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The Healthcare Blog - Wed, 05/11/2016 - 19:31
Together, hospital and physician services account for more than half of national health spending. In its 2014 National Health Expenditures estimates, the Centers for Medicare and Medicaid Services’ actuaries make the hospital (nearly $1 trillion) and physician practice (nearly $600 billion) sectors appear to be independent and non-overlapping. This is an optical illusion. Hospitals and physicians are, in day-to-day practice, hopelessly intertwined.
And while power appears to be shifting from physicians to hospitals with the increasing salaried employment of physicians, appearances can be deceiving. This post discusses the economic power balance between hospitals and physician communities, and the policy levers that influence this complex relationship — a relationship that is evolving in a way that could increase financial pressures on both hospitals and the American health system.
Physicians and hospitals must intimately collaborate or care does not get delivered. At the same time, hospitals and physicians directly compete in surgery, imaging, and other ambulatory services. In this relationship of simultaneous competition and interdependency, the borderline between hospitals and physicians is fraught both with economic conflict and moral/legal risk.
Conflict with physicians over contracts, practice prerogatives, and scope of professional practice poses one of the single most significant career threats to hospital administrators. Hospital executive colleagues have commented to us that half or more of their job is “political” — managing the diverse economic interests of their medical staffs. One confessed that there is nothing more dispiriting in his job than fighting with physicians over money.
Hospitals absolutely cannot function without close physician collaboration. Hospitals rely on physicians to admit patients to their facilities, refer to their specialists, and to use their lucrative diagnostic services. These high technology outpatient services represent a significant fraction, some believe well more than half, of hospital profit. Hospitals also cannot grow their market shares or execute any of the new alternative payment methodologies without physician participation.
In turn, hospitals also provide income and security for physicians. This is particularly the case in the frosty northern tier of the US where the economic foundation of private medical practice is increasingly not load bearing. Seeking income security appears to be the principal motivation for many physicians seeking hospital employment. In a recent Jackson survey, more than two-thirds of hospital-employed physicians reported that they initiated the discussions that led to employment.
Historical Divisions Between The Hospital And Physician Spheres
Traditionally, there was a separation between the hospital and physician spheres — a “treaty” imposed by political fiat based on the social and political power of physicians. As Paul Starr documented in his magisterial history, The Social Transformation of American Medicine, physicians expended significant political capital to avoid being captured by the hospital, to maintain both professional autonomy and control over their incomes.
In some states, the physician franchise was explicitly protected by corporate practice of medicine laws which forbade non-physician controlled enterprises from employing physicians. The hospital was intended to function as a “doctors’ workshop,” or a “physicians’ co-operative” in the words of a famous treatise in health services research literature by Mark Pauly and Michael Redisch: an economic entity used by an independent medical community to support its incomes, where physicians could practice their profession free of managerial interference. Physicians set clinical standards and controlled access to the hospital’s services through membership on the medical staff, clinical ordering, and, frequently, vendor selection. Professional ethical standards were intended to moderate physician professional conduct and efforts to maximize income.
Power Begins Shifting In The 1990s
In the early 1990s, this physician-enforced independence began to break down. In their health reform plan, the Clinton administration proposed sweeping delivery system reforms designed to merge hospital and physician spheres into integrated delivery networks, known then as “accountable health plans.” These integrated entities would employ physicians, own hospitals, and offer fixed price health services through state-wide purchasing co-operatives to patients on a per capita basis. These new integrated enterprises were modeled on the Kaiser Foundation Health Plans which employed physicians in large medical groups and also owned hospitals, and which marketed themselves exclusively through their captive insurance product.
Even though the Clinton reform initiative collapsed in 1994, the merger and acquisition boom it catalyzed actually accelerated in the following years, resulting in a wave of regional hospital mergers as well as physician practice acquisitions by hospitals. These acquisitions were encouraged in many markets by competitive pressure from for-profit physician practice management firms—such as PhyCor and MedPartners—that were acquiring large multi-specialty physician groups with the intention of contracting directly with health plans. These firms threatened to turn the hospitals into commoditized subcontractors, squeezing both hospital volumes and payment levels.
By 1998, around 70,000 full-time equivalent physicians (and dentists) were employed by hospitals, in addition to roughly 108,000 interns and residents. After the large physician practice management firms collapsed in the late 1990s, cash losses generated by physician employment forced many hospitals to pare back. Practice acquisitions resumed in earnest in 2004 and continued for the next nine years.
