This week, the North Carolina Court of Appeals ruled in favor of eight physician groups leading a lawsuit against the NC Department of Health and Human Services (NCDHHS) and CSC for damages caused by the NCTracks claims system. CSC, now CSRA, is the state’s contractor responsible for implementing and managing the NCTracks system. This ruling is a positive development in the plaintiffs’ effort to remedy the damages caused by disruptive implementation of the NCTracks in 2013 and 2014.
A trial court dismissed the claims in June 2015 because the doctors had not first appealed their improperly-processed Medicaid claims to NCDHHS or the NC Office of Administrative Hearings (OAH). On appeal, the doctors argued that they were prevented from appealing to NCDHHS or OAH because neither the State nor CSRA had rendered or communicated a final decision or denial as to each claim.
Writing for a 2-1 majority, Judge Valerie Zachary agreed with these arguments, and sent the case back to the trial court for additional proceedings. “We conclude that plaintiffs’ arguments on this issue have merit and that the trial court erred in its analysis[,]” she wrote.
It is not yet known whether the latest ruling will be appealed to the North Carolina Supreme Court or will resume at the trial court level as ordered. Stay tuned to the NCMS Bulletin for updates on this case.
Review the Court of Appeals Opinion here.
The US Department of Health & Human Services (HHS) issued the final rule for the landmark new payment system for Medicare clinicians last Friday, Oct. 14. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program (QPP) is designed to accelerate the health care system’s move toward value-based payment. MACRA replaces the flawed Sustainable Growth Rate (SGR) formula.
“Today, we’re proud to put into action Congress’s bipartisan vision of a Medicare program that rewards clinicians for delivering quality care to their patients,” said HHS Secretary Sylvia M. Burwell. “Designed with input from thousands of clinicians and patients across the country, the new Quality Payment Program will strengthen our health care system for patients, clinicians and the American taxpayer.”
The 2,204-page rule is informed by a months-long listening tour with nearly 100,000 attendees and nearly 4,000 public comments. A common theme in these comments was the need for flexibility, simplicity, and support for small practices. The final policy aims to provide such flexibility, simplicity and support. For instance, the clinicians may now pick one of two pathways depending on what is right pace for them to transition from a fee-for-service health care system to one that uses alternative payment models that reward quality of care over quantity of services. Read the article in the last issue of the NCMS Bulletin to learn more about these options.
With the announcement of the final rule, HHS launched a new Quality Payment Program website, which explains the new program and helps clinicians easily identify the measures most meaningful to their practice or specialty. A service center available by email (QPP@cms.hhs.gov) and phone (1-866-288-8292) will answer questions about the Quality Payment Program.
The Centers for Medicare and Medicaid Services (CMS) will hold a webinar on the final rule next Wednesday, Oct. 26, from 2-3pm. Register for the webinar here. A call with CMS will be held on Tuesday, Nov. 15 from 1:30 to 3 pm. To register or for more information, visit MLN Connects Event Registration. Space may be limited, register early.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ends the sustainable growth rate and moves Medicare closer to a system that pays physicians based on the outcomes that matter to patients. The Quality Payment Program allows clinicians to choose the best way to deliver quality care and to participate based on their practice size, specialty, location, or patient population. During this call, learn about the provisions in the recently released final rule; participants should review the rule prior to the call. A question and answer session will follow the presentation.
In addition to the HHS website mentioned above, a wealth of resources are available through the Centers for Medicare and Medicaid Services (CMS) as well as the American Medical Association. In their initial review of the final rule, the AMA said it appeared many of the concerns expressed by physicians had been addressed in the final rule such as in these key areas:
- Details are provided about the 2017 transition period announced in September. The only physicians who will experience payment penalties in 2019 are those who choose to report no performance data next year, and those who report for at least 90-days will be eligible for positive payment adjustments.
- The low-volume threshold that exempts physicians from all performance reporting has been increased from $10,000 in annual Medicare revenue and less than 100 Medicare patients to $30,000 in revenue or 100 patients. CMS estimates that this change will exempt 32.5 percent of physicians and other clinicians from the program.
- Performance reporting requirements have been further reduced, and the resource use component of the Merit-based Incentive Payment System (MIPS) has been reweighted to zero for 2017.
Here are some valuable resources available to learn more about this important rule and how it may affect your practice in the coming months and years.
- CMS Fact Sheet
- CMS Letter to Clinicians about the Final Rule
- The AMA’s information page including interactive tools to evaluate how your practice may be affected.
- Becker’s Hospital Review’s 10 Things to Know About MACRA Final Rule
HHS will continue to host listening and learning sessions throughout the country, and welcome additional feedback from patients, caregivers, clinicians, health care professionals, Congress and others on how to better achieve the goals. HHS looks forward to feedback on the final rule with comment period and will accept comments until 60 days after the final rule’s release date or December 14, 2016. Learn how to submit a comment on the final rule electronically here.
Watch the NCMS Bulletin for updates and links to more ready resources as well as upcoming educational programs for our members.
