The Clinical View Blog

5 Clinical Performance 5 A Major Paradigm Shift Is Underway

At the recent HFMA Annual National Institute conference in Las Vegas, we learned more about the MAJOR PARADIGM shift underway, currently being driven by CMS. In June of 2016, CMS released the MACRA/MIPS draft rule, which is based on a proposed Quality Payment Program framework. It rewards health care providers for giving better care, not more care. Preparing for the new CMS approach to Medicare reimbursement, Medicare Access and the CHIP Reauthorization Act of 2015 (MACRA) may take significant time and effort to sort out the impact on providers. In November, CMS plans to release the final rule. With little time to digest the complex law and the first performance year expected to begin in January of 2017, now is the time to start assessing and preparing.

This is a MAJOR shift towards VALUE in our healthcare system. How does your healthcare organization and physicians keep abreast of new regulations? How will you prepare your physicians and clinicians to adapt?

Here are a few tips about what you need to know:

1. You can participate in the quality programs in one of two ways: Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).
2. You can prepare in the following ways: make certain you are participating in existing programs, factor APM participation bonus into a risk-based payment model strategy, understand which track your organization will fall into, educate providers in your group about the payment track and stay current on the implementation rulings.
3. There are four major areas that the MIPS proposed rule covers: Quality, Resource Use, Advancing Care Information and Clinical Practice Improvement. Each sets performance targets in advance, when feasible and sets the performance threshold at the median.

To read more about the CMS proposed rule, visit the CMS website here: or contact us to help you navigate this change.

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