Schedule.

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Senate Hearings on Health Care Costs

Payment Innovation: Other

Senate Hearings on Health Care Costs

September 18, 2018

Senate HELP Committee to hold hearings on health care costs.

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Payment Innovation: Other

GAO Recommends that DOD Use Common Key Quality Measures

September 18, 2018

GAO recommends that for all providers, the DOD use common key quality measures, expand their range, and develop consistent performance standards and requirements.

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NQF Releases Report on Quality Measures for Rural Communities

Payment Innovation: Other

NQF Releases Report on Quality Measures for Rural Communities

September 18, 2018

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Payment Innovation: MIPS

MIPS Resource: CMS Posts Infographic on 2019 Payment Adjustments

September 18, 2018

CMS recently posted an infographic on 2019 MIPS adjustments for the 2017 Performance Year.

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CMS Posts Slides and Recording from Integrated Care for Kids Model Webinar

Payment Innovation: Innovation Center

CMS Posts Slides and Recording from Integrated Care for Kids Model Webinar

September 18, 2018

CMS Innovation Center posts resources from Integrated Care for Kids payment model webinar.

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UPDATED: CMS Announces “Slight” Adjustments to 2017 Final MIPS Scores

Payment Innovation: MIPS

UPDATED: CMS Announces “Slight” Adjustments to 2017 Final MIPS Scores

September 18, 2018

CMS announces “slight” adjustments to some 2017 MIPS final scores.

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Energy and Commerce Health Subcommittee Hearing to Review Regulatory Burdens that Impede Value-Based Arrangements

Payment Innovation: Advanced APMs

Energy and Commerce Health Subcommittee Hearing to Review Regulatory Burdens that Impede Value-Based Arrangements

September 11, 2018

On September 13, 2018 at 1:15 pm, the Energy and Commerce Health Subcommittee will hold a hearing entitled “Examining Barriers to Expanding Innovative, Value-Based Care in Medicare.”  The hearing will look at ways to meaningfully evaluate and increase the use of Medicare value-based payment arrangements.

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PTAC Recommends Models for Implementation and Limited Scale Testing at September 2018 Meeting

Payment Innovation: PTAC

PTAC Recommends Models for Implementation and Limited Scale Testing at September 2018 Meeting

September 11, 2018

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MIPS Resource: CMS Posts Details on Beneficiary Assignment Methodology for Groups and Virtual Groups

Payment Innovation: MIPS

MIPS Resource: CMS Posts Details on Beneficiary Assignment Methodology for Groups and Virtual Groups

September 11, 2018

CMS recently posted a report that describes the process used by CMS for assigning beneficiaries to a group or a virtual group participating in the Merit-based Incentive Payment System.

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Five Key Takeaways: CJR Year 1 Performance Evaluation

Insight: original analysis

Five Key Takeaways: CJR Year 1 Performance Evaluation

September 11, 2018

A recently released evaluation of the CMS Comprehensive Care for Joint Replacement Model found a statistically significant reduction in spending in both high cost and low cost areas during the first performance year. Here are our five key takeaways.

ORIGINAL ANALYSIS

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Health Reform 2.0: Litigation

Texas Judge Hears Arguments in ACA Case

September 07, 2018

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CMS Webinar on All-Payer Combination Option

Payment Innovation: Quality Payment Program

CMS Webinar on All-Payer Combination Option

September 05, 2018

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CMS Posts Medicaid Other Payer Advanced APMs List and Eligible Clinician Initiated Submission Form

Payment Innovation: Quality Payment Program

CMS Posts Medicaid Other Payer Advanced APMs List and Eligible Clinician Initiated Submission Form

September 05, 2018

CMS posts two new APM resources related to other payer Advanced APMs.

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Payment Innovation: Other

MedPAC to Discuss Mandated Report on Clinician Payment in Medicare at September 6th Meeting

September 05, 2018

MedPAC is scheduled to discuss a mandated report on clinician payment examining the relationship between Medicare’s payments to clinicians and the supply of and quality of care provided by those clinicians report at their September 6, 2018, meeting.

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CMS Hosts Virtual Office Hours on the 2019 MIPS Performance Period Self-Nomination Process

Payment Innovation: MIPS

CMS Hosts Virtual Office Hours on the 2019 MIPS Performance Period Self-Nomination Process

September 05, 2018

On September 20, 2018, CMS is hosting a virtual office hours session on the 2019 MIPS self-nomination process.

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2018 MIPS Resources for Anesthesiologists, Cardiologists and Radiologists Posted on QPP Resource Center

Payment Innovation: MIPS

2018 MIPS Resources for Anesthesiologists, Cardiologists and Radiologists Posted on QPP Resource Center

September 05, 2018

CMS has posted resource documents on the Merit-based Incentive Payment System (MIPS) for anesthesiologists, cardiologists and radiologists.

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CMS Posts 2018 MIPS Data Validation Criteria

Payment Innovation: MIPS

CMS Posts 2018 MIPS Data Validation Criteria

September 05, 2018

CMS posts validation criteria for the 2018 Merit-based Incentive Payment System (MIPS) program.

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Integrated Care for Kids (InCK) Model Overview Webinar

Payment Innovation: Innovation Center

Integrated Care for Kids (InCK) Model Overview Webinar

September 05, 2018

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CMS Releases 2017 MSSP ACO Performance Data

Payment Innovation: Advanced APMs

CMS Releases 2017 MSSP ACO Performance Data

September 05, 2018

CMS has released a data set showing how Medicare Accountable Care Organizations (ACOs) performed in 2017. 

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Top 5 Takeaways: CMS’s Proposed Overhaul of the MSSP ACOs

Insight: original analysis

Top 5 Takeaways: CMS’s Proposed Overhaul of the MSSP ACOs

August 30, 2018

On August 17, 2018, CMS released proposed rule that would make sweeping changes to the Medicare Shared Savings Program, a federal program that incentivizes integrated health provider networks to form Accountable Care Organizations. Comments are due October 16, 2018. Our top 5 takeaways follow.

ORIGINAL ANALYSIS

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Health Reform 2.0: Legislation

Senate Republicans Introduce Pre-existing Conditions Protection Bill

August 28, 2018

The Ensuring Coverage for Patients with Pre-Existing Conditions Act (S. 3388) was introduced on August 23rd by Senate Republicans in an effort to protect pre-existing conditions.

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Payment Innovation: MIPS

CMS Hosts 2019 Performance Period MIPS Self-Nomination JIRA Demonstration Webinar on August 30th

August 28, 2018

CMS is hosting a webinar at 2:00 PM ET on August 30, 2018, on the 2019 Performance Period MIPS self-nomination process.

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Payment Innovation: MIPS

Call for Nomination: Improvement Activities TEP

August 28, 2018

CMS has issued a call for nominations for its MIPS Improvement Activities Technical Expert Panel (TEP). CMS is seeking feedback from a group of stakeholders, consumers, patients and experts who can contribute direction and thoughtful input on the improvement activities during development and maintenance.

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Payment Innovation: Quality Payment Program

Registration Open for 2018 LAN Summit

August 28, 2018

The Health Care Payment Learning & Action Network (LAN) is hosting their 2018 Fall Summit on Monday, October 22 at the Sheraton Tysons Hotel in Tysons, VA.

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Payment Innovation: MIPS

ONC Releases Request for Information

August 28, 2018

The Office of the National Coordinator for Health IT released a request for information on criteria to measure the performance of certified electronic health record technology, as required by the 21st Century Cures Act.

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OIG Releases Request for Information on Anti-Kickback Statute and Beneficiary Inducements

Payment Innovation: Other

OIG Releases Request for Information on Anti-Kickback Statute and Beneficiary Inducements

August 28, 2018

The OIG published a request for information seeking stakeholder input on potential new safe harbors to the Anti-Kickback Statute and exceptions to the beneficiary inducement prohibition in the Civil Monetary Penalty Law to remove impediments to care coordination and value-based care.

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Payment Innovation: Innovation Center

CMS Releases Next Gen ACO Model Evaluation

August 28, 2018

CMS released the first annual report on the Next Generation Accountable Care Organization (ACO) model.  The report provides results from the 18 active Next Gens who participated beginning January 2016.

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CMS Announces Integrated Care for Kids Model to Address the Opioid Crisis

Payment Innovation: Innovation Center

CMS Announces Integrated Care for Kids Model to Address the Opioid Crisis

August 28, 2018

On August 23, 2018, CMS announced a new model that is intended to address the opioid crisis for children.

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CMS Awards $8.6 Million to Strengthen States Insurance Markets

Health Reform 2.0: Administration

CMS Awards $8.6 Million to Strengthen States Insurance Markets

August 21, 2018

Administration announces State Flexibility to Stabilize the Market Grant Program which will provide funding to 30 states and the District of Columbia for state exchanges.

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CMS Posts Virtual Groups Toolkit for 2019 MIPS Performance Year

Payment Innovation: MIPS

CMS Posts Virtual Groups Toolkit for 2019 MIPS Performance Year

August 21, 2018

CMS hosts virtual group webinar on August 27, 2018 at 2pm ET

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Payment Innovation: Other

2016 Physician Quality Reporting System Experience Report and the 2018 Value Modifier Experience Report Are Now Available

August 21, 2018

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Registration Open for September 6-7, 2018, PTAC Meeting

Payment Innovation: PTAC

Registration Open for September 6-7, 2018, PTAC Meeting

August 21, 2018

The Physician-Focused Payment Model Technical Advisory Committee (PTAC) recently opened registration for public meeting on September 6-7, 2018.

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Payment Innovation: Quality Payment Program

Quality Payment Program Exception Applications Now Available

August 14, 2018

Applications are due by December 31, 2018

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Payment Innovation: Quality Payment Program

CMS Releases First Snapshot of 2018 APM Qualifying Participant and MIPS APM Status

August 14, 2018

CMS updated the Quality Payment Program Participation Status Tool to include 2018 Advanced Alternative Payment Model Qualifying Participant and Merit-based Incentive Payment System APM status.

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CMS Releases Proposed Rule Overhauling Medicare Shared Savings Program

Payment Innovation: Regulation

CMS Releases Proposed Rule Overhauling Medicare Shared Savings Program

August 14, 2018

On August 9th, CMS released the Medicare Shared Savings Program proposed rule.

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CMS Opens Application for Medicare Advantage Qualifying Incentive Arrangement Demonstration

Payment Innovation: Quality Payment Program

CMS Opens Application for Medicare Advantage Qualifying Incentive Arrangement Demonstration

August 07, 2018

CMS is now accepting applications for the Medicare Advantage Qualifying Incentive Arrangement demonstration project under the Medicare Access and CHIP Reauthorization Act Quality Payment Program.

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Payment Innovation: Quality Payment Program

CMS Hosts QPP Conference Calls

August 07, 2018

The Centers for Medicare & Medicaid Services (CMS) is hosting two Quality Payment Program (QPP)-related conference calls.

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Payment Innovation: Other

CMS Solicits Feedback on QPP Website

August 07, 2018

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Administration Finalizes Rule Expanding Availability of Short Term Plans

Health Reform 2.0: Administration

Administration Finalizes Rule Expanding Availability of Short Term Plans

August 01, 2018

The Trump Administration released a final rule amending the definition of short-term, limited duration insurance. The rule lengthens the maximum duration of short-term, limited duration insurance and is intended to provide more affordable consumer choices for health care coverage.

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Payment Innovation: MIPS

Energy and Commerce Health Subcommittee Hosts Hearing on MIPS

July 31, 2018

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Payment Innovation: MIPS

CMS Posts Demonstration Videos on 2017 Performance Feedback and Requesting a Targeted Review

July 31, 2018

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CMS Finalizes Next Implementation Phase of Medicare Appropriate Use Criteria Program for Advanced Diagnostic Imaging Services

Insight: original analysis

CMS Finalizes Next Implementation Phase of Medicare Appropriate Use Criteria Program for Advanced Diagnostic Imaging Services

July 26, 2018

Beginning January 1, 2020, when submitting claims to Medicare for advanced diagnostic imaging services furnishing professionals and entities must certify that professionals ordering services consulted AUC applicable to the imaging modality

ORIGINAL ANALYSIS

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Payment Innovation: PTAC

PTAC Requests Stakeholder Feedback

July 24, 2018

Comments Requested by September 7, 2018

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Payment Innovation: MIPS

CMS Hosting Several MIPS-related Conference Calls

July 24, 2018

The Centers for Medicare & Medicaid Services (CMS) has announced they are hosting several Merit-based Incentive Payment System (MIPS)-related conference calls.

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Payment Innovation: Other

CMS Administrator Seema Verma Releases Letter to Doctors

July 24, 2018

Solicits feedback from clinicians on proposal to overhaul E/M documentation, billing and payment

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Diagnostics: Date of Service

Laboratory Test Codes Subject to Date of Service Exception (Updated 6/25/18)

July 19, 2018

EXTERNAL LINK

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Payment Innovation: MIPS

CMS Launches MAQI Demonstration Website

July 17, 2018

The Centers for Medicare and Medicaid Services (CMS) posted a webpage dedicated to the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration.

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Payment Innovation: MIPS

CMS Extends Deadline for MIPS Targeted Review to October 1, 2018

July 17, 2018

MIPS 2017 Performance Feedback Users Guide now available

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CMS Proposes Changes to Medicare Physician Payment in 2019

Insight: original analysis

CMS Proposes Changes to Medicare Physician Payment in 2019

July 16, 2018

On July 12, 2018, CMS released the CY 2019 Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Medicare Part B, which includes proposals related to Medicare physician payment and the Quality Payment Program. Read our top 10 takeaways from the rule here.

