Medical Practice Issues to Watch in 2019

Originally published in the January 9, 2019 issue of MGMA’s Washington Connection
Reprinted with permission from MGMA

Medical Practice Issues to Watch in 2019

2019 promises to be another busy year in healthcare. The 2018 midterm elections shifted the balance of power in Washington as Democrats now hold the gavel in the U.S. House of Representatives, creating a divided Congress with the Republican-held Senate. MGMA has identified the following legislative and regulatory issues critical for medical practices in the coming year. We will keep members apprised of key developments in these areas and their impact on medical practices and will continue to advocate for policies that enable practices to thrive in their mission to furnish high-quality, cost-effective patient care.

1. HHS doubles down on risk

Despite an anemic pipeline of new voluntary Medicare alternative payment models (APMs) trickling out of the Department of Health and Human Services (HHS), Secretary Alex Azar is planning a new approach to accelerate participation in risk-based APMs. Forgoing incremental implementation, the Secretary is expected to unveil new mandatory models in 2019 and to emphasize performance-based risk as a necessary component of any new APM.

MGMA strongly supports voluntary participation in APMs when it makes financial sense for individual practices and disagrees with the Secretary that the way to expedite the move to value-based care is to mandate participation. We will continue to advocate for new opportunities for practices to participate in voluntary APMs and for development of more physician-led models.

2. Regulatory relief from government burdens

It is expected that Congress and the Administration will continue to work toward reducing the regulatory burden on medical practices participating in government healthcare programs. The Centers for Medicare & Medicaid Services’ (CMS’) “Patients Over Paperwork” initiative is one such example. However, this has translated into only modest relief for practices thus far, as 88% of MGMA members polled reported an increase in overall regulatory burden last year. MGMA will continue to make regulatory relief a top advocacy priority in 2019. Keep up with our efforts at mgma.com/regrelief.

3. Kicking back the Stark Law

As part of the effort to accelerate payment innovation, HHS leaders pledge to revisit antiquated fraud and abuse rules such as the Stark Law and Anti-Kickback Statute. In 2019, watch for proposed rules that expand exceptions and safe harbors to protect value-based arrangements and benefit providers willing to take on performance-based risk.
While a push to simplify Medicare compliance rules is welcomed, it is likely that congressional intervention will be necessary to achieve meaningful reform. It remains to be seen if Congress will also prioritize this issue in 2019.

4. Surprise! Here is a medical bill you didn’t expect

Medical practices can expect to see a push to curb surprise medical bills, including efforts to empower patients and consumers through improved access to healthcare cost information. The sticker shock of surprise hospital bills continues to make headlines and draw bipartisan attention in Congress, making this issue ripe for legislative action in 2019.

5. A spoonful of new regulations to help drug prices go down

With a new Congress and support from the Administration, reducing Medicare drug prices is on the action list for 2019. For physician-administered drugs, one proposal seeks to curb the price of drugs in Part B by tying prices to a new International Price Index, create new private-sector vendors to supply practices with drugs, and set drug administration cost as a flat fee. CMS is also looking to give Part D drug plans greater flexibility to negotiate drug prices in protected classes.

6. The stakes are higher in MIPS

Implementation of the Merit-based Incentive Payment System (MIPS) continues to ramp up. In 2019, MIPS performance will determine whether clinicians receive a positive or negative payment adjustment of up to 7% on 2021 Medicare reimbursement. Medicare is accelerating cost accountability for MIPS clinicians by increasing the cost component to 15% of the overall MIPS score and introducing episode-based measures. The performance threshold required to avoid a payment penalty also doubles from 15 to 30 points in 2019. With more on the line this year, it is critical that MGMA members prepare their practices for success. Visit mgma.com/macra for helpful resources.

