The 2024 Quality Payment Program: Updates for Anesthesia

SPECIAL ANNOUNCEMENT

SUMMARY:  As we close 2023 and look towards the new year of reporting with CMS, we walk through the requirements and changes CMS has made. This alert will serve as a guide on what you can expect and how you can best position yourself and your practice to comply with the Quality Payment Program. This update includes an overview of the MIPS program for 2024, including reporting requirements, measure updates and recommendations for anesthesia groups relative to overall participation.

At the end of the year, CMS provides the healthcare industry with the details of the upcoming reporting year with the Quality Payment Program (QPP); and, last Friday, they released the full list of registries that have been approved for reporting for 2024. Coronis Health has been approved for reporting as a Qualified Clinical Data Registry (QCDR) and a Qualified Registry (QR) for the ninth year, which not only allows us to support our clients in an engaged and supportive way but continues to allow us to be an active participant in the development and deployment of this program over the years. This release, along with the update to the 2024 Medicare Physician Fee Schedule (PFS) Final Rule, provides us with the full landscape of what CMS expects and how we are to comply with the QPP. This alert will walk through the requirements of 2024 reporting and be a resource to review if you have any questions about how you need to participate next year.

MIPS Category Review

The QPP has two main payment tracks: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APM). This update is going to primarily focus on the MIPS track, but we will make some references to the APM. If you have any questions about the APM reporting track, please reach out to your account executive so that we can check your eligibility. Under MIPS, there are four categories to consider, which are Quality, Cost, Improvement Activities and Promoting Interoperability. Some special considerations exist for anesthesia around these categories that we will walk through below. Your participation with MIPS should consider your needs with CMS compliance, strategic value of having this quality data tracked, and potential secondary benefits gained through your facility contracts or payer contracts. Based on your answers, you can review whether reporting through the traditional MIPS track or through a MIPS Value Pathway (MVP) is more advantageous and determine if you should report as an individual or as a group. This can get confusing quickly, but, hopefully, this review will clarify the program as it relates to anesthesia for 2024.

Previous years afforded anesthesia a bit of flexibility with reporting, and 2024 is thankfully no exception. This is primarily because CMS classifies the anesthesia specialty as “non-patient facing clinicians.” This status may be confusing given the nature of anesthesia care, but it is useful as it provides the specialty with options on how it chooses to participate with the QPP. One of the most important benefits is the automatic reweighting of the Promoting Interoperability (PI) MIPS category, which is the new version of the CMS 2012 Meaningful Use program. This is useful as it eliminates the requirement to comply with this category altogether and assigns the composite points that would be assigned to the Quality category. The Cost category is automatically calculated by the government, which leaves only the Quality and the Improvement Activities as the ones that anesthesia providers need to consider. Since CMS decided to keep the weighting of these categories stable for 2024, that means that the Quality category is worth 55 percent of your total score and Improvement Activities is worth 15 percent.

When your compliance in these categories is added together, a minimum of 75 points or more is required to avoid a penalty in 2024. The program isn’t all or nothing, however. 2024 reporting will result in a nine percent penalty assessed on your 2026 Medicare Part B payments if your total score is between 0 and 18.75 composite points. Anywhere from 18.76 to 74.99 composite points will assign a negative adjustment between nine percent and zero percent on a linear sliding scale. 75 composite points exactly will have a neutral adjustment, and anything above will have a sliding scale of a positive, but budget-neutral positive, adjustment. We don’t know exactly what this positive adjustment will be, but you can expect a maximum of around 3.5 percent of your 2026 Medicare Part B payments. This value may substantially increase as the COVID-19 hardship exemption ends, but we will update you if we see any major changes.

One other element of flexibility that anesthesia enjoys is that CMS includes a minimum threshold of collections from Medicare Part B payments. If a clinician collects less than $90,000 in traditional Medicare, they may be excluded from the program altogether. This doesn’t restrict your reporting if you want to participate and seek a bonus, but it may not obligate you if you have no interest. If you are curious about your status, you can search here with your NPI using the MIPS participation lookup tool. Coronis Health will review this on your behalf, as well, but feel free to check anytime.