ORIGINAL ANALYSIS

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CMS Releases the CY 2019 PFS Proposed Rule

Payment Innovation: Regulation

CMS Releases the CY 2019 PFS Proposed Rule

July 12, 2018

Includes proposals for physician payment and the Medicare Quality Payment Program

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Payment Innovation: MIPS

GOP Doctors Caucus Asks CMS to Reduce MIPS Exemptions

July 10, 2018

On July 3, 2018, five members of the House Republican Doctors Caucus asked CMS Administrator Seema Verma to reduce the number of clinicians excluded from the Merit-Based Incentive Payment System (MIPS) in 2019.

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Payment Innovation: Advanced APMs

CMS Extends Key BPCI Advanced Deadlines

July 10, 2018

Submission of signed participation agreements now due August 8, 2018

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CMS Announces Period of Enforcement Discretion on Date of Service Rule

Diagnostics: Date of Service , Original Analysis

CMS Announces Period of Enforcement Discretion on Date of Service Rule

July 09, 2018

EXTERNAL LINK

CMS Advances MACRA Medicare Advantage APM Demonstration

Insight: original analysis

CMS Advances MACRA Medicare Advantage APM Demonstration

July 05, 2018

The Medicare Advantage Qualifying Payment Arrangement Incentive demonstration would waive Merit-Based Incentive Payment System requirements for clinicians taking sufficient risk in contracts with Medicare Advantage plans. The agency seeks comments on the information collection burdens associated with this demonstration that is under consideration for formal approval. More information on the request for comments is available…

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

CMS Advances Medicare Advantage Alternative Payment Model Demonstration

July 03, 2018

The Centers for Medicare and Medicaid Services (CMS) announced that it is pursuing a demonstration project, the Medicare Advantage Qualifying Payment Arrangement (MAQI) demonstration, which would allow clinicians involved in risk contracts in Medicare Advantage (MA) to be exempt from the Merit-Based Incentive Payment System (MIPS).

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Payment Innovation: PTAC

PTAC Update: Comments Requested on New Proposal, Statements from CMS Administrator and PTAC Chair, and New Letter of Intent

July 03, 2018

Comments due by July 23, 2018

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GAO Report Considers Small and Rural Practices’ Experiences in MIPS

Payment Innovation: MIPS

GAO Report Considers Small and Rural Practices’ Experiences in MIPS

July 03, 2018

The Government Accountability Office (GAO) was asked to review certain aspects of small and rural practices participation in legacy incentive programs and the Merit-based Incentive Payment System (MIPS).

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Payment Innovation: Other

CMS Hosts Webinar on Public Reporting on Physician Compare

July 03, 2018

July 24, 2018 11:00 AM ET/8:00 AM PT and July 26, 2018 3PM ET/12:00 PM PT

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QPP Year 1 Update: CMS Informs MIPS Participants of their 2019 Payment Adjustments

Payment Innovation: MIPS

QPP Year 1 Update: CMS Informs MIPS Participants of their 2019 Payment Adjustments

July 03, 2018

The Centers for Medicare & Medicaid Services (CMS) released 2017 Merit-based Incentive Payment System (MIPS) performance feedback.

POST

Top Five Issues to Watch in the 2019 QPP Proposed Rule

Insight: original analysis

Top Five Issues to Watch in the 2019 QPP Proposed Rule

June 25, 2018

The Centers for Medicare and Medicaid Services is scheduled to release the 2019 Quality Payment Program (QPP) proposed rule shortly. For the first time it is expected to be combined with the 2019 Medicare Physician Fee Schedule proposed rule, which generally is released on or around July 1. Our top five issues to watch in…

ORIGINAL ANALYSIS

diagnostic

Diagnostics: Payment Rates

CMS Posts Preliminary Gapfill Pricing Determinations

June 21, 2018

CMS Posts Preliminary Gapfill Pricing Determinations

EXTERNAL LINK

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Health Reform 2.0: Budget Information

House GOP Proposes 2019 Budget Plan

June 20, 2018

The Republican House Budget Committee released a FY 2019 budget roadmap, The Budget for A Brighter American Future, on June 19.

POST

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Payment Innovation: PTAC

GAO Accepting PTAC Nominations

June 19, 2018

The Government Accountability Office (GAO) is currently accepting letters of nomination and resumes for appointments to the Physician-Focused Payment Model Technical Advisory Committee (PTAC).

POST

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Payment Innovation: Quality Payment Program

CMS Announces QCDR Measure Development Google Group and QCDR/Registry Google Calendar

June 19, 2018

The Centers for Medicare & Medicaid Services (CMS) has created a Qualified Clinical Data Registry (QCDR) Measure Development Google Group and QCDR/Registry Google Calendar.

POST

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Payment Innovation: Advanced APMs

CMS Hosts Webinar on BPCI Advanced

June 19, 2018

CMS Hosts Webinar on BPCI Advanced Thursday, June 28, 1 to 2 pm Eastern

POST

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Secretary Responds to PTAC Recommendations

Payment Innovation: PTAC

Secretary Responds to PTAC Recommendations

June 19, 2018

Secretary Responds to PTAC Recommendations; Does Not Commit to Implementing any Models but Indicates Particular Interest in Two Serious Illness Models

POST

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Payment Innovation

PTAC Cancels June 2018 Meeting

June 12, 2018

The June 14-15, 2018 public meeting of the Physician-Focused Payment Model Technical Advisory Committee (PTAC) has been canceled.

POST

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Payment Innovation: MIPS

CMS Posts Report on MIPS Improvement Activities for Year 1 of the QPP

June 12, 2018

The Centers for Medicare and Medicaid Services (CMS) released a report on the Improvement Activities (IAs) Performance Category of the Merit-based Incentive Payment System (MIPS) for Year 1 of the Quality Payment Program (QPP).

POST

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Payment Innovation: Quality Payment Program

CMS Finalizes Extreme and Uncontrollable Circumstances Policy for CJR

June 12, 2018

The Centers for Medicare and Medicaid Services (CMS) published a final rule to provide flexibility to hospital participating in the Comprehensive Care for Joint Replacement (CJR) Model (CJR) located in those areas impacted by extreme and uncontrollable circumstances. 12

POST

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Payment Innovation: Quality Payment Program

Medicare Diabetes Prevention Program Supplier Enrollment Call

June 12, 2018

On Wednesday, June 20, 2018, the Centers for Medicare & Medicaid Services (CMS), will host a call to present information about the Medicare Diabetes Prevention Program (MDPP) supplier enrollment requirements and process.

POST

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Payment Innovation: Quality Payment Program

Upcoming CMS QPP Webinars

June 12, 2018

The Centers for Medicare & Medicaid Services (CMS) is hosting a number of webinars on the Quality Payment Program (QPP) this week.

POST

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Health Reform 2.0: Budget Information

2018 Medicare Solvency Report Released

June 11, 2018

On June 5, 2018, the Board of Trustees released the 2018 annual report on solvency of the Medicare trust funds (the Hospital Insurance Trust Fund and the Supplementary Medical Insurance Trust Fund).

POST

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Payment Innovation: MIPS

MIPS Preliminary Performance Feedback Data Is Available

June 05, 2018

Eligible clinicians that submitted 2017 Merit-based Incentive Payment System (MIPS) data through the Quality Payment Program website, can review their preliminary performance feedback. MIPS final scores and feedback will be available in July.

POST

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Payment Innovation: MIPS

CMS Announces 91% Participation for Year 1 of MIPS

June 04, 2018

The Centers for Medicare and Medicaid Services (CMS) announced that 91 percent of all clinicians eligible for the Merit-based Incentive Payment System (MIPS) participated in the first year of the Quality Payment Program (QPP). 

POST

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Payment Innovation: Quality Payment Program

CMS Seeks Nominations of Clinical Experts for Subcommittees Developing Cost Measures: MSPB Service Refinement Workgroup

May 29, 2018

POST

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Payment Innovation: Quality Payment Program

CMS Opens 2019 QPP Advanced APM Module for MA Plans

May 29, 2018

POST

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Payment Innovation: Quality Payment Program

CMS Webinar about QCDR Measure Development, Processes and Expectations

May 29, 2018

POST

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Health Reform 2.0: Budget Information

CBO Provides Updated Estimates for Uninsured; Small and Non-Group Market Coverage

May 25, 2018

POST

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Payment Innovation: Regulation

CMS Releases Final Rule Containing Technical Corrections for QPP

May 23, 2018

POST

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Payment Innovation: Quality Payment Program

CMS Posts eCQMs for the 2019 Performance Period

May 23, 2018

POST

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Health Reform 2.0: Stakeholder Engagement

Urban Institute Unveils ‘Healthy America’ Plan

May 16, 2018

POST

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Payment Innovation: PTAC

PTAC Submits Recommendations on Four Models to the HHS Secretary

May 16, 2018

POST

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Payment Innovation: Quality Payment Program

Accepting Nominations: MACRA Episode Groups and Cost Measures Clinical Subcommittees

May 15, 2018

POST

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Payment Innovation: Quality Payment Program

CMS Posts New Resources on the Medicare Diabetes Prevention Program Website

May 15, 2018

POST

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Payment Innovation: Quality Payment Program

CMS Updates QPP Website to Offer 2018 MIPS Clinician Eligibility at the Group Level

May 15, 2018

POST

diagnostic

Diagnostics: Regulation

Frequently Asked Questions, CMS 1621 F, Medicare Program

May 14, 2018

Frequently Asked Questions, CMS 1621 F, Medicare Program – Medicare Clinical Diagnostic Laboratory Tests Payment System, Final Rule.

PDF DOWNLOAD

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Health Reform 2.0: Administration

President-Elect Trump Announces Additions to Health Policy Team

May 09, 2018

On January 5, 2017, the President-elect’s transition team announced that Andrew Bremberg will serve as Director of the White House Domestic Policy Council and Katy Talento will lead Healthcare Policy.

POST

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Health Reform 2.0: Administration

2016 Republican Party Platform

May 09, 2018

2016 Republican Party Platform – Downloadable pdf.

PDF DOWNLOAD

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Health Reform 2.0: Administration

President-Elect Trump’s Transition Website

May 09, 2018

President-Elect Trump’s Transition Website  

EXTERNAL LINK

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Payment Innovation: Quality Payment Program

CMS Hosts Webinar on Participation Criteria for Year 2 of the Quality Payment Program

May 08, 2018

POST

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Payment Innovation: Innovation Center

CMS Posts Updated Timeline for the BPCI Advanced Model

May 08, 2018

POST

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Payment Innovation: Quality Payment Program

2018 Measure Development Plan Annual Report Released

May 08, 2018

POST

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Payment Innovation: Quality Payment Program

CMS Updates Eligibility Criteria for MACRA Measure Development Cooperative Agreements

May 07, 2018

POST

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Payment Innovation: Quality Payment Program

Deadline to Submit MIPS Quality Candidate Measures to JIRA

May 07, 2018

POST

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Payment Innovation: Innovation Center

CMS Administrator Encourages Participation in Expanded Medicare Diabetes Prevention Program Model

May 01, 2018

POST

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GAO Report on CMS Innovation Center, Model Implementation and Performance

Payment Innovation: Innovation Center

GAO Report on CMS Innovation Center, Model Implementation and Performance

April 30, 2018

The Government Accountability Office (GAO) released a report on the Center for Medicare and Medicaid Innovation (Innovation Center) and their work to test payment and delivery options.

POST

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Payment Innovation: Other

CMS Public Forum on Oncology Care Model – Stakeholder Feedback

April 30, 2018

POST

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Payment Innovation: Quality Payment Program

CMS Webinar on Frequently Asked Questions about the Quality Payment Program

April 30, 2018

POST

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Payment Innovation: Quality Payment Program

CMS posts new MIPS group participation resources

April 30, 2018

POST

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Payment Innovation: Innovation Center

CMS Releases Comments from RFI on Innovation Center

April 30, 2018

POST

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Payment Innovation: Regulation

CMS Announces Rebrand of ACI MIPS Performance Category

April 30, 2018

POST

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Payment Innovation: Quality Payment Program

National Physician Specialty Societies Request CMS to Shorten the 2018 MIPS Reporting Period

April 24, 2018

POST

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Payment Innovation: Quality Payment Program

CMS and America’s Physician Groups Host Webinar on MIPS APMs

April 24, 2018

POST

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Payment Innovation: Quality Payment Program

CMS Announces Extension of MACRA Measure Development Funding Opportunity

April 24, 2018

POST

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Payment Innovation: Innovation Center

CMS Posts Responses to Innovation Center New Direction RFI

April 24, 2018

POST

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Payment Innovation: Innovation Center

Innovation Center Requests Comments on Direct Provider Contracting

April 24, 2018

POST

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Payment Innovation: Innovation Center

Feedback Solicited on Opioid Alternative Payment Model

April 19, 2018

The American Medical Association (AMA) and the American Society of Addiction Medicine (ASAM) are soliciting feedback on a proposed alternative payment model (APM)

POST

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Payment Innovation: Quality Payment Program

Earn Improvement Activity Credit in 2018 for Participating in a Study on the Burden of Quality Measure Reporting

April 19, 2018

Clinicians and groups who are eligible for the Merit-based Incentive Payment System (MIPS) that participate successfully in the study will receive full credit for the 2018 MIPS Improvement Activities performance category.

POST

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Payment Innovation: Quality Payment Program

CMS Hosts Two-Part Webinar Series on Quality Measures

April 19, 2018

The Centers for Medicare and Medicaid Services (CMS) is hosting a two-part webinar series that covers an introduction to quality measures, overview of the measure development process, how the public can get involved.

