Advanced Alternative Payment Models,APMs,MACRA,Medicare Access and CHIP Reauthorization Act,Merit-based Incentive payment system,MIPS,Stoltenberg Consulting

MACRA considerations for physicians in 2017

Joncé Smith, Vice President of Revenue Cycle Management, Stoltenberg Consulting

Written by: Joncé Smith

Entering 2017 brings a huge degree of uncertainty amid major healthcare industry changes. In particular, the Medicare Access and CHIP Reauthorization Act (MACRA) holds several options for Medicare physician payment paths as healthcare providers interpret implications and exemption possibilities.

MACRA replaces the old sustainable growth-rate (SGR) formula for physician payment, shifting focus from the fee-for-service model to value-based care. Physicians must now pick from one of two reimbursement tracks: the Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs).

To help you better understand MACRA, we’ve outlined the program’s tracks below.

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AMGA,Centers for Medicare & Medicaid Services,CMS,Government Perspectives,Medicare Part B Drug Demonstration

AMGA applauds the decision to not implement Part B drug proposal

AMGA applauded the Centers for Medicare & Medicaid Services’ (CMS’) decision to not move forward with the Medicare Part B Drug Demonstration.

In May, AMGA submitted comments to CMS outlining concerns that the proposal could hinder beneficiary access to needed medications while doing little to improve quality.

“AMGA appreciates that the administration considered stakeholder feedback from AMGA and others and will not move forward with this proposal,” said Donald W. Fisher, Ph.D., CAE, AMGA’s president and chief executive officer. “AMGA supports the transition to value-based payment and looks forward to working with the current and incoming administration on building a healthcare system that truly rewards quality of care, reduces cost, and advances population health.”

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consolidation,Health Care 2020: Consolidation,HFMA

Environmental assessment explores impact of consolidation in the healthcare industry

Healthcare organizations will be challenged to prove that the changing healthcare landscape has created an environment in which consolidation actually improves value to consumers. That is the conclusion of Health Care 2020: Consolidation, a new report published by the Healthcare Financial Management Association.

“Consolidation is a trend that’s here to stay,” says HFMA President and CEO Joseph J. Fifer, FHFMA, CPA. “But controversy about the impact is ongoing. In many cases, consolidated entities have not demonstrated value to the communities served. Across the industry, the challenge going forward is to achieve and demonstrate higher value from consolidation by lowering the total cost of care and improving quality.”

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Centers for Medicare & Medicaid Services,CMS,Government Perspectives,quality payment program

CMS launches new online tool to make Quality Payment Program easier for clinicians

Today, the Centers for Medicare & Medicaid Services (CMS) released a tool to share automatically electronic data for the Medicare Quality Payment Program. This new release is the first in a series that will be part of CMS’s ongoing efforts to spur the creation of innovative, customizable tools to reduce burden for clinicians, while also supporting high-quality care for patients.

In October, CMS released the Quality Payment Program website, an interactive site to help clinicians understand the program and successfully participate. Today’s release, commonly referred to as an Application Program Interface (API), builds on that site by making it easier for other organizations to retrieve and maintain the Quality Payment Program’s measures and enable them to build applications for clinicians and their practices. The API, available at, will allow developers to write software using the information described on the Explore Measures section of Based on interviews with clinicians, CMS created the Explores Measures tool, which enables clinicians and practice managers to select measures that likely fit their practice, assemble them into a group, and print or save them for reference. Already, tens of thousands of people are using this tool.

Dr. Kate Goodrich, Director of the CMS Centers for Clinical Standards and Quality said, “The API released today will continue CMS’s focus on user-driven design by providing developers and our partners the opportunity to turn our data into powerful applications. CMS is committed to collaborating with the organizations that doctors trust to make their lives easier, while supporting their efforts to improve the quality of care across America.”

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ACA,Affordable Care Act,Epic,Patient Financial Clearance,TransUnion Healthcare

TransUnion Healthcare announces integration of its Patient Financial Clearance solution with the Epic Prelude Registration System

TransUnion Healthcare announced its Patient Financial Clearance solutions are live in production with the Epic Outgoing Address Verification Query Interface (AVQI). The integration allows Epic clients to query TransUnion’s consumer databases to validate patient demographic and financial data at scheduling, pre-registration or registration.