Category Details – Quality & Improvement Activities

CMS updated the program with one big change. The data completeness requirement has increased to 75 percent for quality category reporting (up from 70 percent in 2023), meaning clinicians will need to report on 75 percent of each measure’s full year eligible population to be fully counted. There are a few more measures to choose from this year through the Coronis Health or the other anesthesia registries. The list of measures includes the following:

• #404: Anesthesiology Smoking Abstinence
• #424: Perioperative Temperature Management
• #430: Prevention of Post-Operative Nausea and Vomiting (PONY) – Combination Therapy
• #463: Prevention of Post-Operative Vomiting (POV)- Combination Therapy (Pediatrics)
• #477: Multimodal Pain Management (MIPS CQMs Specifications)
• #ABG41: Upper Extremity Nerve Blockade in Shoulder Surgery
• #ABG42: Known or Suspected Difficult Airway Mitigation Strategies
• #ABG43: Use of Capnography for non-Operating Room anesthesia Measure
• #AQI48: Patient-Reported Experience with Anesthesia
• #AQI56: Use of Neuraxial Techniques and/or Peripheral Nerve Blocks for Total Knee Arthroplasty (TKA)
• #AQI68: Obstructive Sleep Apnea: Mitigation Strategies
• #AQI69: Intraoperative Antibiotic Redosing
• #AQI71: Ambulatory Glucose Management
• #AQI72: Perioperative Anemia Management
• #AQI73: Prevention of Arterial Line-Related Bloodstream Infections
• #AQI67: Consultation for Frail Patients
• #ABG44: Low Flow Inhalational General Anesthesia

Under the traditional MIPS model, you would be required to report on at least six of the above measures. It will be important to choose the measures together with your team at Coronis Health as there are considerations around maximum scores achievable with the above measures through its historical benchmarks.

One thing to keep in mind is the final 2024 measures have not yet been published on the CMS website. These generally are viewable in the Resource Library, and we hope to see these posted by January 2, 2024. If there are any substantial changes to these measures, we will let you know; but, for now, review the above list, and you can select a minimum of six of them if participating in the traditional MIPS program.

Regarding Improvement Activities, there were some changes, but they don’t substantially affect anesthesia, with one exception. We will review this topic further in the next section, but CMS added an improvement activity for better support of the MIPS Value Pathways (MVPs). It is described as:

• IA_MVP: Practice-Wide Quality Improvement in MIPS Value Pathways

In essence, you can consider this improvement activity to double dip on MVP participation as it gives you an automatic credit for the category if you participate in an MVP. Given that support, there are a few considerations with MVPs for 2024.

MIPS Value Pathways

In 2023, CMS introduced the MVP reporting pathway as a method to simplify the entire process of reporting measures to CMS. In essence, the MVP provides a prescriptive list of options and a reduced burden of reporting to enable easier overall compliance with the QPP. This is a great way to comply; and, with Coronis Health as your partner, we will additionally work with you to maximize your bonuses. To do so, we will work on a combination of strategies to evaluate the best option with traditional MIPS, MVP, or, if you are a participant with ACO, through a reporting option called an APM (Advanced Alternate Payment Model). If you are participating in an ACO and have any questions about how the APM works, let your account executive know, and we can review your options.