POST

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Payment Innovation: Other

CMS Releases Analysis of Medicare Fee-for-Service Request for Information Comments

April 13, 2018

POST

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Adam Boehler Named as Head of CMS Innovation Center

Payment Innovation: Innovation Center

Adam Boehler Named as Head of CMS Innovation Center

April 10, 2018

On Friday, April 6, 2018, Health and Human Services Secretary Alex Azar named Adam Boehler, the founder and former CEO of Landmark Health, as the deputy administrator and director of the Centers for Medicare & Medicaid Services (CMS) Innovation Center. Created under the Obama Administration through the Affordable Care Act, the CMS Innovation Center supports the development and…

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

CMS Releases 2018 MIPS Eligibility Tool

April 10, 2018

The Centers for Medicare and Medicaid Services (CMS) updated their MIPS Participation Tool for the 2018 MIPS program. By entering a National Provider Identification (NPI) number, clinicians can determine if they are eligible to participate in the 2018 MIPS program.

ORIGINAL ANALYSIS

diagnostic

Diagnostics: Guidance

CMS releases April CLFS pricing file

April 05, 2018

EXTERNAL LINK

diagnostic

Diagnostics: Payment Rates

CMS releases list of lab codes for review at Annual CLFS Public Meeting

April 02, 2018

PDF DOWNLOAD

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Payment Innovation: Quality Payment Program

MIPS 2017 Data Submission Deadline Extended to April 3 at 8PM EDT

March 30, 2018

ORIGINAL ANALYSIS

macra

Payment Innovation: PTAC

PTAC Recommends Models for Implementation and Limited Scale Testing at March 2018 Meeting

March 30, 2018

The Physician-Focused Technical Advisory Committee (PTAC) met March 26-27, 2017, in Washington, DC, to review four proposed payment models.

ORIGINAL ANALYSIS

macra

Payment Innovation: Innovation Center

Innovation Center Hosting Public Forum on Oncology Care Model

March 30, 2018

ORIGINAL ANALYSIS

diagnostic
CMS announces meeting of Advisory Panel on Clinical Diagnostic Tests

Diagnostics: Payment Rates

CMS announces meeting of Advisory Panel on Clinical Diagnostic Tests

March 29, 2018

PDF DOWNLOAD

diagnostic
CMS announces Annual CLFS Public Meeting, June 25, 2018

Diagnostics: Payment Rates

CMS announces Annual CLFS Public Meeting, June 25, 2018

March 29, 2018

PDF DOWNLOAD

diagnostic

Diagnostics: PAMA

Guidance for Laboratories on ADLTs

March 23, 2018

PDF DOWNLOAD

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CMS releases application for ADLT status

Diagnostics: PAMA

CMS releases application for ADLT status

March 23, 2018

PDF DOWNLOAD

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GOP Releases Legislation Intended to Stabilize Exchange Markets

Health Reform 2.0: Congress

GOP Releases Legislation Intended to Stabilize Exchange Markets

March 21, 2018

Republican congressional health leaders introduced legislation to stabilize individual federal insurance exchange markets on March 19th.

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

MedPAC Recommends Elimination of MIPS and Adoption of Alternative Approach in March 2018 Report to Congress

March 16, 2018

On Thursday, March 15, 2018, the Medicare Payment Advisory Commission (MedPAC) released its semiannual report to Congress with a recommendation to eliminate the Merit-Based Incentive Payment System (MIPS) and replace it with an allegedly less burdensome program referred to as the Voluntary Value Program (VVP).

ORIGINAL ANALYSIS

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Payment Innovation: Other

Bipartisan Healthcare Innovation Caucus Announced

March 16, 2018

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

AMA Asks OIG for APM Safe Harbors

March 16, 2018

The American Medical Association (AMA) recently submitted a letter to the Office of the Inspector General (OIG) to create a safe harbor to facilitate coordinated care and promote well-designed alternative payment models (APMs).

ORIGINAL ANALYSIS

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Payment Innovation: PTAC

PTAC Update: Preliminary Review Team Reports Released for March 26-27, 2018, Public Meeting

March 16, 2018

ORIGINAL ANALYSIS

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Bipartisan Efforts from Various Stakeholder Groups to Kickstart Health Reform efforts

Health Reform 2.0: Stakeholder Engagement

Bipartisan Efforts from Various Stakeholder Groups to Kickstart Health Reform efforts

March 07, 2018

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

Upcoming 2017 MIPS Deadlines and Milestones

March 05, 2018

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

CMS Announces Funding Opportunity: Measure Development for the Quality Payment Program

March 05, 2018

ORIGINAL ANALYSIS

Insight: original analysis

Five Key Takeaways on Healthcare Priorities from the President’s Budget

February 27, 2018

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

CMS Releases Medicaid APM Certification Process for the Advanced APM Track of the QPP

February 22, 2018

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

2017 Scores Available for MIPS Quality Data Submitted Via Claims

February 22, 2018

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

CMS Seeks Nominations of Clinical Experts for Subcommittees Developing Cost Measures

February 22, 2018

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

Individual Clinicians and Groups Can Earn MIPS Credit for Participating in a Study on the Burden of Quality Measure Reporting

February 22, 2018

ORIGINAL ANALYSIS

Insight: original analysis

Bipartisan Budget Act of 2018 Includes Significant Changes in Medicare, Other Federal Health Programs

February 09, 2018

ORIGINAL ANALYSIS

macra

Payment Innovation: Innovation Center

BPCI Advanced Update

February 01, 2018

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

CMS Posts 2018 Patient-Facing Codes

January 26, 2018

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

CMS Releases Episode-based Cost Measures

January 26, 2018

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

109 Physician Specialty Societies, Large Practice Groups and Patient Advocacy Groups Urge Congress to Remove Part B Drugs from MIPS Payment Adjustment

January 26, 2018

A collection of 109 organizations representing providers and patients submitted a letter urging Congress to block CMS from applying the Merit-based Incentive Payment System (MIPS) adjustment to Part B drug payments.

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

Upcoming CMS Webinar: Annual Call for Measures and Activities

January 26, 2018

ORIGINAL ANALYSIS

Insight: original analysis

5 Things You Need to Know About Medicare’s New Voluntary Bundled Payment Model

January 17, 2018

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

MedPAC Votes to Replace MIPS

January 16, 2018

On Thursday, January 11, 2018, the Medicare Payment Advisory Commission (MedPAC) recommended eliminating the Merit-based Incentive Payment System (MIPS) and its related reporting requirements and replacing it with a voluntary value program. Under the proposed model, all clinicians would have a portion of their fee schedule payment withheld. Clinicians then could earn the withhold back…

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

Upcoming CMS Webinars

January 12, 2018

The Centers for Medicare & Medicaid Services (CMS) has just announced two webinars related to the Quality Payment Program. Upcoming webinars are listed below.

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

CMS Solicits Comments on Specialty Measure Sets

January 12, 2018

The Centers for Medicare & Medicaid Services (CMS) is accepting recommendations from stakeholders for potential consideration of new specialty measure sets and/or revisions to existing specialty measure sets for program year 2019 of the Merit-based Incentive Payment System (MIPS) program. The current 2018 specialty measure sets are located in the Appendix measure tables of the…

ORIGINAL ANALYSIS

macra

Payment Innovation: Innovation Center

CMS Announces New Voluntary BPCI Advanced Model

January 12, 2018

On Tuesday, January 9, 2018, the Centers for Medicare and Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (Innovation Center) announced a new voluntary episode payment model, Bundled Payments for Care Improvement Advanced (BPCI Advanced Model) that will test a new iteration of bundled payments for 32 Clinical Episodes. The Advanced BPCI Model will operate…

ORIGINAL ANALYSIS

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Payment Innovation: PTAC

PTAC Recommends Two Models for Implementation at December 2017 Public Meeting

January 03, 2018

The Physician-Focused Technical Advisory Committee (PTAC) met December 18-20, 2017, in Washington, DC, to review seven proposed payment models.

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

List of 2018 Qualified Registries and QCDRs Now Available

January 03, 2018

ORIGINAL ANALYSIS

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2018 MIPS Measures and Activities Posted

Payment Innovation: Quality Payment Program

2018 MIPS Measures and Activities Posted

January 03, 2018

The Centers for Medicare and Medicaid Services (CMS) posted documents for the measures and activities for each of the four Merit-based Incentive Payment System (MIPS) performance categories in 2018.

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

CMS Launches Website to Submit 2017 QPP Data

January 03, 2018

The Centers for Medicare and Medicaid Services (CMS) announced that eligible clinicians participating in the Quality Payment Program (QPP) can begin submitting their 2017 performance data using a new data submission system on the QPP website. Eligible clinicians can use the web-based system to submit their 2017 QPP performance data during the 2017 submission period which…

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

OIG Releases QPP Report: Concludes CMS has Made Progress in QPP Implementation but Challenges Remain

December 14, 2017

The Office of the Inspector General (OIG) recently released a follow-up report to a 2016 early implementation review of the Quality Payment Program (QPP).

ORIGINAL ANALYSIS

Insight: original analysis

ACLA Files Lawsuit Challenging CMS Implementation of PAMA Section 216

December 12, 2017

ORIGINAL ANALYSIS

diagnostic

Diagnostics: Litigation

ACLA Files Lawsuit Challenging CMS Implementation of PAMA Section 216

December 12, 2017

On Monday December 11, the American Clinical Laboratory Association (ACLA) filed a legal challenge to CMS’s implementation of the revised Clinical Laboratory Fee Schedule (CLFS) required under Section 216 of the Protecting Access to Medicare Act (PAMA) of 2014.

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

Specialty Societies Ask Congress to Act to Avert Application of MIPS Adjustment on Part B Drugs

December 08, 2017

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

Nomination Period Open for MACRA Measure Development Plan Technical Expert Panel

December 08, 2017

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

CMS Releases List of 22 Measures Under Consideration for the MIPS Program

December 08, 2017

As required by statute, on November 30, 2017, the Centers for Medicare and Medicaid Services (CMS) released a list of quality measures that are under consideration for Medicare quality reporting and value-based purchasing programs. Of the 32 measures on the list, 22 are being considered for the Merit-based Incentive Payment System (MIPS). The release of…

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

MedPAC Discusses Draft Recommendation to Repeal MIPS

December 08, 2017

ORIGINAL ANALYSIS

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Payment Innovation: Innovation Center

CMS Finalizes Changes to the Comprehensive Care for Joint Replacement Model, Cancels Episode Payment Models and Cardiac Rehabilitation Incentive Payment Model

November 30, 2017

On Thursday, November 30, 2017,  CMS released the final rule and interim final rule to implement changes to the Comprehensive Joint Replacement Program (CJR).

ORIGINAL ANALYSIS

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Payment Innovation: PTAC

PTAC Update: Preliminary Review Team Reports Released for Dec. 18-20, 2017, Public Meeting

November 30, 2017

ORIGINAL ANALYSIS

diagnostic

Diagnostics: Payment Rates

CMS Releases Final CY 2018 CLFS Payment Rates

November 22, 2017

Zip file available for download.

EXTERNAL LINK

diagnostic

Diagnostics: Guidance

CMS Releases Final CY 2018 Crosswalk and Gapfill Determinations

November 22, 2017

PDF DOWNLOAD

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Payment Innovation: PTAC

PTAC Update: New Proposals Open for Comment

November 14, 2017

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

MIPS Comparison Table: CY 2018 Final Rule vs CY 2017 Final Rule

November 14, 2017

ORIGINAL ANALYSIS

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Health Reform 2.0

Republicans Face Difficult Post-Election Healthcare Decisions (Managed Healthcare Executive)

November 14, 2017

Piper Su provides additional election-related health care insights.

ORIGINAL ANALYSIS

Insight: original analysis

10 Things to Know about the 2018 Quality Payment Program

November 09, 2017

ORIGINAL ANALYSIS

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Payment Innovation: Other

LAN Releases Report on Progress of APM Adoption

November 06, 2017

ORIGINAL ANALYSIS

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Payment Innovation: Innovation Center

Innovation Center Update: Mandated Report on Radiation Therapy Released and Expansion of the Medicare Diabetes Prevention Program Finalized in in CY 2018 PFS Final Rule

November 06, 2017

ORIGINAL ANALYSIS

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Payment Innovation: PTAC

PTAC Solicits Comments on Emergency Care and Headache-related PFPMs and Submits Reports to the Secretary on Proposals Reviewed at September 2017 Public Meeting

November 06, 2017

ORIGINAL ANALYSIS

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Payment Innovation: Regulation

CMS Releases CY 2018 Quality Payment Program (MACRA) Final Rule

November 02, 2017

Register Today for a Live Webinar – Overview and Analysis of the CY 2018 QPP Final Rule

ORIGINAL ANALYSIS

diagnostic

Diagnostics: PAMA

Unlisted procedure code data collection

November 01, 2017

PDF DOWNLOAD

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Payment Innovation: Quality Payment Program

CMS and CAPG Host Webinar: How to Control Costs for the MIPS Resource Use Component

October 31, 2017

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

MedPAC November 2017 Public Meeting Agenda Released

October 31, 2017

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

New Resource Available: Advance APM Pathways Presentation

October 26, 2017

ORIGINAL ANALYSIS

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Health Reform 2.0: Budget Information

CBO Scores Alexander Murray Legislation

October 26, 2017

ORIGINAL ANALYSIS

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Health Reform 2.0

CBO Scores Bipartisan Health Care Stabilization Act, Introduced by Sens. Alexander and Murray

October 26, 2017

On October 25 the Congressional Budget Office (CBO) released its score for the Alexander Murray bill.