7. Data interoperability a priority for feds

The Office of the National Coordinator for Health Information Technology (ONC) is expected to release regulations to meet requirements of the 21st Century Cures Act and facilitate improved data sharing between healthcare entities. ONC will define and seek to discourage “information blocking,” develop a framework to facilitate data movement between heath information exchange entities, and release specifications for the use of apps to foster data exchange between different providers and between providers and patients. The goal of using apps, a component of MIPS and Stage 3 Meaningful Use, is to permit practices to efficiently and securely move administrative and clinical data via their EHR.

8. Cybersecurity continues to be a top practice concern

Medical practices can be a prime target for phishing and other cybersecurity attacks because they possess valuable information assets (patient clinical and financial data) and often have inadequate cybersecurity protections. HHS’ HIPAA enforcement arm is expected to ramp up audits and fines in 2019. Medical practices should protect both their data and business continuity by completing a comprehensive risk assessment, identifying vulnerable areas of the organization, and taking the steps necessary to mitigate risk. Check out MGMA security resources to prepare your practice this year.

9. Site-of-service payment differentials remain a target

Policymakers will continue the trend toward site-neutral payments with the goal of equalizing Medicare payments for the same services across clinical sites. Medicare expanded this policy through 2018 rulemaking by phasing-in payment reductions for clinic visits at hospital outpatient departments (HOPDs), including HOPDs excepted from previous site-neutral payment rules. In addition to saving money for patients and the government, site-neutral payments are viewed as a policy lever for increasing market competition, eliminating the incentive for hospitals to purchase freestanding clinics and leveling the playing field.

10. “Repeal and replace” is out, “Medicare for all” is in

This shift in power within Congress will recast the role the federal government plays in healthcare in 2019. With “Medicare for all” a key platform for many progressives during the 2018 primaries, the politicized debate over a single-payer health system shows no signs of slowing down and will likely gain steam ahead of 2020 elections.
Passage of any major health reform bill is highly unlikely anytime soon. However, as presidential contenders begin campaigning for the 2020 primaries, universal healthcare will almost certainly become a point of debate.

ACMPE Program Enhancements Start January 1

Special announcement from MGMA

We are pleased to share with you upcoming enhancements to the ACMPE board certification and Fellowship programs.

In our mission to elevate the ACMPE credentials and secure ACMPE designations that continue to demonstrate value in our ever-changing industry, new program enhancements to the ACMPE board certification and Fellowship programs will take effect Jan. 1, 2019.

After thorough review of our ACMPE programs with current and future medical practice leaders, these updates were unveiled at the 2017 MGMA Annual Conference.

We wanted to remind you of these enhancements by highlighting some of the major changes for each of our programs below. You can also find a full overview of the new qualifications by visiting our 2019 board certification enhancement page or 2019 Fellowship enhancement page.

2019 board certification enhancements:

MGMA is introducing two board certification pathways in 2019 to allow candidates who may not yet meet the educational and experience requirements to enter the program for attaining the Certified Medical Practice Executive (CMPE) credential:

  • Pathway One: Applicants must have two years of healthcare experience, hold a bachelor’s degree or 120 hours of college credit, be a current MGMA member and pay the application fee.
  • Pathway Two: Applicants must be a current MGMA member and pay an application fee to be eligible to take the multiple-choice exam. Upon passing, applicants become “board eligible” as they work toward earning a bachelor’s degree or 120 hours of college credit, as well as obtaining two years of healthcare experience. Once the 120 college credit hours and two years of experience is obtained, they are then eligible to take the scenario-based exam.

The ACMPE board eligible classification allows candidates to enter the board certification program even though they may not yet meet the education or experience requirements. Passing the multiple-choice exam allows candidates to show understanding and knowledge of the principles of medical practice administration.

Both pathways require registering for and passing both the multiple choice and the scenario-based exam, as well as earning continuing education credit hours. All applicants after Jan. 1, 2019, will have three years from application date to complete their exams and earn the requisite continuing education hours to become certified.

Program nominee requirements:

If current nominees do NOT hold a bachelor’s degree or have 120 college credit hours by Dec. 31, 2018 and are not obtaining college credit, they will need to:

  • Have passed both examinations.
  • Log all 50 hours of continuing education (CE) hours under the current CE requirements, starting 30 days prior to their acceptance date by June 30, 2019.

