<html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns:dt="uuid:C2F41010-65B3-11d1-A29F-00AA00C14882" xmlns:m="http://schemas.microsoft.com/office/2004/12/omml" xmlns="http://www.w3.org/TR/REC-html40"><head><meta name="Microsoft Theme 2.00" content="CALAAEM NS template 6.18.15v2.htm 011"><META HTTP-EQUIV="Content-Type" CONTENT="text/html; charset=us-ascii"><meta name=Generator content="Microsoft Word 15 (filtered medium)"><!--[if !mso]><style>v\:* {behavior:url(#default#VML);}
o\:* {behavior:url(#default#VML);}
w\:* {behavior:url(#default#VML);}
.shape {behavior:url(#default#VML);}
</style><![endif]--><style><!--
/* Font Definitions */
@font-face
{font-family:"Cambria Math";
panose-1:2 4 5 3 5 4 6 3 2 4;}
@font-face
{font-family:Calibri;
panose-1:2 15 5 2 2 2 4 3 2 4;}
@font-face
{font-family:Verdana;
panose-1:2 11 6 4 3 5 4 4 2 4;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{margin:0in;
margin-bottom:.0001pt;
font-size:12.0pt;
font-family:"Times New Roman",serif;}
a:link, span.MsoHyperlink
{mso-style-priority:99;
color:#0563C1;
text-decoration:underline;}
a:visited, span.MsoHyperlinkFollowed
{mso-style-priority:99;
color:#954F72;
text-decoration:underline;}
span.EmailStyle17
{mso-style-type:personal-compose;
color:black;}
.MsoChpDefault
{mso-style-type:export-only;}
@page WordSection1
{size:8.5in 11.0in;
margin:1.0in 1.0in 1.0in 1.0in;}
div.WordSection1
{page:WordSection1;}
--></style><!--[if gte mso 9]><xml>
<o:shapedefaults v:ext="edit" spidmax="1026" />
</xml><![endif]--><!--[if gte mso 9]><xml>
<o:shapelayout v:ext="edit">
<o:idmap v:ext="edit" data="1" />
</o:shapelayout></xml><![endif]--></head><body lang=EN-US link="#0563C1" vlink="#954F72"><div class=WordSection1><p class=MsoNormal><span style='font-size:9.0pt;font-family:"Arial",sans-serif'> <img width=623 height=151 id="Picture_x0020_1" src="cid:image001.jpg@01D21CE6.C4E2CF20" alt="Description: Description: Description: Description: CAL/AAEM: California Chapter of the American Academy of Emergency Medicine"><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:9.0pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><div style='margin-left:15.0pt;margin-top:7.5pt;margin-right:15.0pt;margin-bottom:7.5pt' id=content><div style='border-top:solid #7F7F7F 1.0pt;border-left:none;border-bottom:solid #7F7F7F 1.0pt;border-right:none;padding:4.0pt 0in 4.0pt 0in'><p class=MsoNormal><b><span style='font-size:11.0pt;font-family:"Arial",sans-serif;color:#7F7F7F'>September 8, 2016<o:p></o:p></span></b></p></div><div style='margin-top:11.25pt;margin-bottom:11.25pt'><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:#DF0009'><o:p> </o:p></span></b></p><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:#DF0009'>MACRA: CMS will give docs 4 options for 2017<o:p></o:p></span></b></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0070C0'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0070C0'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0000CC'><a href="http://www.fiercehealthcare.com/practices/macra-cms-will-give-docs-4-options-for-2017?utm_medium=nl&utm_source=internal&mrkid=905528&mkt_tok=eyJpIjoiTjJabVpqVTBNV0ZtWmpOaSIsInQiOiJzdmNOa05cL0grOFZEbVRLOStlU3N1bk01T3ZEcml5Vnh4bkJrRzhMS2xvUE9JZEozeHZYdmI1dXdWb3pqNTNrdk95THhIazJ1eFZcL3d3cUp0S25wWUNnZkpwVFk0RnZaMEZnazlXWDFRVG9BPSJ9"><span style='color:#0000CC'>Fierce Healthcare</span><span style='font-family:"Times New Roman",serif;color:#0000CC'><o:p></o:p></span></a></span></p><p class=MsoNormal style='margin-right:15.7pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>By Ilene MacDonald<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Bowing under industry pressure, the Centers for Medicare & Medicaid Services announced Thursday it would ease the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), set to take effect on Jan. 1, 2017.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>MACRA changes how CMS pays practices that provide care to Medicare beneficiaries, placing emphasis on quality care and improved patient outcomes. Physicians can take part via the Merit-based Incentive Payment System (MIPS), or an alternative payment model.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Physician practices will now have four options in order to “pick their pace” to comply with the new Medicare payment reform system, according to Andy Slavitt, acting administrator of CMS.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><b><span style='font-family:"Arial",sans-serif'>Option 1</span></b><span style='font-family:"Arial",sans-serif'>: As long as physician practices submit some data to the quality payment plan (including data from after Jan. 1, 2017), they will avoid a negative payment adjustment. This option will allow practices to “test” their systems and show CMS that it works and the practice is prepared for broader participation in 2018 and 2019.