ORIGINAL ANALYSIS

diagnostic

Diagnostics: Guidance

CMS instructs contractors to stop applying Automated Test Panel edits to claims effective January 1, 2018

October 20, 2017

PDF DOWNLOAD

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Health Reform 2.0: Congress

Senate HELP Committee Releases Bipartisan Bill to Stabilize Markets

October 18, 2017

Yesterday, Senate HELP Committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) announced a bipartisan agreement to provide for short-term stabilization of the individual health insurance market following President Trump’s recent decision to end distribution of cost sharing reduction payments (CSRs) previously available under the Affordable Care Act (ACA).

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

New Resources Available on the Quality Payment Program Website

October 13, 2017

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

APM Look-Up Tool Posted

October 13, 2017

Allows clinicians to check their Qualifying Advanced Alternative Payment Model (APM) Participant (QP) status

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

Virtual Group Election Period is Now Open

October 13, 2017

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

CMS Begins Field Testing MIPS Cost Measures on October 16

October 13, 2017

ORIGINAL ANALYSIS

diagnostic

Diagnostics: Guidance

CMS Instruction to Contractors to Report Claims Data for “Not-OtherwiseClassified” Lab Codes

October 13, 2017

PDF DOWNLOAD

macra

Payment Innovation: Quality Payment Program

MedPAC Proposes Alternative to MIPS

October 09, 2017

The Medicare Payment Advisory Commission (MedPAC) proposed an alternative to the Merit-based Incentive Payment System (MIPS) at their October 5, 2017 public meeting. This proposal expanded on their proposal to redesign MIPS found in their June 2017 Report to Congress.

ORIGINAL ANALYSIS

diagnostic

Diagnostics: Guidance

OIG releases report on Medicare payments for Lab Tests

October 04, 2017

EXTERNAL LINK

diagnostic

Diagnostics: Payment Rates

CMS releases Panel recommendations from September 25, 2017 meeting

September 29, 2017

PDF DOWNLOAD

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Payment Innovation: PTAC

PTAC Solicits Comments on Intensive Care Management in Skilled Nursing Facility Alternative Payment Model

September 22, 2017

Comments Accepted Until October 6, 2017

ORIGINAL ANALYSIS

macra

Payment Innovation: Innovation Center

CMS Seeks Comment on Future of the Innovation Center through “New Direction” RFI

September 22, 2017

Comments due by November 20, 2017

ORIGINAL ANALYSIS

diagnostic

Diagnostics: Payment Rates

CMS Releases Preliminary PAMA Based Payment Rates

September 22, 2017

EXTERNAL LINK

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Health Reform 2.0: Budget Information

Governors Weigh-in on Graham-Cassidy Healthcare Proposal

September 22, 2017

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

Registration Open for 2017 LAN Summit

September 21, 2017

LAN Hosts Summit on Healthcare Innovation on October 30, 2017

ORIGINAL ANALYSIS

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Health Reform 2.0: Congress

Senate Releases Bipartisan Legislation Reauthorizing CHIP Through 2022

September 21, 2017

ORIGINAL ANALYSIS

diagnostic

Diagnostics: Payment Rates , Regulation

CMS Releases Agenda for September 25 virtual meeting of Advisory Panel.

September 20, 2017

CMS Releases Agenda for September 25 virtual meeting of Advisory Panel.

PDF DOWNLOAD

Insight: original analysis

Senate Republicans and Democrats Introduce Competing Visions for Health Reform Beyond the ACA

September 15, 2017

ORIGINAL ANALYSIS

diagnostic

Diagnostics: Payment Rates

CMS Announces Virtual Meeting of CDLT Advisory Panel

September 13, 2017

PDF DOWNLOAD

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Health Reform 2.0: Congress

Senators Graham (R-SC), Cassidy (R-LA), Heller (R-NV), and Johnson (R-WI) Release Revised ACA Overhaul Proposal (September 13, 2017)

September 13, 2017

ORIGINAL ANALYSIS

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Health Reform 2.0: Congress

Senator Bernie Sanders (I-VT) Releases Medicare For All Proposal (September 13, 2017)

September 13, 2017

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

CMS Posts MIPS Resources on QPP Website

September 12, 2017

ORIGINAL ANALYSIS

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Payment Innovation: PTAC

PTAC Update: Secretary Responds to Proposals, Outcome of September Public Meeting and New Proposals Open for Comment

September 12, 2017

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

CMS and CAPG Host Webinars on APMs

September 11, 2017

The Centers for Medicare and Medicaid Services (CMS) is collaborating with CAPG to host two webinars on alternative payment models (APMs). Webinar presenters will include experts from both CMS and CAPG.

ORIGINAL ANALYSIS

Insight: original analysis

September Health Care Round-up: Legislative Activities and Deadlines of Note

September 05, 2017

PDF DOWNLOAD

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Payment Innovation: PTAC

PTAC Update: Preliminary Review Team Reports Released for Sept. 7-8, 2017, Public Meeting

August 18, 2017

ORIGINAL ANALYSIS

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Health Reform 2.0: Budget Information

CBO Estimates Impact of Ending CSR Payments

August 16, 2017

On August 15, the Congressional Budget Office (CBO) released its report estimating the impact of ending the cost-sharing reduction payments (CSRs) currently paid by the federal government to offset the cost of insurance in the public exchange market for individuals with income between 100-250% of the federal poverty level (FPL).  The payments are administered by…

ORIGINAL ANALYSIS

diagnostic

Diagnostics: Guidance

CMS solicitation of comments on 60 codes without reported data

August 08, 2017

PDF DOWNLOAD

macra

Payment Innovation: Quality Payment Program

Questions on the CY 2018 QPP Proposed Rule? CMS Hosts Office Hours on August 16 from 12noon – 1 PM ET

August 04, 2017

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

ACI Hardship Exception Applications for MIPS CY 2017 Now Available

August 04, 2017

ORIGINAL ANALYSIS

health-reform-20

Health Reform 2.0: Congress

Senate GOP Fails to Pass ACA Repeal and Replace Bills

July 28, 2017

This week, Republican leadership brought three separate proposals to repeal the Affordable Care Act (ACA) to the Senate floor for consideration but were unable to find consensus within their caucus, and all three measures failed to pass.  Majority Leader McConnell now must decide how to move forward with their efforts to repeal and/or replace the…

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

CMS Posts Information on Determination of Special Status Under the QPP

July 26, 2017

ORIGINAL ANALYSIS

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Payment Innovation: PTAC

PTAC Solicits Comments on Model for Initial Therapy of Newly Diagnosed Organ-Confined Prostate Cancer

July 26, 2017

Comments Due by August 8, 2017

ORIGINAL ANALYSIS

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Health Reform 2.0: Budget Information

Senate Republicans and CBO Explore Both Options

July 21, 2017

This week, Senate Republican leadership released two potential plans for moving forward with its effort to repeal and/or replace the portions of the Affordable Care Act (ACA) that are appropriate to address in the reconciliation process.

ORIGINAL ANALYSIS

health-reform-20

Health Reform 2.0: Congress

Repeal and Replace: Senate Republicans and CBO Explore Both Options

July 21, 2017

This week, Senate Republican leadership released two potential plans for moving forward with its effort to repeal and/or replace the portions of the Affordable Care Act (ACA) that are appropriate to address in the reconciliation process.

ORIGINAL ANALYSIS

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Payment Innovation: PTAC

PTAC Posts APM Proposal for Medicare Three-Year Value Based Payment Plan

July 17, 2017

Comment period closes on August 1, 2017

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

CMMI Hosts Webinar on the Quality Payment Program Year 2 Proposed Rule Focusing on the All-Payer Combination

July 17, 2017

Scheduled for Tuesday, July 18, from 2:00 to 3:30 pm ET

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

McDermottPlus Releases Hyperlinked Table of Contents of 2018 QPP Proposed Rule

July 17, 2017

An essential tool for a more efficient review of this critically important proposed rule

ORIGINAL ANALYSIS

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Payment Innovation: Other

LAN Releases Updated APM Framework

July 14, 2017

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

Bipartisan Congressional Letter Urging Recognition of Medicare Advantage as Advanced APMs

July 14, 2017

ORIGINAL ANALYSIS

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Payment Innovation: Original Analysis

Analysis of MIPS-related Proposals in the CY 2018 QPP (MACRA) Proposed Rule Now Available

July 05, 2017

Table Compares 2018 Proposed to 2017 Final Policies

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

CMS Posts Slides from June 26th Listening Session on CY 2018 QPP (MACRA) Proposed Rule

July 05, 2017

Other New CMS Resources on Year 1 and Year 2 of the QPP are Also Available

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

CMS Solicits Nominations for Participation on a Technical Expert Panel to Develop Inpatient Outcome Measures for MIPS

July 05, 2017

Nominations accepted until July 28, 2017

ORIGINAL ANALYSIS

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Payment Innovation: PTAC

PTAC Solicits Comments on Model for Low-Risk Maternity Care Provided by Midwife-led Birth Center

July 05, 2017

Comments Due by July 20, 2017

ORIGINAL ANALYSIS

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Health Reform 2.0: Budget Information

CBO Releases Budget Impact Estimate for Better Care Reconciliation Act

June 27, 2017

CBO released its budget impact estimate for the draft Better Care Reconciliation Act on June 26, 2017.  The report reflects the updated version of the discussion draft released by the Senate Budget Committee on June 26, including the addition of a six month lockout period for individuals purchasing insurance after experiencing a lapse in coverage.

ORIGINAL ANALYSIS

Insight: original analysis

2018 Quality Payment Program (MACRA) Proposed Rule: A Focus on Flexibility and Gradual Transition in Year 2

June 27, 2017

ORIGINAL ANALYSIS

health-reform-20

Health Reform 2.0: Congress

Better Care Reconciliation Act

June 26, 2017

PDF DOWNLOAD

Insight: original analysis

Senate Republicans Released an ACA Repeal and Replace Bill Discussion Draft, the “Better Care Reconciliation Act of 2017,” on June 22, 2017

June 26, 2017

A McDermottPlus side-by-side comparison table reflecting the draft’s major proposals compared to the AHCA and the ACA is now available

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

McDermottPlus Hosts Webinar on Newly Released 2018 QPP Proposed Rule

June 26, 2017

An Archived Video is now Available for On-Demand Viewing

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

CMS Posts QPP – Year 1 Fact Sheets on CAHPS® for MIPS Survey Vendors and Approved QCDRs

June 26, 2017

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

CMS Releases the Quality Measure Development Plan 2017 Annual Report

June 26, 2017

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

CMS Hosts Listening Session on the QPP Year 2 Proposed Rule

June 26, 2017

Scheduled for Wednesday, July 5, from 2:00 to 3:30 pm ET

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

LIVE WEBINAR | Quality Payment Program (MACRA) Explained: Overview and Analysis of the CY 2018 Proposed Rule

June 21, 2017

ORIGINAL ANALYSIS

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Payment Innovation: Regulation

CMS Drops 2018 MACRA Proposed Rule – Proposes Continuing Flexibilities for Year 2

June 20, 2017

Comments Due August 21, 2017

ORIGINAL ANALYSIS

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Payment Innovation: MIPS

MedPAC June Report Examines MIPS and Other Medicare Delivery System Topics

June 16, 2017

ORIGINAL ANALYSIS

diagnostic

Diagnostics: Payment Rates

CLFS Public Meeting

June 15, 2017

PDF DOWNLOAD

diagnostic

Diagnostics: Payment Rates

CDLT Advisory Panel Meeting

June 15, 2017

PDF DOWNLOAD

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Health Reform 2.0: Regulation

CMS Actuary Report Differs from CBO; 13M Still Uninsured Under AHCA

June 13, 2017

Today the Centers for Medicare and Medicaid Services’ Office of the Actuary released its report estimating the “financial effect of the ‘American Health Care Act of 2017”, legislation that would repeal and replace portions of the Affordable Care Act.

ORIGINAL ANALYSIS

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Health Reform 2.0: Regulation

CMS seeks public input on reducing the regulatory burdens of the Patient Protection and Affordable Care Act (PPACA)

June 09, 2017

ORIGINAL ANALYSIS

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Payment Innovation: MIPS

CMS Releases Predictive Analysis on Eligible Clinician QP Status

June 07, 2017

Based on historical Part B claims analysis, CMS predicts that nearly 100% of eligible clinicians in Advanced APMs will be QPs in performance year 2017

ORIGINAL ANALYSIS

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Payment Innovation: PTAC

PTAC Submits Recommendations on Three Models to the Secretary and Posts ESRD-related Proposal for Comment

June 07, 2017

PTAC Recommendations to the Secretary

ORIGINAL ANALYSIS

macra

Payment Innovation: Advanced APMs

CMS Solicits Applications from Practices and Payers for Round 2 of CPC+

May 26, 2017

Applications accepted until July 13, 2017

ORIGINAL ANALYSIS

macra

Payment Innovation: MIPS

Sample MIPS Participation Status Letter Posted

May 26, 2017

ORIGINAL ANALYSIS

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Payment Innovation: PTAC

PTAC Posts APM Proposal for Chronic HCV Bundled Payment Model for Comment

May 26, 2017

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

CMS Posts New Fact Sheets on the Quality Payment Program

May 26, 2017

ORIGINAL ANALYSIS

Insight: original analysis

FY 2018 President’s Budget May Signal Challenges for Health Programs on the Horizon

May 25, 2017

ORIGINAL ANALYSIS

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Health Reform 2.0: Budget Information

CBO Releases Revised Estimate of the American Health Care Act

May 24, 2017

The Congressional Budget Office (CBO) today released a new assessment of H.R. 1628, American Health Care Act of 2017 (AHCA), as passed by the U.S. House of Representatives on May 4, 2017.