By 2013, hospital full-time equivalent employment had grown to more than 122,000, a 74 percent increase since 1998, according to the American Hospital Association — roughly 18 percent of US practicing physicians. This number does not countphysicians in non-profit “foundations,” some of which are hospital-controlled, which may include an additional 6.5 percent of practicing physicians. In 2014, there was almost no further growth in hospital-employed physicians, suggesting that this cycle of expansion may have come to an end.
Some of this renewed hospital activism was driven by explicit strategy in preparing for new generation of integrated delivery models—accountable care organizations (ACOs). In other cases, it was an effort to grow fee-for-service (FFS) market share by acquiring and “realigning” physicians who admitted patients to competing facilities. Hospitals were subjected in particular to intense pressure to employ their local private practicing cardiologists; failure to employ them frequently meant losing their catheterization/imaging volumes and open heart surgery referrals to competing facilities. Private practice cardiology was upended by the 2005 federal Deficit Reduction Act, which markedly reduced Medicare’s office-based imaging payments on which cardiologists had increasingly depended for incremental income.
Lots Of Other Ways Hospitals Supply Physicians Income
Direct employment does not exhaust the means by which hospitals provide physicians with income. Many physicians who are not employed by the hospital contract to provide hospital-based services on a 24/7 basis, e.g. to support hospitals’ emergency and intensive care services. Hospitals are required by the federal Emergency Medical Treatment and Active Labor Act of 1986 (EMTALA) to provide emergency services to patients regardless of their ability to pay, which in turn requires 24/7 physician coverage.
Traditionally, physicians voluntarily provided hospital call coverage for evenings and weekends, in exchange for the hospital granting them admitting privileges. Because an increasing percentage of physicians no longer hospitalized patients or even visited the hospital, this practice no longer met the demands of a 24/7 enterprise. And because community physicians no longer were willing to supervise in-hospital care for their patients, hospitals also needed to hire or contract with physicians to provide in-house medical supervision. Hospital medicine, or “hospitalist” services, has been the most rapidly growing medical specialty in the past 15 years, now numbering more than 44,000 practitioners — roughly equivalent to the number of general internists.
While hospitals often contract with local physician groups for coverage in “hospital-based” disciplines—notably emergency physicians, hospitalists, anesthesiologists, and neonatal and adult intensivists—an increasing percentage of coverage in these disciplines is being provided by billion dollar-plus national firms such as MedNaxand Team Health. However, the highly paid general medical and surgical subspecialties that demand call pay tended to be locally controlled. The “pinch point” sub specialties are: general surgery, cardiology, orthopedics, and neurosurgery.
According to Sullivan Cotter’s 2014 survey, the average daily call pay stipend for orthopedics is around $1,200; the amount for neurosurgery and interventional cardiology exceeds $2,000. These subspecialties have simultaneously experienced a wave of consolidation into large single specialty medical groups. It is not unusual today for all the orthopedic surgeons or neurosurgeons in large communities to practice in a single group.
While the initial impulse for this consolidation may have been to spread fixed practice costs over a larger patient base and to avoid being excluded from health insurers’ specialty panels, a fortuitous byproduct of consolidation is to increase specialists’ bargaining leverage over the local hospital regarding call pay and directorships. These dominant single specialty groups have also shown an unsurprising disinclination to participate in their hospitals’ ACOs, given the fact that reducing specialty use is an inevitable future ACO agenda item. Hospitals have often cited unaffordable call pay demands by private practitioners as a reason why they chose to employ the relevant subspecialists directly, triggering explosive political reactions from what remains of their private staffs.
Hospitals’ Fastest Rising Expense Is Physician Related
By our best estimates, perhaps 10 percent of a typical community hospital budget involves physician subsidies of various kinds. For smaller institutions in economically troubled rural areas, these percentages may be much higher because the hospital has no choice but to employ local physicians to keep them in the community.
Not all physicians focus mainly on income maximization. Many or most are simply too busy seeing patients to maximize the economic returns on their practices. Further, in our experience, medical communities differ markedly in their “mercantile” character. However, with physicians’ incomes squeezed by consumer financial problems, the growth in high deductible health plans, and the relentless press of prior authorization by health insurers, pressuring the local hospital for additional income has become the easiest way for physicians to improve their finances.
