Collaboration in Healthcare

To get to the other side, it's true.  Payors and providers are going to have to trust each other and share informaiton.  Unfortunately, the payor holds much of the information needed to determine the true outcomes for patients and how it relates to cost.

Payors are going to have to share information they have on the providers and their practices in order to get providers to jump on board this train.  I see it daily when communicating with payors about contract negotiations.  They are reluctant and downright adverse to sharing information they have on our clients.  Are we not in this together?  Are we not trying to achieve the same goals?  Better care and outcomes for the patients being seen?  Sometimes I wonder.

There needs to be financial alignment between the two so we can assist each other in achieving the results everyone seems to want, but dare they make the appropriate effort.

In my opinion, the only way to get there is to get the providers on board.  This will never happen unless the payors start sharing the data and educating the providers. 

We cannot get to where we want to go if we continue to keep doing the same old song and dance.

CMS Finalizes Quality Payment Program Rule for Year 2

Quality Payment Program Year 2 Policies are Gradually Preparing Clinicians for Full Implementation

Today, the Centers for Medicare & Medicaid Services (CMS) issued the final rule with comment for the second year of the Quality Payment Program (calendar year 2018), as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) as well as an interim final rule with comment.


CMS listened to feedback from the health care community and used it to inform policy making. As a result, the Year 2 final rule continues many of the flexibilities included in the transition year, while also preparing clinicians for a more robust program in Year 3. CMS wants to ensure that the program consists of meaningful measurement while minimizing burden, improving coordination of care, and supporting a pathway to participation in Advanced Alternative Payment Models (APMs).

Year 2 Final Rule Highlights

We’ve finalized policies for Year 2 of the Quality Payment Program to further reduce your burden and give you more ways to participate successfully. We are keeping many of our transition year policies and making some minor changes. Major highlights include:

  • Weighting the MIPS Cost performance category to 10% of your total MIPS final score, and the Quality performance category to 50%.
  • Raising the MIPS performance threshold to 15 points in Year 2 (from 3 points in the transition year).
  • Allowing the use of 2014 Edition and/or 2015 Certified Electronic Health Record Technology (CEHRT) in Year 2 for the Advancing Care Information performance category, and giving a bonus for using only 2015 CEHRT.
  • Awarding up to 5 bonus points on your MIPS final score for treatment of complex patients.
  • Automatically weighting the Quality, Advancing Care Information, and Improvement Activities performance categories at 0% of the MIPS final score for clinicians impacted by Hurricanes Irma, Harvey and Maria and other natural disasters.
  • Adding 5 bonus points to the MIPS final scores of small practices.
  • Adding Virtual Groups as a participation option for MIPS.
  • Issuing an interim final rule with comment for extreme and uncontrollable circumstances where clinicians can be automatically exempt from these categories in the transition year without submitting a hardship exception application (note that Cost has a 0% weight in the transition year) if they were have been affected by Hurricanes Harvey, Irma, and Maria, which occurred during the 2017 MIPS performance period.
  • Decreasing the number of doctors and clinicians required to participate as a way to provide further flexibility by excluding individual MIPS eligible clinicians or groups with ≤$90,000 in Part B allowed charges or ≤200 Medicare Part B beneficiaries.
  • Providing more detail on how eligible clinicians participating in selected APMs (known as MIPS APMs) will be assessed under the APM scoring standard.
  • Creating additional flexibilities and pathways to allow clinicians to be successful under the All Payer Combination Option. This option will be available beginning in performance year 2019.

The final rule with comment further advances the agency’s goals of regulatory relief, program simplification, and state and local flexibility in the creation of innovative approaches to healthcare delivery.

Technical Support

CMS will continue to provide free hands-on support to help individual clinicians and groups participate in the Quality Payment Program.

For More Information

For more information about the Quality Payment Program, please visit: qpp.cms.gov

Obtaining Patient Consent in Pennsylvania

The decision in Shinal v. Toms could have significant ramifications for Pennsylvania physicians. With this decision, the Pennsylvania Supreme Court holds that physicians alone have the duty to provide patients with the sufficient information required to obtain informed consent. Thus, Pennsylvania physicians can seemingly no longer rely upon the aid of their qualified staff in the informed consent process.

Read more: Obtaining Patient Consent in Pennsylvania