ORIGINAL ANALYSIS

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Health Reform 2.0: Budget Information

A New Foundation for American Greatness

May 23, 2017

ORIGINAL ANALYSIS

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Health Reform 2.0: Stakeholder Engagement

Freedom Partners and Americans for Prosperity Letter to Senate

May 22, 2017

In a May 22, 2017 letter, two conservative advocacy groups lay out their principals for the Senate’s health reform bill.

PDF DOWNLOAD

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Health Reform 2.0: Stakeholder Engagement

Health Care Groups Request Senate Fund CSRs

May 19, 2017

In a May 19, 2017 sign-on letter, major health care groups request the Senate take action to guarantee CSR funding through 2018.

PDF DOWNLOAD

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Payment Innovation: Innovation Center

CMMI Posts Slide Presentation from Public Forum on a Radiation Therapy APM

May 18, 2017

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

CMS Hosts Webinar on Quality Payment Program Participation Requirements

May 18, 2017

Webinar Scheduled for Monday, May 22, 2017, 1:00 PM – 2:00 PM ET

ORIGINAL ANALYSIS

macra

Payment Innovation: Advanced APMs

Organizations Advocate to CMS to Expand Advanced APM Opportunities to Include APMs Under Medicare Advantage

May 17, 2017

On May 12, 2017, ten organizations submitted a letter to Secretary of Centers for Medicare and Medicaid Services Tom Price urging him to afford physicians and physician groups credit for participation in Medicare Advantage Alternative Payment Models (APMs) for the Advanced APM pathway of the Quality Payment Program (QPP). Under the QPP, physicians who meet…

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

Funding Opportunity: Measure Development for the Quality Payment Program

May 17, 2017

The Centers for Medicare and Medicaid Services (CMS) has announced a funding opportunity to support developing, improving, updating or expanding quality measures for use in the Quality Payment Program under the Merit-Based Incentive Payment System and/or Advanced Alternative Payment Models.

ORIGINAL ANALYSIS

macra

Payment Innovation: Innovation Center

Health Affairs Blog Launches New Topic: Diffusion of Innovation

May 16, 2017

On May 16, 2017, the Health Affairs Blog launched a new topic: Diffusion of Innovation. The focus of the blog topic is how innovations are diffused across health care and will continue over the next year followed by the publication of a theme issue in February 2018.

ORIGINAL ANALYSIS

macra

Payment Innovation: PTAC

PTAC Posts APM Proposal for Hospital-Level Services Provided at Home for Comment

May 15, 2017

Comment period closes on May 31, 2017

ORIGINAL ANALYSIS

macra

Payment Innovation: PTAC

PTAC Cancels June 2017 Meeting

May 08, 2017

The Physician-Focused Payment Model Technical Advisory Committee (PTAC) will not be holding a public meeting scheduled for June 5-6. The next scheduled meeting is September 7-8, 2017.

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

CM Updates eCQMs for CY 2018

May 08, 2017

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

Check Your MIPS Eligibility Online at the QPP Website

May 08, 2017

Clinicians can use their 10-digit National Provider Identification Number to check their 2017 Merit-based Incentive Payment System (MIPS) eligibility on the Quality Payment Program website. Clinicians included in MIPS in 2017, will need to decide whether to report as an individual or with a group. Clinicians exempt from MIPS in 2017, will not need to do anything…

ORIGINAL ANALYSIS

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Payment Innovation: PTAC

PTAC Posts Advanced Primary Care APM Proposal for Comment

May 01, 2017

Comment period closes on May 18, 2017

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

MIPS Improvement Activities Data Validation and Auditing Criteria Released

April 29, 2017

Quality and Advancing Care Information Criteria Will Be Released in Summer 2017.  

POST

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Payment Innovation: Quality Payment Program

CMS Hosts Webinar on MIPS Group Reporting 101

April 28, 2017

Webinar Scheduled for May 11, 2017, 1:00 – 2:30 PM ET

ORIGINAL ANALYSIS

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Health Reform 2.0: Congress

Draft Legislative Text of McArthur Amendment Offers More Details on Proposed AHCA Changes

April 26, 2017

On Tuesday, House Republican leaders circulated draft legislative language offering more details about the AHCA amendment developed by Reps. McArthur and Meadows.

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

CMS to Send MIPS Participation Status Letters in Late April and May

April 26, 2017

The Centers for Medicare and Medicaid Services (CMS) just announced that practices will be receiving letters in late April and May informing them if they need to participate in Merit-based Incentive Payment System (MIPS) in 2017. The letter will come from the Medicare Administrative Contractor that processes their Medicare Part B claims and will tell them the…

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

CMS and CAPG Host Quality Payment Program Webinar Series

April 25, 2017

First webinar on MIPS Quality Reporting Scheduled for May 5, 2017 from 3:30 – 4:30 PM ET

ORIGINAL ANALYSIS

health-reform-20

Health Reform 2.0: Stakeholder Engagement

National Governors Association Asks Congress to Fund ACA Subsidies

April 24, 2017

April 24, 2017 letter requesting funding for ACA subsidies in the FY2017 spending negotiations and 2018 budget.

EXTERNAL LINK

macra

Payment Innovation: Other

LAN Spring Forum: Aligning for Action

April 24, 2017

LAN Hosts Virtual Forum on May 1, from 1-3:30 PM ET

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

CMS Convenes TEP on Outpatient Outcome Measures for MIPS

April 19, 2017

Nominations due May 16, 2017

ORIGINAL ANALYSIS

macra

Payment Innovation: Innovation Center

CMMI Hosts Public Listening Session on Radiation Therapy APMs on May 3rd

April 17, 2017

The Center for Medicare & Medicaid Innovation (CMMI) will hold a public listening session regarding the development of a report to Congress on an alternative payment model for radiation therapy services. The listening session, scheduled for May 3, 2017, will provide an important opportunity for all stakeholders to provide input on the report.

ORIGINAL ANALYSIS

macra

Payment Innovation: PTAC

PTAC Recommends Two Payment Models for Limited-Scale Testing

April 13, 2017

The Physician-Focused Technical Advisory Committee (PTAC) met April 10-11, 2017, in Washington, DC, to review three proposed payment models. PTAC recommended two of the models, Project Sonar and the ACS-Brandeis Advanced Alternative Payment Model (APM), to CMS for limited-scale testing. PTAC rejected the third proposal, the COPD and Asthma Monitoring Project. A fourth proposal, the Comprehensive Colonoscopy Advanced APM for…

ORIGINAL ANALYSIS

macra

Payment Innovation: Innovation Center

CMS Hosts Oncology Care Model Stakeholder Feedback Opportunity on May 11

April 10, 2017

CMS is hosting a stakeholder feedback opportunity on the Oncology Care Model (OCM) on Thursday, May 11, 2017 from 1:00-4:00 p.m. EDT. All interested OCM stakeholders are invited to attend this public forum, with the goal of hearing feedback about OCM. The forum will include a brief introduction from the OCM team followed by discussion.…

ORIGINAL ANALYSIS

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Payment Innovation: PTAC

PTAC Solicits Comments on Oncology Bundle

April 10, 2017

Comment period closes April 27, 2017

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

CPT Editorial Panel Considers the Establishment of MACRA-related Modifiers at June 2017 Meeting

April 10, 2017

The American Medical Association (AMA) CPT® Editorial Panel posted the Proposed Agenda for the June 2017 Panel Meeting. Included on the agenda are two MACRA-related coding proposals.

ORIGINAL ANALYSIS

macra

Payment Innovation: PTAC

PTAC Releases Updated Agenda for April 10-11, 2017 Meeting

April 07, 2017

On Friday, April 7, 2017, the Physician-Focused Payment Model Technical Advisory Committee (PTAC) released an updated agenda for their April 2017 meeting. Originally four proposals were scheduled to be presented for public comment and final vote. The Comprehensive Colonoscopy Advanced Alternative Payment Model for Colorectal Cancer Screening, Diagnosis and Surveillance proposal has been withdrawn. PTAC…

ORIGINAL ANALYSIS

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Health Reform 2.0: Congress

Leaked AHCA Amendment Would Allow States to Seek Waivers from Federal Standards Established under the ACA

April 04, 2017

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

CMS Seeks Nominations for 7 Clinical Subcommittees Related to the Development of MACRA Episode-Based Cost Measures

April 04, 2017

Nomination deadline extended from April 17 to April 24, 2017

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

Registration Open for MIPS Group Web Interface and CAHPS Reporting

April 03, 2017

Groups utilizing the CMS web interface and/or CAHPS reporting must register by June 30, 2017

ORIGINAL ANALYSIS

diagnostic

Diagnostics: PAMA

CMS Announces Enforcement Discretion for PAMA Reporting Requirements

March 30, 2017

PDF DOWNLOAD

macra

Payment Innovation: PTAC

PTAC Releases First Batch of Preliminary Review Reports: Declines to Recommend Any Proposals

March 29, 2017

April Public Meeting Agenda Released

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

CMS Announces April 5th Listening Session on Cost Measure Development

March 28, 2017

CMS is hosting a listening session on episode-based cost measure development for the Merit-based Incentive Payment System (MIPS) from 12:00 – 1:30 PM ET on April 5, 2017. During this listening session, CMS will provide more information on cost measures and the role stakeholders play in cost measure development.

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

CMS Hosts Advancing Care Information Webinar on April 4th

March 27, 2017

On Tuesday, April 4 at 1:00 PM ET, the Centers for Medicare & Medicaid Services (CMS) will host a webinar to provide more information on the Advancing Care Information performance category of the Merit-based Incentive Payment System (MIPS). During the webinar, CMS will highlight requirements for the 2017 Advancing Care Information performance category and participants…

ORIGINAL ANALYSIS

macra

Payment Innovation: Regulation

2018 Quality Payment Program Proposed Rule Lands at OMB

March 24, 2017

This week the Centers for Medicare Medicaid Services (CMS) sent the 2018 Quality Payment Program (QPP) Proposed Rule (CMS-5522-P) to the Office of Management of Budget (OMB) for review. Established through the Medicare Access and CHIP Reauthorization Act (MACRA), the QPP established two tracks for Medicare physician payment: the Merit-Based Incentive Payment System (MIPS) and…

ORIGINAL ANALYSIS

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Health Reform 2.0: Budget Information

CBO Releases New Assessment of House’s AHCA

March 24, 2017

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

Prior to Implementation of MACRA, Physician Groups Request CMS to Address Administrative Burden of Legacy Physician Quality Programs for 2018

March 23, 2017

On March 21, 2017, the American Medical Association and 86 state and specialty medical societies submitted a letter requesting the Centers for Medicare and Medicaid Services (CMS) reduce the administrative burden and provide for hardship exemptions for the three legacy physician quality programs: Meaningful Use (MU), Physician Quality Reporting System (PQRS) and the Value-based Modifier (VM) in…

ORIGINAL ANALYSIS

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Health Reform 2.0: Congress , Original Analysis

Republicans Revise AHCA Before Floor Vote

March 21, 2017

House Republican leaders unveiled amendments to the American Health Act Monday night in anticipation of a floor vote Thursday.

ORIGINAL ANALYSIS

macra

Payment Innovation: PTAC

PTAC Begins Public Discussion of Payment Model Proposals at April 2017 Meeting

March 20, 2017

McDermottPlus Releases PTAC Proposal Tracker

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

CMS Requests Comments on Draft Episode Groups, Trigger Codes and Proposed Framework for Cost Measures

March 20, 2017

CMS is accepting comments until April 24, 2017, on draft episode groups, trigger codes and a proposed framework for cost measures. The Merit-based Incentive Payment System (MIPS) measures clinicians’ performance in four areas: quality, clinical practice improvement activities, advancing care information (i.e., meaningful use of certified electronic health record technology or CEHRT), and cost (i.e.,…

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

CMS Seeks Volunteers for QPP Website Testing

March 17, 2017

CMS is seeking volunteers to test the Quality Payment Program website. CMS is seeking comments on the functionality of the current website as well as recommendations for future improvements. Interested Medicare clinicians, practice managers, administrative staff and EHR and registry vendors are encouraged to volunteer.

ORIGINAL ANALYSIS

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Health Reform 2.0: Regulation

Secretary Price and CMS Director Verma Detail Plan for Medicaid Reform in Letter to Governors

March 16, 2017

ORIGINAL ANALYSIS

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Health Reform 2.0: Budget Information

American First: A Budget Blueprint to Make American Great Again

March 15, 2017

President Trump’s proposed budget for FY 2018

PDF DOWNLOAD

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Health Reform 2.0: Budget Information

CBO Cost Estimate for the American Health Care Act

March 13, 2017

PDF DOWNLOAD

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Health Reform 2.0: Stakeholder Engagement

America’s Health Insurance Plans (AHIP) Recommendations for the American Health Care Act

March 08, 2017

PDF DOWNLOAD

macra

Payment Innovation: Quality Payment Program

MedPAC Considers How to Reduce Burden of MIPS and Encourage Participation in Advanced APMs

March 08, 2017

On March 2, 2017 the Medicare Payment Advisory Commission (MedPAC) met in Washington DC and discussed alternatives to the Merit-based Incentive Payment System (MIPS), Advanced Alternative Payment Models (APMs) and ways to increase support for primary care.