The new year will include some potential changes with the MVP options for anesthesia. Currently, this is only published in the 2024 Medicare Physician Fee Schedule (PFS) Final Rule as a proposed change, but we will update you on the officially published MVP list when the QPP pages are updated. However, for this year, you can choose any four of the following measures if reporting through the Coronis Health QCDR:

• #404: Anesthesiology Smoking Abstinence
• #424: Perioperative Temperature Management
• #430: Prevention of Post-Operative Nausea and Vomiting (PONY) – Combination Therapy
• #463: Prevention of Post-Operative Vomiting (POV)- Combination Therapy (Pediatrics)
• #477: Multimodal Pain Management (MIPS CQMs Specifications)
• #487: Screening for Social Drivers of Health (NEW)
• AQI48: Patient-Reported Experience with Anesthesia

The MVP bundle additionally requires an Improvement Activity; but, as outlined above, the new measure (IA_MVP: Practice-Wide Quality Improvement in MIPS Value Pathways) allows providers to bypass this requirement by being able to double dip and not be overly concerned with the reporting of this category. However, if you are interested in reporting other improvement activities for an alternative reason, you can select two medium-weighted or one high-weighted improvement activity. The only catch to an MVP is that you must proactively register between April 1, 2024 and November 30, 2024, which Coronis Health can do on your behalf.

The measures to choose from are as follows:

Improvement Activities (2 Medium or 1 High)

• IA_BE_6: Regularly Assess Patient Experience of Care and Follow Up on Findings – High
• IA_BE_22: Improved practices that engage patients pre-visit – Medium
• IA_BMH_2: Tobacco use – Medium
• IA_CC_2: Implementation of improvements that contribute to more timely communication of test results – Medium
• IA_CC_15: PSH Care Coordination – High
• IA_CC_19: Tracking of clinician’s relationship to and responsibility for a patient by reporting MACRA patient relationship codes – High
• IA_EPA_1: Provide 24/7 Access to MIPS Eligible Clinicians or Groups Who Have Real-Time Access to Patient’s Medical Records – High
• IA_MVP: Practice-Wide Quality Improvement in MIPS Value Pathways – High
• IA_PCMH: Electronic Submission of Patient Centered Medical Home accreditation – High
• IA_PSPA_1: Participation in an AHRQ-listed patient safety organization – Medium
• IA_PSPA_7: Use of QCDR data for ongoing practice assessment and improvements – Medium
• IA_PSPA_16: Use of decision support and standardized treatment protocols – Medium

The MVP option may be the easiest way to comply with the QPP requirements for 2024, but we can work with you to be strategic about your measure selections to achieve the maximum composite points possible. Feel free to review the details of the MVP at the CMS website.

More information will be coming from us about the registration process but consider the MVP as your easiest avenue to meet overall QPP compliance for 2024. Until then, if you have questions about this topic, please contact your account executive or you can reach out to us at info@coronishealth.com.

from
https://www.coronishealth.com/blog/the-2024-quality-payment-program-updates-for-anesthesia/

Outlawing the Opaque:

Congress Set to Vote on Transparency Mandate

Seeing non-descript shapes and fuzzy images is a common occurrence for those driving on a stormy night with fogged-up windshields. You can see lights coming at you, but you can’t see the road itself or its yellow dividing line. The murkiness of the view can be downright dangerous—even with wipers going at full tilt. In such conditions, it is imperative to get a clearer view—whether that means turning on the defrost or manually wiping away the film of fog with your own hand.

Gaining clarity, sharpening the scene can be critical in helping individuals to better interpret and react to the myriad of data points constantly coming into view. Whether that’s navigating hazardous driving conditions or selecting a healthcare provider in the wake of a concerning diagnosis. As it concerns the latter, greater clarity may be on the way.

Transparency on Track

According to a December 11 article in Becker’s CFO Report, the U.S. House of Representatives could call for a vote in the next few days on The Lower Costs, More Transparency Act (LCMTA). The measure would force hospitals, ambulatory surgery centers, labs, imaging service providers and pharmacy benefit managers to meet new price transparency requirements. The bipartisan legislation, which was first introduced on September 8, not only seeks to improve price transparency but also contains provisions meant to lower overall costs for patients and employers.

According to Beckers, the key takeaways from the proposed LCMTA include the following items:

1. The legislation would require healthcare price information from hospitals, payers, labs, imaging providers and ASCs to publicly list the prices they charge patients.