With hospitals’ unit price growth at historic lows, physician compensation in all its varieties has become the fastest growing expense in many hospital budgets, forcing managements to cut expenses in other areas. This increased cost of physician subsidies of various kinds comes without compensating revenue. A recent report by Moody’s on hospital financial trends found that while physician employment was an effective strategy for growing hospital and health system revenues, it comes at a price of damaging their operating margins and, by implication, their creditworthiness
Regulatory Constraints On The Hospital Physician Relationships
Two key elements of federal law constrain the ability of physicians and hospitals to exploit one another at patients’ and Medicare’s expense. Under Medicare’s “anti-kickback” statutes, it is illegal for hospitals to offer physicians financial inducements to admit patients to their institutions or to order the hospitals’ services. This prohibition covers such inducements as directorships and practice or medical office rent subsidies and loans. But these prohibitions also extend to the hospital’s paying physicians more than market value for their own services as employees.
In addition to these decades-old prohibitions, the so-called Stark Laws enacted in the early 1990’s (named after longtime Ways and Means health subcommittee chair Pete Stark [D-CA, retired]) prohibit physicians from having an ownership interest in services they order and use. This law was originally intended to curb the practice of physicians “self-referring” patients to imaging or surgical facilities in which they had an ownership interest. But as hospitals created hospital-physician joint ventures for surgical and imaging services during the 1990’s, the Stark laws also acted as a brake on economically abusive partnerships that rebated back to physicians some of the income they generated by using the joint-ventured services. The Stark laws required these transactions to be “commercially reasonable.”
However, the Stark laws are riddled with loopholes (euphemistically termed “safe harbors”), including exceptions for physicians that own an entire hospital (tightened in the ACA in 2010); for group practices which own their own imaging or surgical facilities; and for imaging services located in the same physical office location as a physician practice. Since the government does not provide guidance on fair market value or commercial reasonableness of these arrangements, management (or artful use) of these loopholes has become a vast and lucrative subspecialty in health care law.
Medicare also exerts tremendous influence over where physicians practice by how the program prices ambulatory services. In 2005, for example, in the budget reconciliation law known as the Deficit Reduction Act, Congress dramatically reduced what Medicare paid for freestanding or office-based imaging services compared to rates paid to hospitals for the same services. This triggered the aforementioned surge of cardiologists, whose incomes had become highly dependent on their own office-based imaging revenues from nuclear scans and CT, into hospital employment.
In addition due to Medicare Part B payment policy, hospitals can mark up their employed physicians’ services as “provider based” and can charge technical fees for their services. This in turn enables hospitals to offer some physicians salaries that significantly exceed what they can earn in private practice. These physicians refer patients to the higher-reimbursed hospital ancillaries, whose profits hospitals use to support physician compensation.
The recent (2015) MACRA legislation, which “fixed” the Medicare Part B Sustainable Growth Rate (SGR) problem, appeared to correct this payment anomaly, i.e., that physician services are worth more to Medicare in hospital employment than in private practice. In reality, however much protesting hospital representatives did during the negotiations, what MACRA actually did was grandfather in most of the existing payment differentials while reducing some payments for hospital ambulatory services provided more than 200 yards from the main hospital campus.
Policy Goals Do Not Align With Reality In The Hospital/Physician Nexus
The movement of formerly FFS-based private practitioners to hospital salaried employment is conceptually appealing to policymakers because it seemingly dilutes physicians’ incentive to render more services than patients need, and also offers the potential for better coordinated care. The reality, however, appears to be that salaried employment actually increases health costs.
Market pressures have pushed hospital compensation and practice expenses for some specialties far above what they actually generate in cash collections. Losses in excess of $200,000 per hospital employed physician are not unusual, according to the Medical Group Management Association. Hospitals make up the cash losses on the practices by placing their employed physicians on RVU-based incentive compensation formulae. (RVUs, or relative value units, are Medicare’s billing units for physician services.) These formulae encourage the employed physician to maximize consultative requests for other specialists, as well to use in-house imaging and laboratory services (which are highly profitable to the hospital). In effect, physician care has become a “loss leader” for the hospital’s profitable diagnostic and surgical services.