ORIGINAL ANALYSIS

health-reform-20

Health Reform 2.0: Stakeholder Engagement

Blue Cross Blue Shield Association Key Recommendations for the American Health Care Act

March 07, 2017

AHA and AMA Letters to Congress Opposing Newly Unveiled American Health Care Act

ORIGINAL ANALYSIS

macra

Payment Innovation: Innovation Center

CMS Hosts Webinar on ACO Track 1+ Model

March 07, 2017

Registration is open for a webinar hosted by the Centers for Medicare and Medicaid Services (CMS) on the ACO Track 1+ model.  Previously, CMS announced that beginning in 2018 the ACO Track 1+ model would be an option under the Advanced APM track of the Quality Payment Program.

ORIGINAL ANALYSIS

health-reform-20

Health Reform 2.0: Stakeholder Engagement

Republican Governors Criticize American Health Care Act

March 06, 2017

On March 16, 2017, four Republican governors (John Kasich of Ohio, Rick Snyder of Michigan, Brian Sandoval of Nevada and Asa Hutchison of Arkansas) sent congressional leaders a letter criticizing the American Health Care Act and proposing an alternative framework for reforming the Medicaid program. The four governors endorse per capita caps and block grants,…

POST

health-reform-20

Health Reform 2.0: Congress

American Health Care Act

March 06, 2017

On March 6, 2017 House Republicans unveiled the American Health Care Act, their Repeal and Replacement legislation for the Affordable Care Act.

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

CMS Posts Updated eCQM Table

March 06, 2017

The Centers for Medicare and Medicaid (CMS) recently posted an updated electronic clinical quality measures (eCQM) table on its website. In an effort to improve alignment of the eCQMs with current quality initiatives, this update removes the previous meaningful use domains and now aligns the measures with the domains listed in the Merit-based Incentive Payment System and…

ORIGINAL ANALYSIS

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Health Reform 2.0: Stakeholder Engagement

Congressional Research Service Posts Summary of the American Health Care Act

March 04, 2017

On March 14, 2017, the Congressional Research Service posted a summary of the American Health Care Act. This summary includes references to actions taken by the House Ways & Means and Energy and Commerce Committees on March 6th, and the analysis issued by Congressional Budget Office on March 13th, but predates action by the House…

POST

diagnostic

Diagnostics: PAMA

Updated FAQs addressing determination of “applicable laboratory” status

March 01, 2017

Updated FAQs addressing determination of “applicable laboratory” status.

PDF DOWNLOAD

macra

Payment Innovation: Quality Payment Program

MedPAC Will Discuss MIPS and Advanced APMs During March 2 Meeting

February 28, 2017

The Medicare Payment Advisory Commission (MedPAC) has placed discussion of the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs) on the agenda for their March 2 meeting scheduled to be held in Washington, DC.

ORIGINAL ANALYSIS

macra

Payment Innovation: Innovation Center

CMS Releases RFI on Pediatric APMS

February 27, 2017

On Monday, February 27, 2017, CMS released a Request for Information (RFI) to collect stakeholder input on the development of pediatric Alternative Payment Models (APMS). The focus of this RFI is on the improvement of quality and reduction in cost for the care of children enrolled in Medicaid and the Children’s Health Insurance Plan (CHIP).

ORIGINAL ANALYSIS

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Payment Innovation: Quality Payment Program

CMS Awards $20 Million in MACRA-related Training and Technical Assistance Targeted at Small Practices

February 23, 2017

Agency commits to another $80 million in funding over the next four years

ORIGINAL ANALYSIS

macra

Payment Innovation: PTAC

PTAC Announces Public Meetings for March and April 2017

February 21, 2017

The Physician-Focused Payment Model Technical Advisory Committee (PTAC) recently announced two public meetings scheduled for March 13-14 and April 10-11. Registration information is available here.

ORIGINAL ANALYSIS

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Health Reform 2.0: Congress

Obamacare Repeal and Replace: Policy Brief and Resources

February 16, 2017

Summary of the Republican ACA Repeal and Replace Proposal prepared by House Republican leadership.

PDF DOWNLOAD

macra

Payment Innovation: Quality Payment Program

CMS Opens Call for Measures and Activities

February 14, 2017

The Centers for Medicare and Medicaid Services (CMS) opened the submission period of the Annual Call for Measures and Activities for the Merit-Based Incentive Payment System (MIPS) track of the Quality Payment Program.

ORIGINAL ANALYSIS

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Health Reform 2.0: Stakeholder Engagement

Committee for a Responsible Federal Budget: The Cost of Full Repeal of the Affordable Care Act

February 04, 2017

January 4, 2017 report released by the Committee for a Responsible Federal Budget, which currently estimates that the repeal and replacement of the ACA in its entirety would cost roughly $350 billion through 2027 under conventional scoring and $150 billion using dynamic scoring.

PDF DOWNLOAD

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Health Reform 2.0

Episode One: Governing Health Podcast Series

January 31, 2017

In this inaugural episode, McDermott governance partner Michael Peregrine interviews Eric Zimmerman, a Washington-based McDermott partner, and Chip Falahee, Senior Vice President for Legal and Legislative Affairs at Bronson Healthcare Group, to discuss how boards can prepare for the changes ahead – particularly with regard to the Affordable Care Act.

EXTERNAL LINK

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Health Reform 2.0: Administration

Executive Order on Reducing Regulation and Controlling Regulatory Costs

January 30, 2017

PDF DOWNLOAD

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Health Reform 2.0: Congress

H.R. Bill Protecting Patients with Pre-Existing Conditions

January 26, 2017

Energy and Commerce Committee Chairman Greg Walden (R-OR) proposes legislation that would require insurance companies to accept everyone who applies, as long as they sign up during certain enrollment periods or certain life events like getting married.

PDF DOWNLOAD

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Health Reform 2.0: Stakeholder Engagement

Healthcare Stakeholders Urge President Trump and Congress to Back Value-Based Care

January 25, 2017

January 25, 2017 letter addressed to President Trump and congress to continue to move forward with value-based payment models.

PDF DOWNLOAD

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Health Reform 2.0: Congress

S.222 The Obamacare Replacement Act

January 25, 2017

On January 25, 2017 U.S. Senator Rand Paul, M.D. (R-KY) introduced the Obamacare Replacement Act. Senator Paul’s plan offers some limited protections for those with pre-existing conditions, and seeks to address the cost of health care through expanded health savings accounts and tax credits. While legislative text is not yet available, a summary is available.

ORIGINAL ANALYSIS

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Health Reform 2.0: Administration

Executive Order Freezing the Hiring of Civilian Employees

January 24, 2017

PDF DOWNLOAD

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Health Reform 2.0: Stakeholder Engagement

NGA Response to Request for Feedback on Changes to ACA

January 24, 2017

January 24, 2017 National Governors Association (NGA) response to the December 2, 2016 letter from House Leadership request input on changes to the Affordable Care Act.

PDF DOWNLOAD

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Health Reform 2.0: Congress

Patient Freedom Act of 2017

January 23, 2017

On January 23, 2017 U.S. Senators Susan Collins (R-ME), Bill Cassidy, M.D. (R-LA), Shelley Moore Capito (R-WV) and Johnny Isakson (R-GA) released the legislative text for the Patient Freedom Act of 2017, a replacement plan for the Affordable Care Act that proposes a compromise to repeal – offering states the option to keep the Affordable…

ORIGINAL ANALYSIS

health-reform-20

Health Reform 2.0: Administration

Executive Order Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal

January 20, 2017

PDF DOWNLOAD

health-reform-20

Health Reform 2.0: Stakeholder Engagement

The Commonwealth Fund: Medicaid’s Future: What Might ACA Repeal Mean?

January 12, 2017

January 12, 2017 report examining how repeal legislation could affect Medicaid.

PDF DOWNLOAD

diagnostic

Diagnostics: Payment Rates

CLFS User guide

January 09, 2017

PDF DOWNLOAD

macra

Payment Innovation: Quality Payment Program

CMS Posts Numerous MACRA Resources on QPP Website

January 06, 2017

CMS recently posted a variety of MACRA-related educational resources for clinicians, registries, qualified clinical data registries (QCDRs) and EHR vendors to the Quality Payment Program website.

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

CMS Hosts Call: Transitioning from PQRS to MIPS

January 06, 2017

CMS is hosting a conference call on Tuesday, January 24 from 2:00 to 3:00 PM ET on how to complete the final reporting period for the legacy Medicare quality reporting programs and transitioning to the Merit-based Incentive Payment System (MIPS).

ORIGINAL ANALYSIS

health-reform-20

Health Reform 2.0: Stakeholder Engagement

Urban Institute: The Impact on Health Care Providers of Partial ACA Repeal Through Reconciliation

January 05, 2017

January 2017 examining the repeal of the Affordable Care Act if conducted through the budget reconciliation process used in Jan. 2016 legislation vetoed by President Obama.

PDF DOWNLOAD

diagnostic

Diagnostics: PAMA

Additional Guidance for Clinical Laboratories as Data Reporting Begins

January 05, 2017

PDF DOWNLOAD

macra

Payment Innovation: Innovation Center

Released: CMS Innovation Center Report to Congress

January 05, 2017

On Thursday, January 5, 2017 the CMS Innovation Center released its third Report to Congress. While the focus of the report was on activities between October 1, 2014 and September 30, 2016, it also included initiatives between September 30, 2016 and December 31, 2016.

POST

macra

Payment Innovation: Quality Payment Program

CMS Accepting Applications for CPIA Measurement Study

January 05, 2017

Participants receive full credit for the Improvements Activities Performance Category

ORIGINAL ANALYSIS

health-reform-20

Health Reform 2.0: Stakeholder Engagement

Healthcare Leadership Council Letter to President-elect Trump

January 04, 2017

January 4, 2017 letter to President-elect Trump detailing actions specific steps that should be taken to stabilize the health insurance marketplace both short-and long-term.

PDF DOWNLOAD

health-reform-20

Health Reform 2.0: Congress

The American Health Care Reform Act of 2017

January 04, 2017

On January 4, 2017 the House Republican Study Committee released a new plan for the repeal and replacement of the Affordable Care Act (ACA).

ORIGINAL ANALYSIS

health-reform-20

Health Reform 2.0: Stakeholder Engagement

American Medical Association (AMA) Letter to Congressional Leaders on Reform of Health Care System

January 03, 2017

January 3, 2017: AMA letter to congress requesting replacement policies in place prior to the repeal of the ACA.

PDF DOWNLOAD

health-reform-20

Health Reform 2.0: Budget Information

CBO Report: How Repealing Portions of the Affordable Care Act Would Affect Health Insurance Coverage and Premiums

January 01, 2017

The Congressional Budget Office and Joint Committee on Taxation released an updated report on the projected impact of H.R. 3762, the Restoring Americans’ Healthcare Freedom Act of 2015, if enacted. The report, prepared at the request of the House Minority Leader and the Ranking Member of the Senate Committee on Finance, would result in a…

PDF DOWNLOAD

macra

Payment Innovation: Regulation

CMS Finalizes Policies for New Mandatory Cardiac and Orthopedic Models, Adjustments to CJR; Previews Details of Medicare Track One Plus ACO Model

December 22, 2016

On Tuesday, December 20, 2016 the Centers for Medicare and Medicaid Services (CMS) finalized several new Innovation center models expanding the agency’s footprint in the value based payment model space.

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

OIG Releases Report on MACRA Early Implementation Efforts

December 21, 2016

The Office of the Inspector General (OIG) recently released a report on the results from an early implementation review of the Medicare agency’s management of the Quality Payment Program (QPP).

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

CMS Expands List of Patient Relationship Categories and Codes List

December 16, 2016

Comments on updated list due no later than January 6, 2017

ORIGINAL ANALYSIS

health-reform-20

Health Reform 2.0: Congress

Senate Finance Committee Letter to RGA on Jan 2017 Medicaid Roundtable

December 13, 2016

In a letter to the Republican Governors Association dated December 13, 2016, the Senate Finance Committee announced that it will convene a Governor Roundtable in January 2017 to discuss the sustainability and future of the Medicaid program.

PDF DOWNLOAD

health-reform-20

Health Reform 2.0: Stakeholder Engagement

America’s Health Insurance Plans (AHIP) Memo to Transition Team

December 09, 2016

Memo to transition team and congressional leadership identifying priority legislative and administrative changes

PDF DOWNLOAD

health-reform-20

Health Reform 2.0: Stakeholder Engagement

Health Care Transformation Task Force Letter to Transition Team

December 06, 2016

Letter addressed to President-elect, transition team and congressional leadership

PDF DOWNLOAD

health-reform-20

Health Reform 2.0: Stakeholder Engagement

American Hospital Association (AHA) Memo to Transition Team

December 02, 2016

Memo to transition team and congressional leadership identifying priority legislative and administrative changes

PDF DOWNLOAD

health-reform-20

Health Reform 2.0: Congress

House Letter to Governors and State Insurance Commissioners

December 02, 2016

December 2, 2016 letter from the House Republican Leadership to Governors and State Insurance Commissioners requesting input on specific questions concerning repealing and replacing the Affordable Care Act.

PDF DOWNLOAD

health-reform-20

Health Reform 2.0: Budget Information

CBO Options for Reducing the Deficit: 2017-2026

December 01, 2016

PDF DOWNLOAD

health-reform-20

Health Reform 2.0: Congress

The World’s Greatest Healthcare Plan (Congressman Sessions and Senator Cassidy)

December 01, 2016

ORIGINAL ANALYSIS

health-reform-20

Health Reform 2.0: Stakeholder Engagement

Brookings Report: Repeal and Replace Obamacare: What Could it Mean?