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><b><span style='font-family:"Arial",sans-serif'>Option 2</span></b><span style='font-family:"Arial",sans-serif'>: Submit data for part of the calendar year. Practices can still qualify for a small positive payment adjustment, even if the data for their first performance period begins after Jan. 1. This data would include quality measures, how your practice uses technology and quality improvement efforts.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><b><span style='font-family:"Arial",sans-serif'>Option 3</span></b><span style='font-family:"Arial",sans-serif'>: For practices that are already prepared for MACRA on Jan. 1, they can submit data for a full calendar year and could quality for a modest positive payment adjustment. “We’ve seen physician practices of all sizes successfully submit a full year’s quality data, and expect many will be ready to do so,” Slavitt said.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><b><span style='font-family:"Arial",sans-serif'>Option 4</span></b><span style='font-family:"Arial",sans-serif'>: Participate in an advanced alternative payment model, such as Medicare Shared Savings Track 2 or 3 in 2017. Practices that receive enough Medicare payments or see enough Medicare patients through the model could qualify for a 5 percent incentive payment in 2019.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Slavitt said more details on all the options will be provided in the final rule, which will be released by Nov. 1.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>“However, you choose to participate in 2017, we will have resources available to assist you and walk you through what needs to be done,” Slavitt said. “And however you choose to participate, your feedback will be invaluable to building this program for the long term to achieve outcomes that matter to your patients.”<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>The decision to give physicians more flexibility came as welcome news to Congressman Rep. Michael Burgess (R-Texas). In a statement to the press, Burgess, a trained obstetrician, said he was committed to leading the charge for continued Congressional oversight of the process to ensure "simplified, streamlined requirements that allow for all doctors to succeed."<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:15.0pt'><span style='font-family:"Arial",sans-serif'>Blair Childs, senior vice president of public affairs, for Premier, Inc., said in a statement that the alliance appreciates the direction CMS has given providers prior to the release of the final rule. But he hopes CMS will also listen to providers and reduce the level of risks for advanced alternative payment models and take steps to create more ACO tracks to provide additional opportunities for eligible clinicians to obtain the percent incentive payment.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.95pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.95pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.95pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p></div><div style='border-top:solid #7F7F7F 1.0pt;border-left:none;border-bottom:solid #7F7F7F 1.0pt;border-right:none;padding:4.0pt 0in 4.0pt 0in'><p class=MsoNormal><b><span style='font-size:11.0pt;font-family:"Arial",sans-serif;color:#7F7F7F'>September 8, 2016<o:p></o:p></span></b></p></div><div style='margin-top:11.25pt;margin-bottom:11.25pt'><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:#DF0009'><o:p> </o:p></span></b></p></div><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:#DF0009'>New MACRA Rules Make Medicare Pay Cut in 2019 Less Likely <o:p></o:p></span></b></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0070C0'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0070C0'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0000CC'><a href="http://www.medscape.com/viewarticle/868599?nlid=109247_3901&src=wnl_newsalrt_160908_MSCPEDIT&uac=116715AZ&impID=1193851&faf=1"><span style='color:#0000CC'>Medscape</span><span style='font-family:"Times New Roman",serif;color:#0000CC'><o:p></o:p></span></a></span></p><p class=MsoNormal style='margin-right:15.7pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>By Robert Lowes<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Under pressure from organized medicine, the Medicare program has drastically simplified what physicians need to do next year to avoid a penalty in 2019 under the Medicare Access and CHIP Reauthorization Act (MACRA).