The integration takes place at a time when patient financial responsibility for healthcare continues to skyrocket despite efforts made by the Affordable Care Act (ACA) to expand insurance coverage. A recent American Hospital Association study found that one in four adults (31 million people) are considered underinsured, and lack the ability to fund their care. The same study found that one in three Americans struggle to pay their medical bills even though 70 percent of them have access to some level of insurance.

“Patient Financial Clearance solutions integrated into Epic Systems equips front-end staff with the necessary information to quickly determine the patient’s ability and willingness to pay, or likelihood to qualify for financial assistance,” said John Yount, vice president of product for TransUnion Healthcare. “This solution is especially important as the industry is pushing the burden of healthcare costs downline so the patient is the new payer.”

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Cerner,Millennium Revenue Cycle,Olathe Health System

Olathe Health System broadens use of Cerner Digital Record

Olathe Health System today announced an expansion of its relationship with Cerner, its health IT supplier. Cerner will integrate its Millennium Revenue Cycle with the existing enterprisewide electronic health record (EHR), which will result in a clinically driven revenue cycle designed to help streamline revenue cycle processes and enable a more efficient billing experience for patients.

“The potential patient benefits and outcomes are truly what drive our business actions, including this decision to expand our health IT system,” said Randy Rahman, vice president and CIO of Olathe Health System. “Our goal is to bring our organization onto one platform to work toward becoming one of the most integrated and progressive health care providers in the region. We understand the value that Cerner’s system-wide integration can provide to Olathe as we strive to develop the best patient experience and satisfaction possible.”

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Cerner,Covenant Health,Healthelntent

Covenant Health selects Cerner’s enterprise-wide clinical, financial and population health IT system

Covenant Health, an integrated not-for-profit health system based in eastern Tennessee, has selected Cerner’s comprehensive suite of integrated health care information technology (IT) solutions to support clinical, financial and population health management initiatives, resulting in a clinically driven revenue cycle across the enterprise’s acute hospitals and nearly 100 ambulatory facilities.

“To advance our goal of providing excellent care for every patient, we needed to select a robust IT system that could effectively and efficiently support multiple aspects of our health system operations,” said Jim VanderSteeg, president and CEO, Covenant Health. “We are confident that Cerner’s enterprise-wide functionalities will help us deliver high-quality care with the goal of improving health outcomes. We believe that Cerner’s predictable total cost-of-ownership will also contribute to Covenant’s financial stability and strength.”

Cerner’s solutions and services will provide model clinical and financial infrastructure, processes and workflows to support the unique needs of Covenant Health’s hospitals and services, and nearly 1,500 affiliated physicians. To provide clinicians a more holistic view of a person’s health status, Covenant Health elected to implement Healthelntent, Cerner’s system-agnostic, near real-time population health management platform designed to aggregate data from multiple sources into a single patient record.

“We are increasingly focused on keeping our patient population healthy by proactively identifying risks and intervening early beyond the four walls of the hospital,” said Dr. Mandy Grubb Halford, system medical director of Clinical Documentation and Informatics, Covenant Health. “With HealtheIntent, we will be able to use clinical information to develop actionable insights to help us better manage care and outcomes.”

“Covenant Health’s decision to bring the health system onto one integrated platform aligns the health system with some of our most successful clients that are committed to providing the best quality care possible to their communities,” said Zane Burke, president, Cerner. “We look forward to working with Covenant to continue its momentum as one of the leading health care providers in Tennessee.”

Patients will be able to engage in their health through an online patient portal that will enable them to schedule appointments, access personal health information and pay bills, all from a single access point. Patients will also experience a comprehensive billing system that reflects their treatment across the health system, regardless of the venue or physician they visited. Additionally, Covenant Health will leverage Cerner’s remote-hosting services, an offering where Cerner will manage data and deliver clinical and financial solutions from Cerner’s data center in Kansas City, Missouri.

