healthcare unplug oct
TRANSCRIPT
HEALTHCARE UNPLUG
Taino Consultants Inc.Dr. Jose I. Delgado
TOPICS Affordable Care Act (ACA) Medicare Access and CHIP Reauthorization Act (MACRA)
AFFORDABLE CARE ACT (ACA) Section 1557
Summary Required Actions
Health Insurance Increases Expected Behavior Alternatives
MACRA Alternative Payment System
Categories Compliance
Security Risk Assessments Chronic Conditions
Diabetic Care Weight Loss
ICD 10
ACA SECTION 1557 Prohibits discrimination in health care
activities Race Color National origin Age Disability, and Sex
ACA SECTION 1557 - APPLICABILITY Covered Entities
“every health program or activity, any part of which receives Federal financial assistance or made available by”
Example: Health care providers, such as physicians’ practices, hospitals, community health centers, nursing facilities, home health agencies, clinical laboratories, residential or community-based treatment facilities, intermediate care facilities for people with intellectual/developmental disabilities, hospices, and organ procurement centers
ACA SECTION 1557 – DECISION TREEMedicaid Provider
Medicare Provider
Receive HHS $$
Receive HIT
FundsCoveredEntity
Doesn’t Apply
YES
YES
YES
YES
NO
NO
NO
ACA SECTION 1557 - ACTIONS Immediate
Develop and implement an effective written language access plan.
Provide free, accurate, and timely language assistance services for individuals with Limited English Proficiency (LEP).
Post a notice regarding non-discrimination policies. Provide non-discrimination notice in English and include
taglines in the top 15 languages spoken by individuals with LEP within the state.
If less than 15 employees just the top 2 languages other than English
ACA SECTION 1557 – TAG LINE English
[Name of covered entity] complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
Spanish (Español) [Name of coveredentity] cumple con las leyes federales de
derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.
French Creole (Haitian Creole) [Name of covered entity] konfòmaklwasoudwasivil Federal
kiaplikabyo e li pa fèdiskriminasyonsoubazras, koulè, peyiorijin, laj, enfimiteoswasèks.
ACA HEALTH INSURANCE Average increase is 25 percent Carriers pulling out of the market 1.4 million people will be lose their plan
ACA HEALTH INSURANCE Risk Corridor completely ineffective
Insurers requested $2.87 billion Government paid $362 million
17 of 23 approved healthcare cooperatives folded
3 of the 5 largest insurers have decided to significantly pull back United, Aetna and Humana
ACA HEALTH INSURANCE – EXPECTED BEHAVIOR
Consumers picking higher deductible plans or no plans
Employees moving to jobs with health insurance coverage
Narrow Networks
ACA HEALTH INSURANCE - ALTERNATIVES Increase outreach for self paying
customers Create and nurture networks Be creative with benefit plans
Life Insurance Long Term Care
MACRA Merit Based Incentive Payment System
(MIPS) Modified fee-for-service model Expected Model for Majority
Alternative Payment System (APM)
MACRA – MIPS COMPONENTS
Quality RepAlternative
Payment System (APM)orting (PQRS)
Resource Use or Cost (Value-based
Modifier)
Advancing Care Information (MU)
Clinical practice improvement
activities
MIPS
MACRA – CHRONIC CONDITIONS Diabetic Care
Identify Patients Annual Requirements
Education Vision Foot Care Nutrition
Weight Loss Documentation
MACRA - QUALITY REPORTING BASICS
• 50% in of total MIPS score in 2019, phases down to 30% in 2022• Full-year reporting periodMIPS weight
• 6 measures required out of 200 available, reported by physicians• Include one cross-cutting measure, one outcome measure (if
outcome measure not available, substitute with choice of another “high priority” measure)
• 3 population health measures from former VBM calculated by CMS administratively via claims (groups of 10 or more only)
Measures
• Each measure worth up to 10 points• 90 total points for groups >10• 80 total points for smaller groups (all-cause hospital readmission
measure not applied)• Distribution of points for each measure based on performance
benchmarks (80% for claims reporting, 90% for registry reporting)
Scoring
• Up to 4 bonus points may be added for reporting on outcome and high priority measures
• 1 bonus point possible for each measure captured and reported through CEHRT
• Total bonus points capped at 5% of those used to calculate the quality score
Bonus points
MACRA - COMPLIANCE (MEANINGFUL USE) 50 point base score threshold still
100% Security attestation required Measures reduced Exclusions eliminated Full year reporting
19
MACRA - TIMELINE 2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026 on
Fee Schedule Updates
MIPS
QPs in Adv.APMs
0.5% annual baseline updates
No annual baseline updates
4%
5%
7%
9%Max
Adjustment(additional bonuses possible)
0.25% or 0.75
%
9%
9%
9%
5% bonus
MACRA – ICD 10
MACRA - ICD 10 October 1st Significance Trends Recommendations
SUMMARY Affordable Care Act (ACA) Medicare Access and CHIP Reauthorization Act (MACRA)
RESOURCES Taino Consultants Inc.
www.tainoconsultants.com [email protected]
Diabetic Centers for excellence Lavern Dowell
People Helping People [email protected]
Stat Medical Telephone 904-824-4990 www.statmos.com
Vassallo Health Center Telephone 904-797-7722