2019 Fellowship enhancements:

Education and experience eligibility: To participate in the Fellowship program candidates must either have a Bachelor’s degree AND seven years of healthcare experience, OR a Master’s degree AND five years of healthcare experience. At least two years of this experience must be in a leadership role.

Volunteer hours: Fellows will be required to complete six volunteer hours to showcase commitment to our industry. These hours must include at least three hours from healthcare related opportunities and the remaining can be from general community service.

Business plans: To ensure Fellows are seen as thought leaders within healthcare organizations, program changes focus on demonstrating the ability to execute on dynamic solutions to business problems. Therefore, the professional paper submission will be phased out and replaced with a submission of an innovative business plan. We believe this move will better support our Fellows to concretely demonstrate practical skills to current and potential employers.

Fellowship deadline: Candidates who enter the Fellowship program in 2019 will have two years from their application date to complete their Fellowship requirements.

Continuing education requirements:

Starting Jan. 1, 2019, maintaining ACMPE credentials – CMPE and Fellow of ACMPE – will require 50 hours of continuing education every three years. Of those 50 hours:

  • 30 hours must come from MGMA national, state or local offerings (12 from live learning, such as face-to-face events, live webinars or live teleconferences). 20 hours must come from qualified sources or MGMA that pertain to the medical practice management field.
  • To maintain Fellowship, we will require six hours of volunteering every three years as well.

The role of certification and Fellowship has always been to distinguish skilled leaders who can solve healthcare’s most pressing business challenges, which is why the Commission firmly believes these new changes will create stronger recognition and demand for our designations in the industry.

As we move forward in implementing these changes, we look forward to your support and thank you for continuing to act as advocates for certification and Fellowship.

If you have any questions at all, please feel free to contact the MGMA certification staff at acmpe@mgma.com or call the service center at 877-275-6462 ext. 1888.

Cyber Monday SALE

Save Today at MGMA.com!

The MGMA Cyber Monday sale is today (November 26th)! Visit www.mgma.com to receive 25% off select products, including:

  • Membership and member renewals
  • ACMPE Board Certification and Fellowship
  • Select online course and webinars
  • and so much more…

Dems take the House in 2018 midterms: What’s next for healthcare

Originally published in the November 7, 2018 issue of MGMA’s Washington Connection
Reprinted with permission from MGMA

Following last night’s elections, Democrats won the U.S. House of Representatives for the first time since 2010, while Republicans will likely increase their numbers and maintain control of the Senate. Healthcare issues dominated the campaign cycle, yet it remains to be seen what role healthcare will play in agenda-setting for the upcoming Congress. One issue now unlikely to advance on the legislative front is the repeal of the Affordable Care Act (ACA). Democrats have solidified their ability to block any ACA repeal bill, and Republican leaders appear open to supporting aspects of the ACA such as protections for pre-existing conditions.

The Democratic victory in the House means new leaders will chair key committees overseeing health policy. Nancy Pelosi (D-Calif.) is expected to reclaim her role as Speaker of the House and has promised to make drug pricing a priority for the next Congress. The Trump administration has similarly prioritized this issue, but it is unclear whether leaders from the administration and Senate will work together with House leadership on their shared priority to lower drug costs.

New ACMPE Study Group for Test or Retest in December

For those of you who tested for board certification in September and will need to retest for one or both parts of the test in December, MGMA has created a special pilot study group session “to ensure we are being transparent of what is on our current exams, and see if laying out the main topics will help the examinee.” This study group session is not yet available on the website. Anyone preparing for December testing is invited to attend.If you’d like to be added to the roster to participate in the pilot study group, please email me at mtorak@gapgi.com and I will forward your information to MGMA. Don’t give up!