November 30, 2016

November 30, 2016 report from Brookings on what would happen if the Affordable Care Act were to be repealed on the first day, and a suggested stepby-step approach.

PDF DOWNLOAD

health-reform-20

Health Reform 2.0: Regulation

Rep. Tom Price Nominated as Secretary of Health & Human Services

November 29, 2016

ORIGINAL ANALYSIS

health-reform-20

Health Reform 2.0: Regulation

President Trump Selects Seema Verma to Serve as CMS Administrator

November 29, 2016

ORIGINAL ANALYSIS

diagnostic

Diagnostics: PAMA

Additional Support Materials from Data Reporting Call

November 23, 2016

EXTERNAL LINK

health-reform-20

Health Reform 2.0: Stakeholder Engagement

Heritage Foundation Issue Brief

November 22, 2016

Memo outlining steps for a smooth transition for the repeal of the Affordable Care Act

PDF DOWNLOAD

health-reform-20

Health Reform 2.0: Stakeholder Engagement

What Would Block Grants or Limits on Per Capita Spending Mean for Medicaid?

November 18, 2016

November 18, 2016 report from the Commonwealth Fund examining the President-elect Trump and some congressional leaders’ calls for absolute limits on the federal government’s spending on Medicaid.  This report explores the two most common proposals for reengineering federal funding of Medicaid: block grants that set limits on total annual spending, regardless of enrollment; and caps…

PDF DOWNLOAD

diagnostic

Diagnostics: Payment Rates

CMS MLN Matters: FISS Implementation of the Restructured Clinical Lab Fee Schedule

November 18, 2016

PDF DOWNLOAD

diagnostic

Diagnostics: Regulation

CMS instructs Medicare claims system maintainer to be ready for PAMA based CLFS

November 18, 2016

CMS instructs Medicare claims system maintainer to be ready for PAMA based CLFS.

POST

macra

Payment Innovation: Regulation

Lost Your Bearings in the MACRA Final Rule? M+ Table of Contents Will Help You Find Your Way

November 18, 2016

Both a standalone TOC and TOC hyperlinked to the Official Federal Register Published Final Rule are available.

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

CMS Posts Slide Decks on MACRA Final Rule

November 16, 2016

The Centers for Medicare & Medicaid Services (CMS) recently posted a number of slide decks and a webinar recording on the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 final rule.

ORIGINAL ANALYSIS

health-reform-20

Health Reform 2.0: Stakeholder Engagement

American Medical Association (AMA) Vision on Health Reform

November 15, 2016

Summary of the AMA’s current policy on health reform

PDF DOWNLOAD

Briefing Points for the Board  – The Election and the 2017 Health Policy Agenda

Insight: original analysis

Briefing Points for the Board – The Election and the 2017 Health Policy Agenda

November 14, 2016

It is vitally important for the health system board, as well as certain of its key committees, to receive an introductory briefing as soon as possible on the health policy implications of last week’s Presidential and Congressional elections, as they are currently understood.

ORIGINAL ANALYSIS

health-reform-20

Health Reform 2.0

How Congress, President-Elect Trump Might Proceed on Promise to Repeal, Replace ACA

November 11, 2016

EXTERNAL LINK

Insight: original analysis

WEBCAST: The Election and the 2017 Health Policy Agenda

November 10, 2016

An Election Breakdown and What It Means for the Health Care Industry

ORIGINAL ANALYSIS

diagnostic

Diagnostics

PUB 100-04 Medicare Claims Processing – FISS Implementation of the Restructured Clinical Lab Fee Schedule

November 08, 2016

PDF DOWNLOAD

health-reform-20

Health Reform 2.0: Regulation

Republican Leadership Letter Directing Agencies to Halt Rulemaking

November 05, 2016

ORIGINAL ANALYSIS

diagnostic

Diagnostics: Guidance

CMS Presentation on Data Reporting Required by PAMA

November 02, 2016

PDF DOWNLOAD

Insight: original analysis

MACRA Final Rule Released: CMS Establishes 2017 as Transition Year for QPP

October 31, 2016

CMS finalized policies for 2017 that will offer providers more flexibility and opportunity to meet requirements under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

CMS Hosting Webinars on MACRA Final Rule

October 19, 2016

ORIGINAL ANALYSIS

macra

Payment Innovation: Regulation

CMS Releases MACRA Final Rule

October 14, 2016

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

CMS Announces Reduced Medical Review Pilot Program for Providers Aligned with Certain Advanced APMs

October 13, 2016

On October 13, 2016, the Centers for Medicare & Medicaid Services (CMS) announced an 18-month pilot program to reduce the burden of medical record review of clinicians participating in certain Advanced Alternative Payment Models (APMs). CMS uses contractors to review payments and claims for accuracy. Despite the administrative burden on both the agency and providers…

ORIGINAL ANALYSIS

diagnostic

Diagnostics: PAMA

CMS Hosting Conference Call on Data Reporting Required by PAMA

October 12, 2016

The Protecting Access to Medicare Act requires certain laboratories to submit payment data for certain clinical diagnostic laboratory tests to CMS by March 31, 2017.  CMS has promised labs that an online portal would be available to help them submit data and that CMS would provide assistance in helping labs understand their requirements.

ORIGINAL ANALYSIS

Insight: original analysis

CMS Releases Final 2016 Gapfill Lab Payment Rates, CY 2017 Preliminary Crosswalk and Gapfill Determinations

October 05, 2016

The final lab payment amounts for several well-established tests fall well below current Medicare pricing. Stakeholders have until October 30, 2016, to request reconsideration of these rates.

ORIGINAL ANALYSIS

diagnostic

Diagnostics: Guidance

Changing How Medicare Pays for Clinical Diagnostic Laboratory Tests: An Update on CMS’s Progress (OEI-09-16-00100)

October 04, 2016

PDF DOWNLOAD

diagnostic

Diagnostics: Guidance

Medicare Payments for Clinical Diagnostic Laboratory Tests in 2015: Year 2 of Baseline data (OEI-09-16-00040)

October 01, 2016

PDF DOWNLOAD

diagnostic

Diagnostics: Payment Rates

CMS Released Preliminary Crosswalk and Gapfill determinations for CY 2017

September 30, 2016

PDF DOWNLOAD

diagnostic

Diagnostics: PAMA

CMS Releases Final 2016 Gapfill Determinations

September 30, 2016

EXTERNAL LINK

health-reform-20

Health Reform 2.0: Regulation

House Republicans Call on CMS to Halt Future CMMI Models

September 29, 2016

PDF DOWNLOAD

macra

Payment Innovation: PTAC

PTAC Accepts Comments on Draft RFP and PFPM-related Guidance Until October 14

September 28, 2016

The Physician-Focused Technical Advisory Committee (PTAC) is accepting comments until October 14, 2016, on a draft Request for Proposals (RFP) for physician-focused payment models (PFPMs) and draft guidance on characteristic of payment models likely to be recommended by PTAC.

ORIGINAL ANALYSIS

macra

Payment Innovation: PTAC

PTAC Anticipates Accepting PFPM Proposals Beginning December 1

September 20, 2016

The Physician Focused Technical Advisory Committee (PTAC) announced during a recent public meeting that they anticipate accepting proposals for Physician-Focused Payment Models (PFPMs) beginning December 1, 2016. Since it is anticipated that there will be few Advanced Alternative Payment Model (APM) options for physician specialists, PTAC and the development of PFPMs are considered critical in…

ORIGINAL ANALYSIS

macra

Payment Innovation: Regulation

MACRA Final Rule Lands at OMB

September 15, 2016

ORIGINAL ANALYSIS

diagnostic

Diagnostics: PAMA

Fee-For-Service Data Collection System: Clinical Laboratory Fee Schedule Data Reporting Template

September 12, 2016

PDF DOWNLOAD

diagnostic

Diagnostics: PAMA

CMS Releases Reporting Template for PAMA Data Reporting

September 12, 2016

CMS has released a reporting template to assist laboratories with fee-for-service data collection.

POST

macra

Payment Innovation: Quality Payment Program

CMS Releases MACRA Participation Options for 2017

September 12, 2016

On September 8, 2016, the Centers for Medicare & Medicaid Services (CMS) announced updated 2017 MACRA participation options via the CMS blog.

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

Nominations Due on September 15 for MACRA CMS Quality Measure Development Plan Technical Expert Panel

September 06, 2016

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

Nominations Due on September 15 for MACRA CMS Quality Measure Development Plan Technical Expert Panel

September 06, 2016

CMS is currently soliciting nominations for technical expert panel members to support the CMS Quality Measure Development Plan (MDP) project.  The MDP is mandated by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which also requires the preparation of an annual report on the development of measures for the CMS Quality Payment Program.

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

Bipartisan Letter Urges CMS to Consider Flexibility on MACRA Implementation

September 06, 2016

On September 6, 2016 bipartisan leaders from the House Energy and Commerce Committee and the House Ways and Means Committee sent a letter to CMS urging flexibility in the implementation of the Medicare Access & CHIP Reauthorization Act (MACRA).

POST

macra

Payment Innovation: PTAC

PTAC Public Meeting Announced for September 16

August 18, 2016

The Physician-Focused Payment Model Technical Advisory Committee (PTAC) announced a public meeting for September 16, 2016. Registration information is available here. While a formal agenda has not yet been released, it is anticipated that PTAC will discuss its revised Proposal Review Process document which was recently posted on their website along with a document summarizing their response to public…

ORIGINAL ANALYSIS

macra

Payment Innovation: Original Analysis

MACRA: Building a Winning Strategy Webcast

August 15, 2016

On August 10, 2016, McDermott+Consulting and McDermott, Will & Emery hosted a webcast on the impact of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) statute in reshaping the physician services market and strategic considerations for health systems.

ORIGINAL ANALYSIS

diagnostic

Diagnostics: PAMA

Guidance to Laboratories for Collecting and Reporting Data for the Private Payor Rate-Based Payment System

August 10, 2016

PDF DOWNLOAD

diagnostic

Diagnostics: Guidance

Shape the CPT® Proprietary Lab Analyses Code Set

August 05, 2016

EXTERNAL LINK

diagnostic

Diagnostics: PAMA

Codes subject to reporting during the first reporting period.

August 05, 2016

Codes subject to reporting during the first reporting period (January 1 – March 30, 2017) (File requires WinZIP to open).

EXTERNAL LINK

diagnostic

Diagnostics: Payment Rates

September 12th Clinical Diagnostic Laboratory Test Advisory Panel Meeting

August 01, 2016

September 12th Clinical Diagnostic Laboratory Test Advisory Panel Meeting

POST

macra

Payment Innovation: Regulation

CMS Drops 2018 MACRA Proposed Rule – Proposes Continuing Flexibilities for Year 2

July 26, 2016

On July 25, 2016 the Centers for Medicare and Medicaid Services (CMS) released a Proposed Rule for a new mandatory bundled payment model for cardiac care, an expansion of the Comprehensive Care for Joint Replacement (CJR) model and a Cardiac Rehabilitation (CR) incentive payment model. CMS also indicated that these proposed bundled payment models could…

ORIGINAL ANALYSIS

macra

Payment Innovation: Regulation

CMS Proposes Cardiac Payment Bundle and Expansion of CJR

July 26, 2016

ORIGINAL ANALYSIS

health-reform-20

Health Reform 2.0: Congress

H.R. 3100 (Congressman Tom Price, M.D.)

July 16, 2016

Prohibits HHS and States from requiring physicians to participate in certain health plans or the Meaningful Use program as a condition of licensure

PDF DOWNLOAD

diagnostic

Diagnostics: Regulation

CY 2017 Medicare OPPS – Proposed Rule (CMS-1656-P)

July 14, 2016

CMS discusses their proposed laboratory test packaging policy on page 45,628

PDF DOWNLOAD

diagnostic

Diagnostics: Payment Rates

New and substantially revised test codes to be priced under the (nonPAMA) CLFS beginning January 1, 2017

July 08, 2016

EXTERNAL LINK

macra

Payment Innovation: Other

ONC Announces Metrics to Measure Widespread Interoperability

July 07, 2016

PDF DOWNLOAD

diagnostic

Diagnostics: Regulation

Overview of CMS-1621-F: Medicare Clinical Diagnostic Laboratory Test Payment System Final Rule

July 06, 2016

PDF DOWNLOAD

macra

Payment Innovation: Regulation

CMS Finalizes Qualified Entity Rule – Expands Access to Medicare and Private Sector Claims

July 01, 2016

PDF DOWNLOAD

diagnostic

Diagnostics

+Dx Webinar: Examining the New Medicare Lab Payment System

June 23, 2016

ORIGINAL ANALYSIS

diagnostic

Diagnostics: Regulation

Medicare Clinical Diagnostic Laboratory Tests Payment System – Final Rule (CMS-1621-F)

June 23, 2016

PDF DOWNLOAD

health-reform-20

Health Reform 2.0: Congress

Better Way Plan (Speaker Paul Ryan)

June 22, 2016

ORIGINAL ANALYSIS

diagnostic

Diagnostics: Payment Rates

Medicare Will Use Private Payor Prices to Set Payment Rates for Clinical Diagnostic Laboratory Tests Starting in 2018

June 17, 2016

EXTERNAL LINK

macra

Payment Innovation: Quality Payment Program

CMS Posts New MACRA Slide Decks

June 13, 2016

The Centers for Medicare & Medicaid Services (CMS) recently posted new MACRA slide decks on the Quality and Resource Use performance categories. These are the latest additions to a series of presentations CMS is releasing on the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. Both of these presentations go into greater detail, than…

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

CMS Announces Funding Opportunity to Support Small Practice Transformation

June 10, 2016

On Friday, June 10, 2016 the Centers for Medicare & Medicaid Services (CMS) announced funding for the Support and Alignment Networks under the Transforming Clinical Practice Initiative (TCPI). Up to $10 million over the next three years is available to leverage primary and specialist care transformation work and learning in the support of the adoption of…

ORIGINAL ANALYSIS

Insight: original analysis

CMS Finalizes Medicare Laboratory Payment Overhaul

June 03, 2016

Implementing modernization of Medicare payment for lab services

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

Upcoming CMS MACRA Webinars

June 03, 2016

EXTERNAL LINK

macra

Payment Innovation: Quality Payment Program

CMS Posts Slide Deck on Advanced APM All-Payer Combination

June 01, 2016

PDF DOWNLOAD

macra

Payment Innovation: Quality Payment Program

Joint Quality Payment Program Task Force Met on Tuesday, May 24 – Next Meeting Scheduled for Friday, May 27

May 24, 2016

On May 24, 2016, the Joint Quality Payment Program Task Force, an advisory board of the Office of the National Coordinator for Health Information Technology (ONC), met to review the Task Force charge and work plan. The Task Force is charged with reviewing the MACRA Proposed Rule with a specific focus on how the use…

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

Alliance for Health Reform Hosts MACRA Briefing

May 20, 2016

EXTERNAL LINK

macra

Payment Innovation: Regulation

MACRA Proposed Rule Published in the Federal Register

May 17, 2016

EXTERNAL LINK

macra

Payment Innovation: Quality Payment Program

Andy Slavitt Provides Testimony at MACRA Hearing

May 13, 2016

On May 11, 2016 Andrew Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services (CMS) provided testimony at a hearing on the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 held by the Subcommittee on Health of the House Ways and Means Committee.