“This relationship will play a significant role in our ability to provide better and more efficient care, and it represents a major investment in the health of our patients and the future of our health system,” VanderSteeg said. “Cerner’s IT solutions will enable us to work in an efficient and cost-effective manner, not only to improve individual patient outcomes, but also to improve population health and positively impact the quality of life in the communities we serve. We see Cerner as our companion in helping us fulfill our commitment to excellence, now and for many years to come.”

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athenahealth,Centers for Medicare and Medicaid Services,CMS,MACRA,Merit-based Incentive payment system,MIPS,MIPS Guarantee

athenahealth announces industry’s first MIPS guarantee

athenahealth, a leading provider of cloud-based services and mobile applications for medical groups and health systems, today announced its Merit-Based Incentive Payment System (MIPS) Guarantee, which aims to shield healthcare providers and practices from downward payment adjustments under the proposed Medicare reimbursement program of the same name. The guarantee comes months ahead of the Centers for Medicare and Medicaid Services’ (CMS) release of the final MACRA rule and amidst mounting debate over reimbursement change and complexity.   

“At a time when nearly all providers across the U.S. are expected to keep up with ever-changing reimbursement rules and an estimated 45 percent of those who bill Medicare Part B are facing payment cuts under the MIPS program, we’re looking to lift the burden,” said Jonathan Bush, chief executive officer, athenahealth. “The complexity of government reimbursement is just too onerous; and, it’s not something providers or practice staff should have to master. Because of our national network, our quality management and payer rules engine, our team of experts, and our track record of client success as part of other government-run programs, we believe we can free the industry of reimbursement cuts associated with MIPS. And if we can’t, we’ll put our money where our mouth is and reimburse clients up to the penalty amount.”

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ClarityQx,HealthQX,McKesson,McKesson's Episode Managemen,value-based reimbursement,VBR

McKesson Health Solutions extends VBR portfolio with ClarityQx value-based payment technology

Last month McKesson HealthSolutions released a nationalstudy that found value-based reimbursement (VBR) has firmly taken hold but that payers and providers are struggling to operationalize some of the fastest growing payment models.

Today McKesson Health Solutions announced it has expanded its portfolio to include ClarityQx value-based payment technology through the acquisition of HealthQX. This technology enhances McKesson’s ability to help customers rapidly and cost-effectively transition to value-based care by automating and scaling complex payment models, such as retrospective and prospective bundled payment.

Health plans use ClarityQx for analytics and for automation of retrospective bundled payment models and McKesson’s Episode Management to support automation of prospective bundled payment. Pairing ClarityQx with McKesson’s Episode Management gives health plans the ability to automate retrospective bundled payment processes today and move to prospective payment as they are ready.

“The growth of bundled payment is something payers and providers can’t ignore, and we want to ensure our customers have all the tools they need to succeed,” said Carolyn Wukitch, senior vice president of McKesson Health Solutions. “These new value-based payment analytics, reconciliation, and automation capabilities complement our value-based reimbursement suite, because they give our customers the capabilities to prepare for and scale bundled payment.”

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Healthcare Financial Management Association,HFMA

New HFMA Chair Mary Mirabelli takes office

The Healthcare Financial Management Association (HFMA) inducted Mary Mirabelli, FHFMA, into office as Chair of its Board of Directors for the 2016-2017 term, during HFMA’s annual conference in Las Vegas. Her term began on June 1, 2016. 

In her role as the chief elected officer of HFMA, Mary will be responsible for providing overall direction to the Association by actions such as establishing policies, appointing key leaders, planning educational programs, choosing a program theme, and representing the Association at various events.

Mirabelli is Vice President, Global Healthcare Practice at Hewlett Packard Enterprise (HPE). In this role, Mirabelli works to bring the power of HPE for healthcare clients across the globe to sustain and grow their businesses in the provider, payer, and life sciences market segments.

“With Mary’s global healthcare experience, she brings a unique perspective to the association,” said HFMA President and CEO Joseph J. Fifer, FHFMA, CPA. “She also has insights into improving the financial experience that will inform our consumerism initiatives. We’re excited to welcome Mary as HFMA chair.”

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