2. Hospitals would be required to publish all standard charges for at least 300 shoppable items and services. The charges would be published through machine-readable files and would have to include payer-specific negotiated charges in addition to charges for cash-paying patients.

3. Under the proposed legislation, ASCs, when owned by a hospital, would be required to make public insurer-negotiated rates and cash prices for all items and services, as well as prices for approximately 300 shoppable services.

4. The proposed bill would also reduce costs for patients and employers by requiring payers and pharmacy benefit managers to disclose negotiated drug rebates and discounts, revealing the true costs of prescription drugs.

5. Medicare Advantage organizations would be required to report to the U.S. Department of Health and Human Services (HHS) information about PBMs, pharmacies and other providers when they share common ownership.

6. The proposed bill would eliminate $8 billion a year in proposed disproportionate share hospital cuts during fiscal year 2024 through 2025, as well as $7 billion in funding for the Medicaid Improvement Fund.

7. The legislation would lower out-of-pocket costs for seniors who receive medication at a hospital owned facility or physician office and expand access to more affordable generic drugs.

8. Under the bill, employers would be equipped with the drug price information they need to get the best deal possible for their employees.

9. The proposed bill also fully pays for investments into programs that strengthen the healthcare system by the following actions:
   

• The funding of community health centers, deemed crucial for patients in rural and underserved areas, would be extended through 2025. The proposed funding is $4.4 billion per year.
• Supporting training programs for new physicians in communities.
• Preserving Medicaid funding for hospitals that provide care to uninsured and low-income patients.
• Extending funding for research to find better treatments and a cure for diabetes, which CMS said affects more than 38 million Americans.
  

Rationale and Next Steps

In a September 8 press release, Rep. Virginia Foxx, chair of the House Education and the Workforce Committee, stated the following:

Hidden fees, dishonest billing, and other harmful practices in the healthcare industry have left patients in the dark about the cost of care. No patient should be saddled with higher premiums just because he or she wasn’t presented with all of the facts. This good faith effort will allow patients to cut through the confusion in the healthcare marketplace and make informed decisions.

The House could vote on the LCMTA this week. If passed, it would then have to proceed through the next steps of approval before becoming law. We will keep you updated on the bill’s progress.

from
https://www.coronishealth.com/blog/outlawing-the-opaque/

Discouraging Information Blocking: Government Issues Proposed Rule

He’s coming right at you. A 295-pound defensive end who is attempting to bull rush you on the inside gap; and all that stands between him and your franchise quarterback is you. Blocking is one of the essentials of American football. It’s considered a major asset for those who can execute it well. But blocking, in some contexts, is a definite no-no and could wind up actually costing you.

A few weeks ago, the U.S. Department of Health and Human Services (HHS) published a proposed rule that would establish disincentives for healthcare entities and individual providers determined by HHS’ Office of Inspector General (OIG) to have committed “information blocking.” The OIG describes this term as occurring “when a provider knowingly and unreasonably interferes with the access, exchange, or use of electronic health information except as required by law or covered by a regulatory exception.”

Proposed Penalties

The proposed rule implements the HHS Secretary’s authority under section 4004 of the 21st Century Cures Act (Cures Act) and acts to complement the OIG’s rule that established information blocking penalties for the other actors previously identified by Congress. These include health information technology (IT) developers of certified health IT or other entities offering certified health IT, health information exchanges, and health information networks. Specifically, the OIG’s final rule establishes civil money penalties authorized by the Cures Act that applies to these IT entities. According to an HHS press release, if the OIG determines that one of these entities has committed information blocking, it may be fined up to $1 million per violation. Again, this is based on an earlier OIG final rule.