And here is some additional information about achieving certification or fellowship:

MGMA Website Updates
  • MGMA has launched the new website and they are working daily to optimize the user experience.
  • The ACMPE claiming of continuing education has been launched under “Account Management.” New features will continue to be added including export and transcript details.
  • Information on Board Certification and Fellowship can be found under “Career Pathways.”
What the 2019 Changes Mean:
For Nominees:

If you do NOT hold a bachelor’s degree or have 120 college credit hours by Dec. 31, 2018 you will need to:

  • Complete and pass both examinations by the Dec. 1-15 exam cycle. Registration is open now through 11/6/18!
  • Log all 50 hours of continuing education (CE) hours under the current CE requirements, starting 30 days prior to their acceptance date. If your exams are passed, you will receive a 6 months extension to complete your 50 hours by June 31, 2019 under the 2019 continuing education requirements.

If you have a bachelor’s degree, 120 college credits or are currently in the process of completing your degree, you will remain as a nominee and will need to begin working toward the following starting on Jan. 1, 2019:

  • Earn your CMPE credential within three years. If accepted before Jan. 1, 2019, you will have until Dec. 31, 2021 to complete the program.
  • Log 50 hours of CE credit under the new 2019 CE requirements.
For CMPEs pursuing Fellowship:

If you do NOT hold a bachelor’s degree by Dec. 31, 2018 you will need to:

  • Receive approval on a business plan proposal or paper outline AND submit a final business plan or manuscript by Dec. 31, 2018.

If you have a bachelor’s degree AND seven years of healthcare management AND two years in a leadership role; OR if you have a master’s degree with five years management, AND two years in a leadership role, you will need to begin work on the following starting Jan. 1, 2019:

  • Complete Fellowship within two years of your application date. If accepted before Jan. 1, 2019, you will have until Dec. 31, 2020 to complete.
  • If you have a paper outline submitted and accepted prior to Jan. 1, 2019, you may continue working on your paper manuscript up until two years from your outline approval date. Starting in 2019, business plan submissions will be the only acceptable submission if no outline is previously accepted.
  • Log 50 hours of continuing education (CE) every three years following the new 2019 CE requirements. These CE requirements also apply to maintain your current CMPE credential in 2019.
Incentives to join MGMA-ACMPE:
Offering ACMPE credit for state educational programs:

For an activity to meet the criteria for ACMPE continuing education credit hours, it must:

  • Be relevant to the Body of Knowledge for Medical Practice Management
  • Be delivered in a structured learning environment
  • Have an element of interactivity
Study Groups:
  • Fellowship Preparation Series is available on-demand presented by Lee Ann H. Webster, FACMPE and Nina Chavez, FACMPE.
    • Session 1 – ACMPE Fellowship: Requirements and the Submission Process
    • Session 2 – Developing a Fellowship Manuscript or Business Plan
  • ACMPE Board Certification Study Group Series
    • Registration is open for on-demand, For CE credit, you must also register for the post assessments for each session.Topic:
      • Board Certification Program Overview
      • Financial Management
      • Operations Management
      • Risk and Compliance Management
      • Human Resources Management
      • Organizational Governance and Patient-Centered Care
2019 Continuing Education Criteria:

To become board certified:

  • Earn 50 continuing education (CE) credit hours
    • 30 hours from MGMA resources
      • 12 hours required from MGMA national/state/local chapter face-to-face events
    • 20 additional hours from qualified sources

To maintain your CMPE/FACMPE credential:

  • Earn 50 continuing education (CE) credit hours every 3 years
    • 30 hours from MGMA resources
      • 12 hours required from MGMA national/state/local chapter face-to-face events
    • 20 additional hours from qualified sources

Tell Your Congressperson to Co-sign CMS Med Advantage Prior Authorization Guidance Letter

Prior authorization in Medicare Advantage plans continue to burden medical practices with unnecessary paperwork and place barriers to care for Medicare patients. This issue has gotten the attention of two physician members of congress, Reps. David Roe, MD (R-TN) and Ami Bera, MD (D-CA), who have drafted the attached letter to provide guidance and support to CMS for improving the system of prior authorization used by Medicare Advantage plans.