Whatever the theoretical benefits in improved efficiency or care coordination, a growing body of evidence suggests that hospital employment of physicians increases health costs. Some hospitals have amassed sufficient bargaining leverage with health plans to increase their physician groups’ rates, raising antitrust concernsabout hospital monopolization of local physician markets. Physician employment apparently raises hospital prices and spending over institutions that do not employ physicians (testimony to the success of the RVU compensation models discussed above). Finally, physician employment also appears to raise per capita health spending relative to when hospitals and physicians are nominally separate.
Overall, despite the appearance of increasing hospital influence, the terms of trade between hospitals and physicians actually appear to be deteriorating for hospitals as baby boom physicians retire. Entrepreneurial baby boom physicians who did not wish to be employed by the hospital are being replaced by Millennial physicians heavily burdened by medical school debt, with a revealed preference for significantly shorter work weeks compared to their elders. Many younger physicians also appear disinclined to participate in the system development and medical policymaking required to participate in new payment models like the ACO and bundled payment.
Hospitals have a vital interest in the renewal of the primary care physician base in their communities, a particularly vital one if the community is struggling economically. Yet all over the US, hospitals have become midwives to an expensive intergenerational transition in medicine, perhaps permanently raising their expense base. Due to competitive pressures, hospitals are supplying an increasing percentage of physician income at a time their top line revenues are growing in the low single digits, if at all. This rise in physician expense challenges hospital managers and clinical leaders to improve clinician productivity as well as the quality of their work product.
Goldsmith is national advisor for Navigant and an associate professor of public health sciences at the University of Virginia. Kaufman is an independent health care strategy and physician-hospital consultant. Lawton R. Burns is a professor at Warton. This post first appeared in the Health Affairs blog.
Categories: OIG Advisory Opinions
The Healthcare Blog - Wed, 05/11/2016 - 12:45
It’s a lousy Saturday morning in Southeastern Pennsylvania. The 100-mile bike ride I had scheduled, the first century of the year, was cancelled at 5 AM due to inclement weather. I’ve been scanning my Twitter feed ever since.
I only joined Twitter yesterday, so I’m a bit obsessed at this point. The synapses in my prefrontal cortex are getting fresh hits of dopamine every time I land on another exciting science/political story, journal article, or blog that’s been tweeted about. Yes, I’m a nerd.
Through Twitter, I was introduced to Michel Accad less than 24 hours ago. He’s a cardiologist, philosopher, writer, and creator of the blog “Alert and Oriented”. Over last evening and this morning, I read most of his blog articles as well as a few research papers he has authored. In short, I think he’s a fantastic writer and very intelligent guy but I have to take issue with a recent piece titled “The devolution of evidence-based medicine”. In it, he praises Anish Koka’s recent article on this site titled, “In defense of small data”. I know Anish personally; he is brilliant and paradoxically, he positively covered my own research using big data in another recent article.
Before making my case I need to state that I suspect that Michael, Anish and I agree more than we disagree. Also, I believe that to be an “expert” in EBM (if that’s even a desirable thing), one must fully appreciate its limitations. In reading their prior arguments I do believe Michael and Anish would qualify as experts; however, to me, their arguments come dangerously close to the idiomatic expression “throwing the baby out with the bathwater” and seem to favor the return of “eminence-based medicine” of yesteryear. While I think it’s healthy to point out EBMs limitations and even to recognize that it’s been hijacked by various interests as John Ioannidis argues in a recent commentary we must not lose all perspective.
Since Michel Accad and I are both enthusiasts of Austrian economics I thought it best to defend EBM from a Hayekian perspective. This may seem counterintuitive because Austrian economics is against central planning and to some extent, EBM seems like a well-orchestrated, centrally-planned cabal designed to rob average physicians of their “ability to think, judge, and reason for [themselves]” in Accad’s words. In fact, I share that view and argued it in an article I wrote for Mises Daily in 2011. But at the same time, we need to appreciate EBM, with all its shortcomings, and here’s my Austrian economist spin on it. [Disclaimer: Mises, Hayek, Rothbard or any other prominent Austrian economist never discussed this, so I’m taking liberty]
The primary concern of economics is to understand the factors that determine the production, distribution and consumption of goods within society. Without describing the various schools, Austrians believe the best social order arises spontaneously through the mechanism of prices in an un-fettered capitalist system, you could call them radical capitalists and no, not like Donald Rumsfeld, Dick Cheney, Alan Greenspan or any other right wing figure universally loathed by the left.