Now, back to the HHS proposed rule. In it, the federal department seeks to establish certain disincentives for healthcare organizations, such as hospitals, as well as for individual practitioners, who have been determined by the OIG to have engaged in information blocking. The OIG is then to refer such organizations and individuals to the Centers for Medicare & Medicaid Services (CMS). Upon receiving a referral, CMS will be empowered to perform the following disciplinary actions:

• Under the Medicare Promoting Interoperability Program, an eligible hospital or critical access hospital (CAH) would be deemed to not be a meaningful electronic health record (EHR) user in an applicable EHR reporting period. The impact on eligible hospitals would be the loss of 75 percent of the annual market basket increase; for CAHs, payment would be reduced to 100 percent of reasonable costs.
• Under the Promoting Interoperability performance category of the Merit-based Incentive Payment System (MIPS), an eligible clinician or medical group would be held to not be a meaningful user of certified EHR technology in a performance period and would therefore receive a zero score in the Promoting Interoperability performance category of MIPS, if required to report on that category. According to the HHS press release on the proposed rule, “The Promoting Interoperability performance category score typically can be a quarter of a clinician or group’s total MIPS score in a year.”
• Under the Medicare Shared Savings Program, a healthcare provider in an Accountable Care Organization (ACO), ACO participant, or ACO provider or supplier would be deemed ineligible to participate in the program for a period of at least one year. This may result in a healthcare provider being removed from an ACO or prevented from joining an ACO.

Of course, HHS is only getting started with these proposed punishments.  The proposed rule includes an appeal to the general healthcare community for additional ideas on disincentives that would apply to those not impacted by the rule as currently proposed. Translation: there may be more disincentives in the final rule or future rulemaking.

Rationale and Response

Obviously, HHS believes it is off to a good start with these proposed provisions. According to HHS Secretary Xavier Becerra:

HHS is committed to developing and implementing policies that discourage information blocking to help people and the health providers they allow to have access to their electronic health information. We are confident the disincentives included in the proposed rule, if finalized, will further increase the appropriate sharing of electronic health information and establish a framework for potential additional disincentives in the future.

To ensure appropriate sharing and the protection of patient privacy and preferences, the information blocking regulations include exceptions, such as the privacy exception.

The proposed rule was published in the Federal Register on November 1, 2023. It remains available for public comment via the Federal Register, but comments must be submitted no later than 11:59 p.m. ET on January 2, 2024.

With best wishes,

Chris Martin
Senior Vice President—BPO

from
https://www.coronishealth.com/blog/discouraging-information-blocking-government-issues-proposed-rule/

CORONIS HEALTH EMPWR Coat Fund

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Empowerment Plan – 10 years of Impact

Life Cycle of an Empowerment Plan Employee

The EMPWR Coat by Empowerment Plan (2023)

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from
https://www.coronishealth.com/blog/coronis-health-empwr-coat-fund/

2024 Final Rule: 340B Drug Resolution

In light of the Supreme Court’s decision in American Hospital Association v. Becerra [142 S. Ct. 1896 (2022)] and the district court’s remand to the responsible federal agency, the Centers for Medicare and Medicaid Services (CMS) issued a final rule outlining the remedy for the invalidated OPPS 340B-acquired drug payment policy for calendar years 2018-2022. CMS published a final rule earlier this month that will act to remedy the payment rates the Court held to be invalid. This final rule will affect nearly all hospitals paid under the Outpatient Prospective Payment System (OPPS).

Background

Section 340B of the Public Health Service Act (hereinafter, “340B”) allows participating hospitals and other providers to purchase certain covered outpatient drugs or biologicals (hereinafter referred to collectively as “drugs”) from manufacturers at discounted prices. Prior to 2018, the Medicare payment rate for Part B covered outpatient drugs provided in outpatient hospitals was generally the statutory default of average sales price (ASP) plus six percent.

In the 2018 OPPS final rule, CMS adjusted the payment rate for 340B drugs to ASP minus 22.5 percent to reflect more accurately the actual costs incurred by 340B hospitals when acquiring 340B drugs. This rate applied from 2018 through approximately the third quarter of 2022. To comply with statutory budget neutrality requirements under the OPPS, CMS made a corresponding increase to payments to all hospitals (340B hospitals and non-340B hospitals) for non-drug items and services, which was in effect from 2018 through 2022.

