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