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

CMS Posts Fact Sheet Focusing on Flexibility in MACRA for Small Practices

May 13, 2016

PDF DOWNLOAD

macra

Payment Innovation: Regulation

Getting Lost in the MACRA Proposed Rule? M+ Table of Contents Can Help

May 12, 2016

ORIGINAL ANALYSIS

macra

Payment Innovation: Regulation

Getting Lost in the MACRA Proposed Rule? M+ Table of Contents Can Help

May 12, 2016

On May 9, 2016 the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 Proposed Rule was published in the Federal Register.

PDF DOWNLOAD

macra

Payment Innovation: Quality Payment Program

CMS Posts Slide Deck on Advancing Care Information MIPS Performance Category

May 11, 2016

The newest addition to the catalog of Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 educational slide decks is on the Advancing Care Information (ACI) performance category of the Merit-Based Incentive Payment System (MIPS). The ACI performance category is designed to meet many of the same objectives of the current Meaningful Use Program.

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

CMS Solicits Comments on Episode Groups

May 06, 2016

CMS posted for comment episode groups that are being developed to help measure resource use under the MACRA Merit-Based Incentive Payment System (MIPS) and the Advanced Payment Model program.

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

CMS Posts Slide Decks from Recent MACRA Webinars

May 05, 2016

On May 5, 2016 the Centers for Medicare and Medicaid Services (CMS) posted slide decks from recent webinars on the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act (MACRA) of 2015 Proposed Rule.

ORIGINAL ANALYSIS

macra

Payment Innovation: PTAC

PTAC Requests Comments on Proposal Review Process

May 04, 2016

PDF DOWNLOAD

macra

Payment Innovation: Regulation

Medicare Unveils Plan for New Medicare Physician Payment System

May 03, 2016

MACRA will impact millions of clinicians across all specialties that provide services to Medicare beneficiaries. This presentation is a guide to understanding the major components of this complex Proposed Rule in a brief and easily understandable format.

POST

Insight: original analysis

MACRA Proposed Rule: CMS Unveils Plan for NewMedicare Physician Payment System (PPT)

May 03, 2016

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

CMS Announces Competition for the Development of a MIPS Mobile Platform to Support Provider Education and Outreach

May 02, 2016

On May 2, 2016 the Centers for Medicare and Medicaid Services (CMS) announced a competition for the development of a Merit-based Incentive Payment System (MIPS) Mobile Platform to support provider education and outreach.

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

CMS Releases Final Quality Measure Development Plan

May 02, 2016

PDF DOWNLOAD

macra

Payment Innovation: Other

ONC Releases RFI on Establishing Metrics to Assess Interoperability

April 28, 2016

ONC releases RFI regarding Assessing Interoperability for MACRA. Comments are due on June 3, 2016. 

POST

macra

Payment Innovation: Regulation

CMS Posts MACRA Proposed Role

April 27, 2016

PDF DOWNLOAD

macra

Payment Innovation: Regulation

MACRA Proposed Rule Posted (Updated)

April 27, 2016

CMS posted the proposed rule to implement the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

POST

macra

Payment Innovation: Quality Payment Program

CMS Requests Comments on Patient Relationship Categories

April 15, 2016

PDF DOWNLOAD

macra

Payment Innovation: Regulation

ONC Releases RFI on Establishing Metric to Assess Interoperability

April 07, 2016

PDF DOWNLOAD

macra

Payment Innovation: Regulation

CMS Sends MIPS/APM Proposed Rule to OMB

March 28, 2016

ORIGINAL ANALYSIS

health-reform-20

Health Reform 2.0: Congress

H.R. 4848 (Congressman Tom Price, M.D.)

March 23, 2016

Would delay implementation of the Medicare Comprehensive Care for Joint Replacement (CJR) payment model

PDF DOWNLOAD

macra

Payment Innovation: Quality Payment Program

MACRA Update: Physician Focused Payment Model TAC Conducts First Meeting

February 01, 2016

Tension between Need for Specialty Focused Versus More General Models Emerged from Public Comments

ORIGINAL ANALYSIS

macra

Payment Innovation: Regulation

CMS Proposes Changes to Qualified Entity Program: Expands Release of Provider Data

January 29, 2016

PDF DOWNLOAD

macra

Payment Innovation: Quality Payment Program

MACRA Physician-Focused Payment Model Technical Advisory Committee Meets on Feb 1, 2016

January 19, 2016

The Physician-Focused Payment Model Technical Advisory Committee will hold its first public meeting on February 1, 2016 in Washington, DC. More information on the meeting, including registration information, is available here.

ORIGINAL ANALYSIS

macra

Payment Innovation: Other

LAN Releases Final APM White Paper

January 12, 2016

On January 12, 2016 the Health Care Payment Learning & Action Network (LAN) released the final Alternative Payment Model (APM) Framework White Paper. The paper defines payment model categories and establishes a common framework and a set of conventions for measuring progress in the adoption of APMs.

ORIGINAL ANALYSIS

macra

Payment Innovation: Regulation

CMS and ONC Release RFI on Quality Reporting

December 30, 2015

CMS and ONC Release RFI on Quality Reporting.  

PDF DOWNLOAD

macra

Payment Innovation: Quality Payment Program

CMS Releases a Quality Measure Development Plan – Comments Due by March 1, 2016

December 23, 2015

CMS posts a draft Quality Measure Development Plan

POST

macra

Payment Innovation: Regulation

CMS Releases RFI Regarding the Awarding and Administration of MAC Contracts

December 18, 2015

PDF DOWNLOAD

macra

Payment Innovation: Regulation

CMS Releases a Quality Measure Development Plan

December 18, 2015

PDF DOWNLOAD

macra

Payment Innovation: Quality Payment Program

CMS Announces MACRA Listening Session on Collecting Data on Global Surgery

December 17, 2015

EXTERNAL LINK

health-reform-20

Health Reform 2.0: Congress

H.R.3762 Budget Reconciliation Bill

December 03, 2015

Approved by Congress and vetoed by President Obama in January 2016

ORIGINAL ANALYSIS

health-reform-20

Health Reform 2.0: Stakeholder Engagement

Improving Health and Health Care: An Agenda for Reform

December 01, 2015

2015 Paper laying out ACA alternative authored by 10 Republican thought leaders

PDF DOWNLOAD

macra

Payment Innovation: Regulation

CMS Seeking Comment on MACRA Episode Groups

November 10, 2015

ORIGINAL ANALYSIS

diagnostic

Diagnostics: Regulation

Diagnostic Tests and Laboratory Operations Hearing Rescheduled

October 26, 2015

E&C Hearing on “Examining the Regulation of Diagnostic Tests and Laboratory Operations” has been rescheduled to Tuesday, November 17, 2015

POST

macra

Payment Innovation: PTAC

GAO Makes Appointments to New HHS Advisory Committee on Physician Payment Models

October 09, 2015

On October 9, 2015 the Government Accountability Office (GAO) announced the first appointments to the Physician-Focused Payment Model Technical Advisory Committee. The Medicare Access and CHIP Reauthorization Act of 2015 established this committee to provide comments and recommendations to the Secretary of Health and Human Services on physician payment models, giving the Comptroller General responsibility…

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

MedPAC Discusses MIPS and APMs

October 08, 2015

EXTERNAL LINK

macra

Payment Innovation: Quality Payment Program

CMS Webinar on MACRA, MIPS and APMs

October 08, 2015

EXTERNAL LINK

diagnostic

Diagnostics: Guidance

Clinical Laboratory Payment System

October 05, 2015

PDF DOWNLOAD

diagnostic

Diagnostics: Regulation

Medicare Clinical Diagnostic Laboratory Tests Payment System – Proposed Rule (CMS-1621-P)

October 01, 2015

PDF DOWNLOAD

Insight: original analysis

CMS Releases Proposed Plan to Overhaul Medicare Laboratory Payment

September 30, 2015

ORIGINAL ANALYSIS

macra

Payment Innovation: Other

CMS Releases RFI on the Implementation of MIPS and the Promotion of Alternative Payments Models

September 29, 2015

On September 28, 2015, the Centers for Medicare and Medicaid Services (CMS) released Request for Information (RFI) on the Implementation of the Merit-based Incentive Payment System (MIPS), Promotion of Alternative Payment Models (APMs) and Incentive Payments for Participation in Eligible APMs (CMS-3321-NC).

POST

macra

Payment Innovation: Regulation

CMS Releases RFI on the Implementation of MIPS and the Promotion of Alternative Payments Models

September 28, 2015

PDF DOWNLOAD

diagnostic

Diagnostics: Regulation

Breaking: CMS Releases Anticipated PAMA 216 Regulations

September 25, 2015

The Centers for Medicare and Medicaid Services today posted the long-awaited proposed rule to implement section 216 of the Protecting Access to Medicare Act.

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Diagnostics: Guidance

Medicare Payments for Clinical Laboratory Tests in 2014: Baseline Data

August 01, 2015

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Health Reform 2.0: Congress

H.R. 2300 Empowering Patients First Act of 2015 (Congressman Tom Price, M.D.)

May 13, 2015

ORIGINAL ANALYSIS

macra

Payment Innovation: Original Analysis

Eric Zimmerman Discusses Impact of MIPS

April 29, 2015

Eric Zimmerman discusses the impact the new Merit-Based Incentive Payment System (MIPS) will have on smaller practices: ” the MIPS program, in combination with the incentives for providers to participate in APMs, has the potential to profoundly increase the administrative burden for practicing physicians.”

ORIGINAL ANALYSIS

macra

Payment Innovation: Quality Payment Program

MACRA Legislation Signed into Law

April 16, 2015

EXTERNAL LINK

Insight: original analysis

UPDATE: With Senate Approval of H.R. 2, Congress Completes SGR Reform

April 15, 2015

With draconian 21% cuts to physician payments looming, the Senate took action late yesterday; approving H.R. 2 by an overwhelming majority (92-8), and permanently repealing the much-maligned Sustainable Growth Rate (SGR). While six amendments were considered, none survived, clearing the way for the President’s signature. President Obama has announced that he will sign the bill.

ORIGINAL ANALYSIS

health-reform-20

Health Reform 2.0: Congress

H.R. 1650 (Congressman Tom Price, M.D.)

March 26, 2015

Expands Medicare beneficiary-physician private contracting rights

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macra

Payment Innovation: Legislation

Medicare Access and CHIP Reauthorization Act of 2015

March 25, 2015

Section-by-Section Summary of the Medicare Access and CHIP Reauthorization Act of 2015.

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Health Reform 2.0: Congress

H.R. 1234 (Congressman Tom Price, M.D.)

March 04, 2015

Repeals select aspects of the Affordable Care Act

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Health Reform 2.0: Stakeholder Engagement

New England Journal of Medicine: Medicare at 50 – Origins and Evolution

January 29, 2015

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Health Reform 2.0: Budget Information

CBO Options for Reducing the Deficit: 2015 to 2024

November 01, 2014

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Insight: original analysis

Anticipated Framework for Regulatory Oversight of Laboratory Developed Tests

August 07, 2014

ORIGINAL ANALYSIS

diagnostic

Diagnostics: Legislation

Protecting Access to Medicare Act (PL 113-93)

April 01, 2014

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Health Reform 2.0: Budget Information

CBO Options for Reducing the Deficit: 2014 to 2023

November 01, 2013

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diagnostic

Diagnostics: Guidance

Comparing Lab Test Payment Rates: Medicare Could Achieve Substantial Savings

June 05, 2013

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diagnostic

Diagnostics: Regulation

42 CFR 414 Subpart G: Medicare Program

October 01, 2011

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diagnostic

Diagnostics: Guidance

Report on Variation in the Clinical Laboratory Fee Schedule

July 05, 2009

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Health Reform 2.0: Budget Information

CBO Budget Options Volume I: Health Care

December 01, 2008

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