In The Use of Knowledge in Society (1945) F.A. Hayek explained how prices communicate information. To state his theory in an over-simplistic way: there is a lot of knowledge out in the economy (this is sometimes referred to as the knowledge problem) and there is no way to collate all of it into a single place or central body and thus, economic calculation or central planning will usually fail to achieve its desired ends. Better economic order arises based on information from price signals. Only prices can communicate what is ultimately valuable to consumers and entrepreneurs. Value roughly equates to truth and in the Austrian economic sense it is an unequivocally subjective property. Thus, prices serve to share and synchronize local and personal knowledge and values, allowing society’s members to achieve diverse and complex ends through a principle of spontaneous organization.
Take my road bike for example, which is sitting idle in the bed of my truck. I paid a lot for it, even more for the carbon wheels; most would say I’m crazy. But I love to ride, and even more, I love to ride fast. I’ve had a handful of road bikes in my life, each one more expensive than the last. And I’m not alone; the small band of guys I ride with all have bikes equally or more expensive than my own. How did this boutique bike market come to be? Making one of these marvelous machines is incredibly complex; for a simpler example that underscores my point, I recommend reading “I, Pencil” by Leonard Reed.
How does any of this apply to medicine?
Like the economy, the human body is a complex system composed of 100 trillion individual cells – the number of chemical reactions occurring at any one time is too numerous to count and furthermore, each human being is different. Its complexity multiplied hundreds of billions of times. Like the knowledge problem that exists in economics; the same could be applied to the complexity of managing disease and preventing illness. In a recent journal article, Saurabh Jah did a nice job addressing medicine’s information problem and its application to overdiagnosis.
However, this doesn’t mean we can’t arrive at truth when it comes to managing disease or preventing illness but it means that arriving at the truth is not a simple process. And while prices enable us to arrive at some rough level of truth in the economy; outcomes allow us to arrive at a rough level of truth in medicine. By outcomes, I am referring to meaningful, patient-level outcomes in response to an intervention collected as part of a well conducted clinical trial, where attempts are made to limit biases as much as possible. This is clinical science or population science, it’s not Newtonian physics as has been pointed out, but I reject the notion that there’s anything “soft” about it either.
Other forms of research serve a useful purpose for generating testable hypotheses but alone, are insufficient for promoting new interventions. The medical community has been fooled too many times and based on the work of people like Vinay Prasad and Adam Cifu it is reasonable to estimate that the majority of what clinicians do in practice may be simply incorrect. Yes, it’s a tough pill to swallow but we have to get over it. In my own field of cardiology, examples abound.
Arguing for a return to small data and physician judgment based on personal experience is, in my opinion, the worst thing we could be promoting. Human judgement (even that of physicians) is too frail and susceptible to cognitive biases such as confirmation, misattribution, overconfidence and illusion of control to simply concede that EBM is a lost cause and we should return to the days of common sense and physicians’ applying their idiosyncratic judgments or those of so-called experts in the field. Many, if not all, medical reversals made good sense. PVC suppression with antiarrhythmics in post-MI patients is a classic example.
In the 1980’s there was a plethora of observational research showing that in patients who had suffered a major heart attack, premature ventricular contractions (PVCs) were associated with an increased risk of sudden cardiac death. Thus, it was reasoned that suppressing PVCs, through the use of antiarrhythmic medications, would prevent the development of a full blown ventricular arrhythmia leading to sudden cardiac death. Patients who had suffered a heart attack and were found to have asymptomatic PVCs would be given a trial of an antiarrhythmic drug and followed with the use of a 24-hour continuous cardiac monitor to see whether the drug significantly suppressed the PVCs. If it did, the patient would be maintained on the drug; if not, more drugs would be tried until one was found that worked.
Against this backdrop, the Cardiac Arrhythmia Suppression Trial (CAST) was undertaken to test the hypothesis that PVC suppression would reduce the risk of sudden cardiac death compared with placebo. As of March 30, 1989, 2309 patients had been recruited for the initial drug-titration phase of the study. In this phase, all patients were given antiarrhythmic therapy but only those who had adequate PVC suppression were then randomized to receive active drug or placebo. 1727 out of 2309 patents (75%) had initial suppression of their arrhythmia and were randomized. During an average of 10 months of follow-up, the patients treated with active drug had a significantly higher rate of death than the patients assigned to placebo (7.7% vs. 3.0%). This means that for every 21 patients treated with an antiarrhythmic medication, 1 additional death was caused. The results from CAST suggest that either PVCs are not on the causal pathway of sudden cardiac death or that the negative effects of treatment with antiarrhythmic drugs far outweigh the benefits of PVC suppression. It is estimated that 50,000 Americans died due to this practice and millions more would have if not for this clinical trial.
