CMS seeks input on new patient relationship categories and codes under MACRA; Congress hears from physician groups on preparations for new Medicare payment law

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Posted by Anne Phelps, Principal, US Health Care Regulatory Leader and Daniel Esquibel, Senior Manager, Deloitte & Touche LLP on April 20, 2016.

The Centers for Medicare and Medicaid Services (CMS) this week released draft patient relationship categories and codes as required under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The patient relationship categories and codes are intended to help CMS more effectively measure resource use, a major performance category under the Merit-based Incentive Payment System (MIPS). The patient relationship categories and codes also could be utilized through alternative payment models (APMs).

CMS approached the development of the categories by distinguishing whether items and services are furnished on an acute basis or a non-acute basis. The draft categories are:

Continuing care relationships:

  1. Clinician who is the primary health care provider responsible for providing or coordinating the ongoing care of the patient for chronic and acute care.
  2. Clinician who provides continuing specialized chronic care to the patient.

Acute care relationships:

  1. Clinician who takes responsibility for providing or coordinating the overall health care of the patient during an acute episode.
  2. Clinician who is a consultant during an acute episode.

Acute care or continuing care relationship:

  1. Clinician who furnishes care to the patient only as ordered by another clinician.

CMS provides a list of eight questions for consideration, such as whether distinguishing relationships by acute care and continuing care is the appropriate way to classify relationships and what clinician workflow issues are involved in the coding process.

Comments are due by August 15, 2016.

MACRA hearing

The House Energy and Commerce Health Subcommittee on Tuesday, April 19, 2016, held its second oversight hearing on MACRA. Witnesses at the hearing were:

  • Dr. Jeffery W. Bailet MD, MSPH, FACS, Executive Vice President Aurora Health Care, Co-President Aurora Health Care Medical Group
  • Dr. Barbara McAneny MD on behalf of American Medical Association
  • Dr. Robert McLean MD, FACP on behalf of American College of Physicians
  • Dr. Robert Wergin MD, FAAFP, Board Chair, American Academy of Family Physicians

Each of the witnesses voiced support for MACRA and expressed optimism that the law will provide new opportunities for physicians and other clinicians to improve care and control costs. In addition, the witnesses also consistently highlighted the importance of having an interoperable electronic health record as they work to coordinate care more effectively. Witnesses urged Congress to continue to focus on interoperability.

Consistent with their support for interoperability, the witnesses also said it would be helpful to have more timely access to data that could help them make changes to improve care. The delay in receiving data through current quality reporting efforts makes the data less helpful to clinicians, witnesses said.

In the realm of quality measures, witnesses said it was critical that CMS propose measures that reflect different specialties and that would be meaningful to different patient populations in different regions.

Notably, Dr. Bailet also is the chair of the Physician-Focused Payment Technical Advisory Committee (PTAC), an independent advisory body established under MACRA to help review proposals for new payment and delivery models. Dr. Bailet said the group is working to develop bylaws and rules of engagement for reviewing proposals, as well as a methodology for scoring proposals. The statute requires HHS to establish criteria for new physician-focused payment models under MACRA by November 1, 2016.

Anne Phelps
Principal
US Health Care Regulatory Leader
Latest conversations from Anne Phelps on Twitter

Daniel Esquibel
Senior Manager | Deloitte Advisory
Deloitte & Touche LLP

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