The Medical Group Management Association's (MGMA) annual conference is underway in Las Vegas this week. FiercePracticeManagement caught up with Jeb Shepard, (pictured), MGMA's senior government affairs representative, to bring you the highlights of this year's Washington Update.
FPM: What are the top legislative and regulatory items on your radar this year?
Shepard: As many group practice managers are aware, the legislative and regulatory environment right now is as challenging as it's ever been. While there's gridlock on the Hill making it hard to get anything done policy-wise, the regulatory spigot is wide open.
The majority of MGMA members participate in Medicare, and if they're billing Part B, then they're required to report in federal quality reporting programs. And 2015 is a big year because we're moving away from carrot and it's going to be all stick. There's not a lot of incentive money to be earned but penalties will be leveled in 2015 based off of previous years' experience.
These federal quality reporting programs like the physician quality reporting system (PQRS), meaningful use and Medicare's Value-Based Payment Modifier are very nebulous, they're confusing, and the goal posts are always moving. So in my opinion, the most important type of information we can give members is how to comply with these programs, with guidance on what they need to report and when.
Members should know that we're not just here in Washington looking out for their interests, but we're also providing them with resources they may not know about to help them comply with these programs.
FPM: What are some examples of compliance resources MGMA provides?
Shepard: As part of the MGMA ACA Resource Center, members can access tools such as The Insurance Exchange Essentials for Practice Executives, which includes information that helps group practice managers understand exactly how the insurance exchanges impact them. There is so much information floating around out there and we've done a lot of the sifting for our members. We've also put together an Electronic Funds Transfer (EFT) and Electronic Remittance Advice Guide, with a sample letter members can use to request EFT from their private payers, which is a HIPAA requirement starting Jan. 1 as a result of the Affordable Care Act.
In addition to various other guides, memos and webinars we've developed on various issues such as the Sunshine or Open Payments Act and CMS Fee Schedule Analysis, we've put together a PQRS/Value Modifier Survival Guide to help members navigate these two programs based on tier group size and reporting option.
We also publish our Washington Connection every Wednesday with concise updates to help busy group practice managers keep up with what they need to do to meet various deadlines and find the right resources.
Finally, what many members don't realize is that they can just pick up the phone and give us a call if they need help understanding their responsibility under a regulatory program. We're happy to get answers to members in a timely manner.
FPM: When members do contact you, what are the challenges you're hearing about most often?
Shepard: The biggest concerns surround the federal quality reporting programs, specifically PQRS, the Value Based Payment Modifier and Meaningful Use. We're looking at a cumulative 11 percent penalty in 2017 if you're not participating in these programs, and for a lot of small groups that's incredibly challenging.
Even if you're a PQRS whiz one year, for example, you really have to relearn the entire program the next year. There's no uniformity. There's so much frustration and group managers often joke, asking, "Got any good news for me today, Jeb?" The answer unfortunately is "No," and that's one of the more challenging parts of this position, but it's better to know this stuff and be aware of it than to get blindsided by it.
Editor's note: This interview has been edited for clarity.