National MGMA News for July 17, 2019

July 17, 2019


This week's headlines:


  • Register now: MGMA Regulatory and Payment Outlook webinar
  • Call to action: Tell Congress to hold health plans accountable for surprise billing
  • 2018 QPP performance results released
  • New Medicare APMs announced
  • MIPS report cards now on Physician Compare



Register now: MGMA Regulatory and Payment Outlook webinar


MGMA Government Affairs invites you to join us for a member-exclusive webinar next Wednesday, July 24 at 1:00 p.m. ET. This 60-minute webinar will feature a comprehensive discussion of federal healthcare policy, the latest congressional efforts to reform healthcare and, if released by the government, a review of the proposed 2020 Physician Fee Schedule. Potential new changes to the Merit-based Incentive Payment System (MIPS) and alternative payment models (APMs) will be outlined and staff will discuss MGMA’s continuing efforts to improve both tracks and reduce the regulatory burden on physician group practices. Attendees will also have a chance to ask their most pressing questions during a question and answer session. Don’t delay! Register now to secure your place.



Call to action: Tell Congress to hold health plans accountable for surprise billing


In recent months, Congress introduced a number of bills that address the issue of surprise billing. There is widespread agreement that patients should be protected from surprise medical bills and taken out of the middle of payment disputes. However, the current legislative “solutions” give too much power to health plans. Instead of the discounted in-network benchmark rate solution proposed by many of these bills, MGMA advocates for out-of-network payments to be set by leveraging commercial data from independent sources. When this payment rate is insufficient, an independent dispute resolution process should be utilized to determine fair payment for the physician.


Please take a moment to submit a letter to Congress through our Contact Congress portal and ask your representatives to hold health plans accountable.



2018 QPP performance results released


CMS has released data outlining preliminary, high-level results of participation data in the 2018 Quality Payment Program (QPP). A key takeaway from 2018 performance is that a higher percentage of participants in MIPS avoided a negative adjustment compared to 2017 performance (almost 98% versus 93%). Additional details of 2018 QPP participation include:

  • The total number of clinicians who participated in MIPS in 2018 was 559,230, down from 716,603 in 2017;
  • Small practice participation in MIPS increased to 89.2% in 2018, up from 81% in 2017; and
  • The number of Advanced Payment Model Qualifying Participants (QPs) rose to 183,306 in 2018, up from 99,076 in 2017.

MGMA members who believe an error has been made to their 2018 performance final scores can request a targeted review through the QPP website until September 30, 2019.



New Medicare APMs announced


CMS announced the creation of two voluntary and two mandatory Medicare APMs for CY2020. The voluntary models are Kidney Care First and Comprehensive Kidney Care Contracting. CMS also proposed a regulation that would create two mandatory models – End-Stage Renal Disease Treatment Choices (ETC) and Radiation Oncology. 


CMS anticipates that all models will open for participation in CY 2020 and that each model, except for the proposed ETC model, will qualify as an Advanced APM starting in performance year CY 2021. While MGMA strongly supports the creation of new voluntary APM opportunities, we oppose mandatory models that subject group practices to untested payment structures that lack evidentiary support. To learn more about these new opportunities, visit MGMA’s APM landing page.



MIPS report cards now on Physician Compare


As part of CMS’s continued phased-in approach to public reporting on Physician Compare, the agency recently published a subset of 2017 QPP information submitted under MIPS and APMs. The information added on profile pages for MIPS eligible clinicians and groups includes select quality measure and CAHPS survey data.


To learn more about Physician Compare and the 2017 QPP data publication, review CMS’s fact sheet. MGMA Government Affairs encourages members to share feedback with us regarding their experiences with Physician Compare.