<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>The 2015 law created a complicated framework called the Quality Payment Program (QPP) that shifts reimbursement from fee-for-service (FFS) to pay-for-performance. The new system debuts in 2017, and how physicians perform then will determine whether they earn bonuses or penalties 2 years down the line.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>The Centers for Medicare & Medicaid Services (CMS) issued its proposed regulations for MACRA in April, and the final version won't surface until October or November. Fearing that their members wouldn't have enough time to master the rules by January, the American Medical Association (AMA), the American College of Physicians, the American Academy of Family Physicians, and other societies asked the government to delay the kick-off until July 2017.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Medicare isn't delaying the new payment system outright, but it promises to do something close to that. Today, CMS acting administrator Andy Slavitt announced in his blog that his agency would give physicians four MACRA options for 2017 that would let them pick their own pace of implementation — a very slow pace, if they choose. And each one would steer clear of a penalty in 2019.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><b><span style='font-family:"Arial",sans-serif'>Physicians Can Merely "Test" the New System Next Year<o:p></o:p></span></b></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>The options play off two reimbursement tracks in the QPP. The default track that initially will encompass the vast majority of physicians is the Merit-Based Incentive Payment System (MIPS). It combines three existing pay-for-performance incentive programs: meaningful use of electronic health records (EHRs), the Value-Based Payment Modifier, and the Physician Quality Reporting System (PQRS). Physicians will receive a bonus or penalty based on their composite score across the performance categories of quality of care, cost of care, clinical practice improvement, and meaningful use of EHRs, now called advancing care information.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>In 2019, MIPS bonuses and penalties will be as high — or low — as 4% percent of Medicare FFS revenue and increase to 9% in 2022 and beyond. CMS initially estimated that most physicians in groups of 24 or less in MIPS would incur a penalty, but qualified the projection as a bit fuzzy.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>The Advanced Alternative Payment Models (Advanced APMs) is the other payment track for physicians. These APMs earn a lump sum bonus of 5% a year as long as they assume serious financial risk under their particular model. Examples of Advanced APMs include next-generation accountable care organizations, Comprehensive Primary Care Plus, and track 3 of the Medicare Shared Savings Program. Physicians participating in Advanced APMs are exempt from MIPS and its penalties.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>The first MACRA option announced by Slavitt today, an option dubbed "test the QPP," allows physicians in MIPS to avoid the 2019 penalty by merely reporting some quality and cost data — "some" is undefined for now — in 2017. Slavitt wrote that this option "is designed to ensure that your system is working and that you are prepared for broader participation in 2018 and 2019 as you learn more."<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Under the second option, physicians in MIPS can submit quality and cost data for just part of 2017, and the performance period could begin later than January 1. Besides avoiding a penalty, these physicians could qualify for a small bonus in 2019.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Submitting performance data for the full calendar year in 2017 is the third option, and Slavitt expects that many practices will be able to do this successfully.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>The fourth option is to join an Advanced APM, which, like the third option, has been available to physicians all along.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Slavitt said that the final regulations for MACRA will flesh out the details of the agency's "pick your pace" plan.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>In a news release today, AMA president Andrew Gurman, MD, said that his group "strongly applauded" the government for listening to physicians' concerns about the timetable originally proposed for MACRA and adopting a "thoughtful and flexible approach."