The Centers for Medicare & Medicaid Services (CMS) recently announced a new initiative to improve the clinician experience with the Medicare program. The goal of the initiative is to reshape the physician experience by reviewing regulations and policies to minimize administrative tasks and seek other input to improve clinician satisfaction. The initiative will be led by senior physicians within CMS who will report to the Office of the Administrator.
“Physicians and their care teams are the most vital resource a patient has. As we implement the Quality Payment Program under MACRA, we cannot do it without making a sustained, long-term commitment to take a holistic view on the demands on the physician and clinician workforce,” said Andy Slavitt, CMS Acting Administrator. “The new initiative will launch a nationwide effort to work with the clinician community to improve Medicare regulations, policies, and interaction points to address issues and to help get physicians back to the most important thing they do – taking care of patients.”
Slavitt appointed Dr. Shantanu Agrawal to lead the development of this function and implementation, which will cover documentation requirements and existing physician interactions with CMS, among other aspects of provider experiences. To ensure CMS is hearing from physicians on the ground, each of the 10 CMS regional offices will oversee local meetings to take input from physician practices within the next six months and regular meetings thereafter. These local meetings will result in a report with targeted recommendations to the CMS Administrator in 2017. Three of CMS’s regional Chief Medical Officers – Dr. Barbara Connors in Philadelphia, Dr. Ashby Wolfe in San Francisco, and Dr. Richard Wild in Atlanta – have agreed to serve as regional champions of this initiative.
Learn more about the first project in the initiative here.
This week two free workshops were held in Raleigh at the North Carolina Medical Society (NCMS) Center for Leadership in Medicine and in Charlotte to give physicians and practice staff the tools and knowledge needed to survive and thrive in the coming value-based health care era. The shift to value-based reimbursement is being ushered in by the federal MACRA legislation (see previous article). While MACRA focuses on Medicare reimbursement, other payers are already starting to follow the federal government’s lead. Now is the time to learn about what’s ahead.
The ongoing series of workshops is made possible by the federal Practice Transformation Network initiative to help small practices, clinics and critical care hospitals currently unaffiliated with an accountable care organization (ACO) prepare for value-based payments. National Rural Accountable Care Consortium (NRACC) is presenting the workshops in cooperation with their partner Caravan Health.
Dates for the 2017 workshops have been tentatively scheduled for the following dates. Mark your calendar now, and watch the NCMS Bulletin for details on location. Raleigh workshops will be held on Tuesday, April 4; Tuesday, Aug. 4 and Tuesday, Oct. 3. Charlotte area workshops will be held on Wednesday, April 5; Wednesday, Aug. 5 and Wednesday, Oct. 4.
Gradually the flood waters of Hurricane Matthew are receding, but many are still affected by the storm and its aftermath. Over the weekend, state emergency officials shared an overall estimate so far of $1.5 billion in damage to businesses, homes and government buildings from the flooding caused by the hurricane. The death toll is 26 people in the state lost their lives due to the storm.
For those who would like to help, Governor McCrory activated the North Carolina Disaster Relief Fund to support long-term recovery efforts in partnership with the United Way of North Carolina. People or organizations that want to help can visit NCdisasterrelief.org or text NCRecovers to 30306.
For more information about hurricane recovery in your area, call 2-1-1. The latest road conditions can be found by calling 5-1-1 or checking the ReadyNC mobile app. For more details about Hurricane Matthew impacts and relief efforts, go to ReadyNC.org and follow N.C. Emergency Management on Twitter and Facebook for the latest on Hurricane Matthew recovery efforts.
Monetary donations to recognized disaster relief organizations is the fastest, most flexible, and most effective method of assisting. Organizations on the ground know what items and quantities are needed, often buy in bulk with discounts and, if possible, purchase through area businesses which supports economic recovery.
North Carolina Voluntary Organizations Active in Disaster (NCVOAD) is helping to coordinate any needed volunteer efforts. Go to the NCVOAD website to learn more.
For those directly affected by the hurricane who need help – and we’ve heard from several member practices that experienced flooding and have not been able to see patients — four Disaster Recovery Centers (DRCs) opened over the weekend: two in Nash County, one in Harnett County and one in Wilson County. The hours are Sunday, noon to 5 p.m. and Monday-Saturday, 9 a.m. to 7 p.m. DRCs are staffed by representatives from FEMA, North Carolina Emergency Management and the U.S. Small Business Administration. Survivors can get help applying for federal assistance, learn about the types of assistance available, learn about the appeals process and get updates about applications.
Individuals, including homeowners, renters, and business owners, in the designated counties who suffered loss or damages due to Hurricane Matthew may register for assistance online at www.DisasterAssistance.gov, by downloading the FEMA mobile app, or by calling 1-800-621-FEMA (3362). For those who use 711 or Video Relay Service (VRS), the number is also 1-800-621-3362. For people using TTY, the number is 1-800-462-7585. Dial 2-1-1 to speak with a trained call specialist about questions you have regarding Hurricane Matthew; the service is free, confidential and available in any language.