This doesn’t mean that clinical trials are beyond reproach. We should critique and even criticize them as John Mandrola does so well in his regular Medscape columns.
We should point out when an effect size is small and question whether it has meaning in clinical practice.
We should be critical in evaluating the harms of an intervention and realistic in expecting that harms in the real world will exceed those in the sterile settings of a clinical trial.
We should encourage data sharing since the epitome of good science lies in being able to replicate its findings.
We should point out when a meta-analysis is simply a case of garbage-in-garbage-out.
We should consider the biases of authors and funding sources because while bias is, in many cases, unavoidable that doesn’t mean it should be ignored.
We should call out “guideline-tyranny” when recommendations are based on low to mid-level evidence and the writing committee is full of conflicted members.
We should fight senseless pay-for-performance measures which are a bastardization of EBM and encourage overtreatment in some cases and potentiate patient harm.
We should also encourage observational research, big and small, to generate hypotheses and allow a platform for medical students, house staff, fellows, and junior attendings to participate in the research process.
We should do all these things but we should not even entertain the idea of abandoning EBM. Nor should we advocate for cookbook medicine either. The best approach combines EBM with well-informed physician judgment. Shared-decision making requires physicians have a good command of EBM and the ability to relay information on benefits and risks to the patient sitting in front of them. I would argue that if, as a physician, you cannot provide the NNT and NNH for a given intervention because either you don’ know it or because insufficient evidence exists to calculate it, then recommending it should give you serious pause. It would be impossible to have this information without EBM – we’d still be in the medical stone ages.
Andrew Foy is an academic cardiologist who is taking up blogging, again, for the instant gratification it brings while his real research is under peer-review. His Twitter account is @AndrewFoy82.
Categories: OIG Advisory Opinions
The Healthcare Blog - Wed, 05/11/2016 - 12:16
CMS recently unveiled a massive regulatory overhaul of Medicaid managed care requirements. Despite the fact that it’s being called a “mega-reg,” and taking some heat for its 1400+ page size, there’s certainly some interesting reading contained within, particularly for the telehealth community.
It’s all about network adequacy standards.
Health plans are regulated by states or CMS and measured based on their ability to demonstrate the adequacy of their in-network providers. How many are there? What’s the availability by specialty? Do consumers understand which providers are in-network? What does access look like in terms of wait times and distance? Answering these questions are the key to meeting the standard.
Historically, CMS adequacy measurements have not allowed for telehealth to meet these criteria. The telehealth world is still somewhat nascent, particularly in terms of CMS policy evolution, and inherently, the geographic mapping tools used to measure adequacy don’t really jibe with the “anywhere, anytime” nature of telehealth.
But, this so called “mega-reg” made the jump none the less, and urged states to consider telemedicine as they create their individual network adequacy standards for private Medicaid plans. This is a first and significant stake in the ground.
Combined with the National Association for Insurance Commissioners model state legislation, which if adopted would formally add telehealth as an acceptable component of meeting adequacy standards, states now have all the tools they need to better serve this high need population through technology.
If network adequacy is truly about ensuring access, transparency, availability, and timeliness, telehealth must be a part of the equation. CMS estimates that approximately 74million Americans will receive care through Medicaid this year. In order to provide sufficient provider access to these millions of patients, states must act and modernize their laws and regulations to take full advantage of the benefits of telehealth.
Kofi Jones is a government affairs specialist for American Well.
Categories: OIG Advisory Opinions
Medical Coding News - Wed, 05/11/2016 - 07:31
CMS’ Medicare Access & CHIP Reauthorization Act of 2015 replaced the current Meaningful Use, Physician Quality Reporting System and Value-Based Payment Modifier this year. Under MACRA, physicians can participate in the Merit-Based Incentive Payment System or the Alternative Payment Models. MIPS consists of a weighted score of quality, resource use, meaningful use and practice improvement […]
The post 6 Strategies for Physicians to Successfully Navigate MIPS appeared first on MedicalCodingNews.Org.
Categories: Healthcare News