Anthem Revises 'Avoidable' ED Visit Policy in MO, KY and GA -AND- A break for doctors: Trump administration wants to reduce reporting burden under MIPS at at
Sun Mar 18 14:43:46 PDT 2018



February 20, 2018


Anthem Revises 'Avoidable' ED Visit Policy in MO, KY and GA



hKwhDSNHbdwf7nAw21vT4hFYWA5o0B-6NeTzM#Headline3> American Hospital



Anthem last week notified network providers in Missouri, Kentucky and
Georgia about changes to its program to prevent "avoidable" emergency
department visits. "Specifically, we have expanded our list of
'always-approve' exceptions," the notice states. "We will take that new list
of exceptions and look back at claims that were previously denied. If one of
those conditions was present, we will change the decision and pay the claim
according to the terms of the benefit plan." While the program also was
implemented in Ohio and Indiana Jan. 1, reviews in these states have already
occurred, the notice states. Anthem has not released the complete list of
exceptions; however, news reports indicate that they include instances where
an individual is directed to an ED by clinical personnel.




February 22, 2018


A break for doctors: Trump administration wants to reduce reporting burden
under MIPS



VjcUwifQ%3D%3D&mrkid=905528> Fierce Healthcare



By Joanne Finnegan


Doctors could get a break from the burden of quality reporting under MIPS if
President Donald Trump's budget proposal for the 2019 fiscal year is


The Trump administration's budget (PDF) proposes to end quality reporting
under the Merit-based Incentive Payment System, one of two tracks under
Medicare's new payment system implemented by the Medicare Access and CHIP
Reauthorization Act (MACRA).


Under the proposal, physicians would see reporting burdens reduced or
eliminated, as the Centers for Medicare & Medicaid Services would assess
performance without requiring clinicians to report information, leaving more
time for providers to focus on patient care.


A summary (PDF) of the proposed budget for the Department of Health and
Human Services makes changes to MACRA. Effective in 2021, the budget calls
for the removal of two performance categories under MIPS and only evaluating
performance based on "meaningful quality and cost measures."


The proposal simplifies MIPS by adopting broader claims and beneficiary
survey-calculated measures that assess performance on quality and cost
during the performance period at the group level only. Payment adjustments
will apply only to payments made under the Physician Fee Schedule rather
than to all payments made under Medicare Part B.


As for the other track under MACRA, Advanced Alternative Payment Models, the
budget proposal removes the thresholds that clinicians must meet to receive
a bonus for participating and instead rewards all clinicians who take part
in them.


The MACRA changes included in the budget proposal drew a mixed response,
according to an article by the Healthcare Financial Management Association.
Some praised the proposal as a way to reduce or eliminate quality reporting
requirements. But the HFMA article said others doubted CMS' ability to
assess performance using internal data alone.


The proposal does reflect the concerns from the Medicare Payment Advisory
Commission (MedPAC), which voted last month to recommend that Congress
replace MIPS with a new voluntary value program. MedPAC said MIPS is costly
to physician practices and won't lead to higher quality care.


However, as much as they dislike aspects of it, two major physician groups
both disagreed with the proposal to replace MIPS, a payment system that's
been in place for just over a year. Instead, the American Medical
Association and the Medical Group Management Association want to work to fix
the existing program.




Jeff Wells
Deputy Editor, CAL/AAEM News Service


Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

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