Before the Bar

Here is a brief review of recent court decisions and subsequent rulemaking that led to the most recent final rule:

• On June 15, 2022, the Supreme Court unanimously ruled that the differential payment rates for 340B-acquired drugs were unlawful because, prior to implementing the rates, the U.S. Department of Health and Human Services (HHS) failed to conduct a survey of hospitals’ acquisition costs under the relevant statute. 
• On September 28, 2022, the U.S. District Court for the District of Columbia vacated the differential payment rates for 340B-acquired drugs going forward. As a result, all 2022 claims for 340B-acquired drugs paid on or after September 28, 2022 were paid at the default rate (generally ASP plus six percent).
• In the 2023 OPPS final rule, CMS finalized a general payment rate of ASP plus six percent for drugs acquired through the 340B Program, consistent with the agency’s policy for drugs not acquired through the 340B program.
• As required by statute, CMS implemented a 3.09 percent reduction to the payment rates for non-drug items and services to achieve budget neutrality for the 340B drug payment rate change for 2023. This budget neutrality change ensured the 2023 OPPS conversion factor was equivalent to the conversion factor that would have been in place had the 340B drug payment policy never been implemented.

Provisions of Final Rule

Lump Sum Payments

An additional payment will be made to affected providers for 340B-acquired drugs as a one-time lump sum payment. Based on monies paid and still owed in connection with the program, CMS is making a one-time lump-sum payment to each 340B-covered entity hospital that was paid less due to the now-invalidated policy. The final rule contains the calculations of the amounts owed to each of the approximately 1,700 affected 340B covered entity hospitals.

Beneficiary Copayments

Beneficiary copayments make up approximately 20 percent of the payments affected 340B covered entity hospitals did not receive due to the 340B payment policy. Because CMS is structuring the remedy as a lump-sum remedy payment, providers are not able to bill beneficiaries for that cost sharing. To account for this, and to ensure that affected 340B providers are put in as close to the same position as if the 340B payment policy had never existed, Medicare is accounting for beneficiary cost sharing within the one-time lump sum payment to affected hospitals. Consequently, affected 340B covered entity hospitals may not bill beneficiaries for coinsurance on remedy payments.

Prospective Offset for Higher Payments for Non-Drug Items

Because CMS is now making additional payments to affected 340B covered entity hospitals to pay them what they would have been paid had the 340B policy never been implemented, CMS is making a corresponding offset to maintain budget neutrality as if the 340B payment policy had never been in effect. To carry out this required $7.8 billion budget neutrality adjustment, CMS will reduce future non-drug item and service payments by adjusting the OPPS conversion factor by minus 0.5 percent starting in 2026. CMS is finalizing for the prospective offset to start for 2026. CMS will continue this adjustment until the full $7.8 billion is offset, which CMS estimates to be 16 years.

For Medicare Advantage payment, more information is in the Hospital Outpatient Prospective Payment System Update on Payment Rates for Drugs Acquired through the 340B Program – Informational for MAOs memorandum that was issued by CMS on December 20, 2022.

New Providers

CMS is finalizing that providers that did not enroll in Medicare until after January 1, 2018, and thus did not fully benefit from the increased payment for non-drug items and services from 2018 through 2022, are excluded from the prospective rate reduction.

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For a fuller summary of the 340B Drug final rule, please click on the following CMS link: Hospital Outpatient Prospective Payment System (OPPS): Remedy for the 340B-Acquired Drug Payment Policy for Calendar Years 2018-2022 Final Rule (CMS 1793-F) | CMS.

With best wishes,

Chris Martin
Senior Vice President—BPO

from
https://www.coronishealth.com/blog/2024-final-rule-340b-drug-resolution/