ANAHEIM, California—It’s always risky business trying to predict the future. Especially so when trying to predict what Washington is going to do and what lies ahead for healthcare.
But Anders Gilberg, senior vice president for government affairs for the Medical Group Management Association, decided to go out on a limb this week at this year’s conference. Some of the questions about what lies ahead for physician practices will get answered soon, as the Centers for Medicare & Medicaid Services will come out with a final rule updating MACRA and a new physician fee schedule by Nov. 1.
“We’ll have 3,000 pages of rules come out in about three weeks,” he said. But what he says is the most onerous issue on the horizon—whether CMS will require a full year of quality reporting under the Merit-based Incentive Payment System (MIPS) in 2018—he admits is a big question mark.
“It’s going to be tricky,” he says. As some practices struggle to participate in MIPS at all this year, the MGMA hopes the government will allow practices to report quality data for a 90-day consecutive period as they continue to ease into the new payment system. The proposed rule that sets requirements for the second year of MACRA called for a full 12 months of reporting for both quality and cost performance in 2018.
Under the first year of MIPS, the government gave practices a big break, putting in place a “pick-your-pace” option that allowed doctors to report only one measure on one patient to avoid a financial penalty.
In its comments on the proposed rule, the MGMA asked CMS to shorten the 12 months of reporting to 90 consecutive days on quality measures, but that participants have the option to report more data as needed. Some quality measures require a longer reporting period for validity, and the MGMA argues that the specific clinical measures should dictate how much data practices need to collect, Gilberg said.
Here’s some of Gilberg’s other predictions of what lies ahead:
Prediction #1: The government will indeed go ahead and delay implementation of rigid electronic health record requirements, as officials said they would in the proposed MACRA rule. That’s a good way to pause implementation of new requirements governing EHRs, he said, as it makes it optional for practices to adopt upgraded systems.
Prediction #2: Practices still won’t have access to timely MIPS feedback reports in 2018. MGMA has argued that practices need timely feedback on their quality data to improve performance, such as quarterly reports. “That is not going to happen next year,” he says.
Prediction #3: There’s no way practices will see EHR interoperability across the healthcare industry. “It’s a huge problem,” he says. Unlike the financial industry, computers in the healthcare industry still can’t talk to each other.
Prediction #4: Congress, which has been divided over attempts to repeal and replace the Affordable Care Act, will take bipartisan action to stabilize the insurance markets created under the reform law. That has a chance of happening, he says, but adds the caveat that “it’s still a tense situation. You never know.”
Prediction #5: Whether a new HHS secretary will be confirmed by the Senate will depend on the nominee. The appointment, which will come from President Donald Trump, will require Senate confirmation. A few names have been floated out there to replace Tom Price, M.D., the orthopedic surgeon, who abruptly resigned after controversy over his use of private planes for travel. In a divided Washington, nothing comes easy. “It’s so contentious now. It could be a real raucous debate. The more partisan the nominee, the longer the debate,” he said.
Prediction #6. Practices will continue to see regulatory relief. That’s a definite, he said, as the administration, including CMS Administrator Seema Verma—who's been mentioned as a possible front-runner in the race to replace Price—has made it clear it wants to reduce the regulatory burden on providers.