The MGMA Government Affairs office is encouraging you to contact the district offices of your representatives to request that they co-sign this letter. Time should be given to helping representatives, and importantly their staff, understand the pain points surrounding prior authorization for medical groups. As such, here are some helpful talking points that you could use when speaking to staff (but real life, concrete examples on how this issue impacts your practice are best!):

  • As a medical practice leader, I regularly see the real-world impact on patients who encounter barriers to timely care that are caused by onerous and often unnecessary prior authorization requirements. Not only do these requirements delay care, they are often approved because Medicare Advantage plans are ultimately required to provide equivalent coverage to fee-for-service Medicare, which generally does not require pre-approval for services. Therefore, plans are precluded from using prior authorization to inhibit access to services.
  • As a member of the Medical Group Management Association, and one of your constituents, I urge you sign-on to this letter and show support for reducing needless prior authorization requirements that interfere with a patient’s care.

The attached letter is planned to be delivered to CMS in September and it is paramount that it be delivered with wide support. Please also remember to make use of the Legislative Liaison Member Community to continue this advocacy discussion. As always, I and the rest of the MGMA Government Affairs team are happy to discuss more with you the contents of the letter and the issue of prior authorization within Medicare Advantage. Please do not hesitate to reach out at any time with questions.

Warmly,

Mollie Gelburg
Associate Director, Government Affairs
MGMA
1717 Pennsylvania Ave NW #600
Washington, DC 20006
202.293.3450
mgelburd@mgma.org

The Next Tennessee ACMPE Study Group Begins the Week of July 30th

Attention ALL ACMPE Nominees!
Need help studying? You are not alone.

Tennessee ACMPE Study Group

The Tennessee ACMPE Study Group begins the week of July 30th and there’s still time to be a part of this great ACMPE Certification prep resource! The Tennessee ACMPE Study Group is a self-paced online study group through the MGMA Member Community. It’s open to anyone studying for the MGMA Board Certification Exams.

To sign up today:

  • Log in to www.mgma.com and click “My Dashboard”
  • Click “My Networks”
  • Click “My Communities – All Communities”
  • Search for “Tennessee ACMPE Study Group”
  • Click “Join”

Here’s the schedule the study group will follow:

  • Week of July 30 – Operations Management
  • Week of August 6 – Financial Management
  • Week of August 13 – Human Resources Management
  • Week of August 20 – Organizational Governance
  • Week of August 27 – Patient Centered Care
  • Week of September 3 – Risk and Compliance Management and Review

Special note: The criteria for board certification are changing. Starting January 1, 2019, a bachelor’s degree or 120 college credit hours will be required to qualify as an applicant for ACMPE Certification, along with two years in a healthcare management position with six months in a supervisory role.

About the Examinations

To become board certified through the ACMPE, members must meet the qualifications, apply and complete two exams. Examinations may be completed once an applicant has been accepted into the program.

Exam Dates

  • Sept. 8-22, 2018 (Registration: July 23-Aug. 7, 2018)
  • Dec. 1-15, 2018 (Registration: Oct. 22-Nov. 6, 2018)

The exams can be taken during the same exam cycle or separately, but you must register for each exam individually. These exams can be completed in the order that works for you.

Testing Formats Include

  • Multiple choice: A 175-item test taken within three hours and 15 minutes. This exam assesses your knowledge of group practice management principles and practices as described in the Body of Knowledge for Medical Practice Management. Registration fee: $165 
  • Scenario: A two-hour test with 90 items of multi-select, multiple choice, short answer, or drag and drop questions pertaining to 18-25 practice administration scenarios. This exam assesses in-depth knowledge of medical practice management principles and issues, problem-solving and decision-making skills. Registration fee: $165 

Questions

If you have any questions, please contact your North Carolina ACMPE Forum Rep, Michelle Wallace Torak, at mtorak@gapgi.com or call MGMA toll-free at 877.275-6462, ext. 1888.