Several North Carolina Medical Society (NCMS) members have reached out to offer assistance to other members in need. If you need help in the aftermath of this natural disaster, please let us know by calling (919-833-3836 x142) or emailing our Solution Center (email@example.com) and we will try to connect you with the available resources.
The North Carolina Medical Society (NCMS) continues to spread the word about Choosing Wisely as part of a grant from the ABIM Foundation, which has enabled the North Carolina Healthcare Quality Alliance (NCHQA) to build a multi-stakeholder alliance including Duke Medicine and Cornerstone Health Care to reduce the use of medical tests and treatments that the Choosing Wisely campaign has identified as overused.
Several Choosing Wisely webinars have been recorded and are available to you to learn more about the campaign and how you may implement it in your practice. Here are the two most recent webinars:
- Engaging Patients about Overuse at the Point of Care with Drs. Reshma Gupta and Chris Moriates
- Choosing Wisely Health System Leaders Webinar with Drs. Peter Yarbrough and Allen Repp
Also, this article from the Journal of General Internal Medicine addresses barriers you may face when trying to implement the Choosing Wisely recommendations: “Perceived Barriers to Implementing Individual Choosing Wisely® Recommendations in Two National Surveys of Primary Care Providers.”
Wilmington Health Access for Teens, a comprehensive primary medical care, mental health, nutrition and prevention services practice for adolescents and young adults ages 11-24, received level 3 patient-centered medical home (PCMH) certification for all four of its sites in Wilmington. This is the highest level of certification.
The practice is part of the North Carolina Medical Society (NCMS) Foundation’s Community Practitioner Program, which offers resources and assistance to individuals through tuition reimbursement and to their practice through consulting help to receive certifications like PCMH.
Wilmington Health Access for Teens has clinics in area high schools and received the highest PCMH designation for its offices at Ashley High School, New Hanover High School and Laney High School as well as its central office on Oleander Drive.
Congratulations to Wilmington Health Access for Teens for this great accomplishment!
The Centers for Disease Control and Prevention (CDC) issued a health advisory regarding non-tuberculous mycobacteria (NTM) infections following exposure to contaminated heater-cooler devices used to warm and cool a patient’s blood during cardiac bypass procedures.
Hospitals or providers caring for patients with confirmed or suspected NTM infections following heart bypass procedures are asked to contact the North Carolina Division of Public Health (NC DPH) at 919-733-3419. All identified cases should also be reported to the U.S. Food and Drug Administration (FDA) via MedWatch here. NC DPH is available to assist facilities should further investigation be necessary.
NC DPH recommends that hospitals performing heart bypass procedures follow CDC and FDA heater-cooler guidance in this CDC Health Advisory. NC DPH will work with facilities that perform cardiac bypass procedures using the implicated devices to encourage notification of potentially exposed patients and adherence to CDC and FDA recommendations.
Recommendations may change as new information becomes available. Additional information is available from CDC and FDA at the following sites:
The Robert Wood Johnson Foundation (RWJF) is seeking exceptional midcareer health professionals and behavioral and social scientists with an interest in health policy to apply for the 2017-2018 Health Policy Fellows program. Since 1973, this non-partisan fellowship offers exclusive, hands-on policy experience with the most influential congressional and executive offices in the nation’s capital.
The fellowship requires a minimum commitment of 12 months in Washington, D.C. Up to six awards of up to $165,000 each will be made in 2017. Application deadline: Nov. 15, 2016.
The new Health Care Leadership and Management (HCLM) class of the North Carolina Medical Society’s (NCMS) Kanof Institute for Physician Leadership embarked on their year-long leadership and management training course last weekend. All 13 participants met at the Rizzo Center at the University of North Carolina-Chapel Hill for two days of education and inspiration.
The HCLM track within the Kanof Institute provides a critical framework for physicians based on economics, finance and leadership development. At the end of their year of training, graduates have the necessary vocabulary for the business realm and are equipped to take on greater leadership positions in their career.
This group’s first session began with a site visit to Duke Connected Care (DCC), an Accountable Care Organization (ACO) in Durham. DCC Executive Medical Director Dev Sangvai, MD, and Senior Medical Director Eugenie Komives, MD explained the physician-led model’s clinical programs and care management including pharmacy programs as well as data collection and analytic support.
On Saturday, the class heard the latest on Health Care Economics from Stuart Altman, PhD, MA, Sol C. Chaikin Professor of National Health Policy, Brandeis University.
Program co-chairs Dr. Sangvai and John Meier, MD, MBA along with NCMS CEO Robert W. Seligson offered remarks. Dr. Meier led several sessions throughout the weekend on finance accounting and corporate finance. Kanof Institute Director Kristina Natt och Dag presented on the topic “Leading Others – Increasing Personal Effectiveness as a Leader.”
Learn more about this and the other tracks of the Kanof Institute for Physician Leadership here.