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Between the repeal of the Independent Payment Advisory Board (IPAB) and changes to the Quality Payment Program, it's fair to say the Bipartisan Budget Act of 2018 is a health care bill tucked inside of a budget bill.
In fact, Jennifer McLaughlin, senior associate director of government affairs for the Medical Group Management Association (MGMA), says there is a "laundry list" of items that affects the health care landscape included in the budget agreement (which passed the Senate by a vote of 71–28 and the House of Representatives, 240–186). While the organization is still going over the list, the changes to IPAB and the QPP (better known as MACRA – the Medicare Access and CHIP Reauthorization Act) are the biggest two.
In regards to MACRA, there were "small changes" that have the potential to make a big difference, McLaughlin says. In the QPP's Merit-based Incentive Payment System (MIPS), the Cost category continues to be a source of confusion for physician practices, she notes, because there hasn't been a ton of discourse coming from CMS about how it will be measured over time. The bill gives CMS more time to clarify, test, and develop episode-based cost measures.
"This bill gives the secretary of HHS three additional years before they have to move to full implementation of [Cost]. It also did away with what would have been a new scoring element for Cost in 2018, which was year-over-year improvement," says McLaughlin. The bill ensured that Cost would stay at 10 percent of physicians MIPS score through 2021. Originally, it was slated to go to 30 percent in 2019.
Later in the podcast, McLaughlin talks about the other major changes the Budget Act will enact on physician practices, which includes "the one negative [aspect] of an otherwise favorable bill." She also talks about the major legislative issues MGMA will be focusing on in the near future.
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