<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:15.0pt'><span style='font-family:"Arial",sans-serif'>"The AMA believes the actions that the administration announced today will help give physicians a fair shot in the first year of MACRA implementation," said Dr Gurman. "This is the flexibility that physicians were seeking all along."<o:p></o:p></span></p><p class=MsoNormal style='margin-right:15.75pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:15.75pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:15.75pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><strong><span style='font-family:"Arial",sans-serif'>Jeff Wells</span></strong><span style='font-family:"Arial",sans-serif'><br>Deputy Editor, CAL/AAEM News Service<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><strong><span style='font-family:"Arial",sans-serif'>Brian Potts</span></strong><b><span style='font-family:"Arial",sans-serif'> MD, MBA</span></b><span style='font-family:"Arial",sans-serif'><br>Managing Editor, CAL/AAEM News Service<br><br></span><o:p></o:p></p></div><p class=MsoNormal style='background:#D9D9D9'><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'>Contact us at: <span style='color:#0000CC'><a href="mailto:calaaem.news.service1@gmail.com"><span style='color:#0000CC'>calaaem.news.service1@gmail.com</span></a></span><br><br>For more articles, visit our <span style='color:blue'><a href="http://www.calaaem.org/news_archives.php"><span style='color:blue'>archives</span></a></span>. <br><br></span><span style='font-size:9.0pt;font-family:"Arial",sans-serif'><a href="mailto:somcaaem@uci.edu"><span style='font-size:7.5pt;font-family:"Verdana",sans-serif;color:black;text-decoration:none'>To</span></a></span><span style='font-size:7.5pt;font-family:"Verdana",sans-serif;color:#0070C0'><a href="https://maillists.uci.edu/mailman/listinfo/calaaem"><span style='color:#0070C0;text-decoration:none'> </span><span style='color:blue'>unsubscribe</span></a></span><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'> from this list, visit our mail server.<br><br>Copyright (C) 2015. The California Chapter of the American Academy of Emergency Medicine (CAL/AAEM).</span> <span style='font-size:7.5pt;font-family:"Verdana",sans-serif;color:#0000CC'><a href="http://www.calaaem.org"><span style='color:#0000CC'>http://www.calaaem.org</span></a></span><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'>. All rights reserved.<br><br>CAL/AAEM, a nonprofit professional organization for emergency physicians, operates the CAL/AAEM News Service solely as an educational resource for physicians. Dissemination of an article by CAL/AAEM News Service does not imply endorsement, agreement, or recommendation by CAL/AAEM News Service, CAL/AAEM, or AAEM.<br><br><o:p></o:p></span></p><p class=MsoNormal style='background:#D9D9D9'><b><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'>Follow CAL/AAEM on Facebook and Twitter:<o:p></o:p></span></b></p><p class=MsoNormal style='background:#D9D9D9'><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='background:#D9D9D9'><a href="http://www.facebook.com/pages/CalAAEM/172577489479442?sk=wall&filter=12" target="_blank"><span style='color:black;text-decoration:none'><img border=0 width=28 height=28 id="Picture_x0020_6" src="cid:image002.jpg@01D21CE6.C4E2CF20"></span></a> <a href="https://twitter.com/#!/CALAAEM"><span style='color:windowtext;text-decoration:none'><img border=0 width=30 height=30 id="Picture_x0020_7" src="cid:image003.jpg@01D21CE6.C4E2CF20"></span></a> <a href="http://escholarship.org/uc/uciem_westjem"><span style='color:windowtext;text-decoration:none'><img border=0 width=112 height=30 id="Picture_x0020_4" src="cid:image004.jpg@01D21CE6.C4E2CF20"></span></a><o:p></o:p></p><p class=MsoNormal style='background:#D9D9D9'><span style='color:black'><o:p> </o:p></span></p></div><br />
<table style="border-top: 1px solid #D3D4DE;">
<tr>
<td style="width: 55px; padding-top: 13px;"><a href="https://www.avast.com/en-us/lp-safe-emailing-2270-b?utm_medium=email&utm_source=link&utm_campaign=sig-email&utm_content=webmail&utm_term=oa-2270-b" target="_blank"><img src="https://ipmcdn.avast.com/images/icons/icon-envelope-tick-round-orange-animated-tick-v1.gif" width="46" height="29" style="width: 46px; height: 29px;" /></a></td>
<td style="width: 470px; padding-top: 12px; color: #41424e; font-size: 13px; font-family: Arial, Helvetica, sans-serif; line-height: 18px;">Virus-free. <a href="https://www.avast.com/en-us/lp-safe-emailing-2270-b?utm_medium=email&utm_source=link&utm_campaign=sig-email&utm_content=webmail&utm_term=oa-2270-b" target="_blank" style="color: #4453ea;">www.avast.com</a>
</td>
</tr>
</table></body></html>