CMS Expands APM Opportunities in MACRA

Welcome to Practice Rounds, our new weekly column exploring what's being covered in the larger world of healthcare.

Opportunities Expand for APM Pathway

CMS announced this week that that it's allowing clinicians more opportunities to join the Advanced Alternative Payment Model (APM) pathway under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). While most clinicians will be forced to take the Merit-Based Incentive Payment System (MIPS) pathway, CMS is hoping to open more avenues for participation in the APM pathway. In 2017, clinicians will be able to receive a 5 percent incentive payment if they are involved with the Comprehensive ESRD Care Model (Large Dialysis Organization (LDO) arrangement), Comprehensive ESRD Care Model (non-LDO arrangement), CPC+, Medicare Shared Savings Program ACOs - Track 2, Medicare Shared Savings Program ACOs - Track 3, Next Generation ACO Model, and the Oncology Care Model (two-sided risk arrangement). In 2018, on top of those models, CMS is making ACO Track 1+, a new voluntary bundled payment model, the Comprehensive Care for Joint Replacement Payment Model (Certified Electronic Health Record Technology (CEHRT) track), and Advancing Care Coordination through Episode Payment Models Track 1 (CEHRT track) all eligible for the 5 percent incentive payment.

Slavitt Promises Small Practices Won't Die

On MACRA, CMS Acting Administrator, Andrew Slavitt told Medical Economics that the law will not kill off small practices. Slavitt has seen the negative press surrounding MACRA, with regard to small practices. He understands where it comes from, but says MACRA can actually help them. "Instead of looking at MACRA as regulation, look at it as deregulation. Instead of measuring and measuring [physicians], we said what if we give [physicians] back an additional 30 minutes in their day and what if, instead of making them feel like they were measured and people were looking over their shoulder, they felt supported and recognized and that their input mattered?" Slavitt said to Medical Economics.

ACA Premiums on the Rise

Premiums in the Affordable Care Act are set to increase by an average of 25 percent next year and many counties will only have one insurer to choose from, the Obama administration confirmed this week. The price spikes, which will only affect a portion of ACA healthcare exchange enrollees, come at a time when the law is under tremendous scrutiny. Republicans running for election have promised to repeal the ACA if put into office, Democrats have talked about fixing what doesn't work. Major insurers such as UnitedHealthcare and Aetna are dropping their exchange plans because of decreased profits.

Violence Prevention Protocols Mandated for Health Professionals

The Division of Occupational Safety and Health of California (Cal/OSHA) recently finalized a rule that would require employers of healthcare professionals to develop violence prevention protocols and involve workers in the process, Kaiser Health News reports. The rules will be reviewed by California's Office of Administrative Law and could take effect in early 2017. This is the strongest act of prevention against health professional-related violence, says California Nurses Association/National Nurses United, which have supported the regulation.

Quote of the Week:

Doctors are Divided on the 2016 Presidential Election

"I don't think we can afford a Hillary Clinton healthcare [plan]. I don't think Donald Trump understands it [either]."

Brenda Fortunate, MD, retired family physician, Grand Blanc, Mich.