Monthly series covering key subjects regarding healthcare business in the USA. This seminar covers: Affordable Care Act section 1557, HIPAA Security, Medicare Payment models and Chronic conditions.
4. MACRA
Alternative Payment System
Categories
Compliance
Security Risk Assessments
Chronic Conditions
Diabetic Care
Weight Loss
ICD 10
5. ACA SECTION 1557
Prohibits discrimination in health care
activities
Race
Color
National origin
Age
Disability, and
Sex
6. ACA SECTION 1557 - APPLICABILITY
Covered Entities
“every health program or activity, any part of which
receives Federal financial assistance or made
available by”
Example: Health care providers, such as physicians’
practices, hospitals, community health centers,
nursing facilities, home health agencies, clinical
laboratories, residential or community-based
treatment facilities, intermediate care facilities for
people with intellectual/developmental disabilities,
hospices, and organ procurement centers
8. ACA SECTION 1557 - ACTIONS
Immediate
Develop and implement an effective written
language access plan.
Provide free, accurate, and timely language
assistance services for individuals with Limited
English Proficiency (LEP).
Post a notice regarding non-discrimination policies.
Provide non-discrimination notice in English and
include taglines in the top 15 languages spoken by
individuals with LEP within the state.
If less than 15 employees just the top 2 languages other
than English
9. ACA SECTION 1557 – TAG LINE
English
[Name of covered entity] complies with applicable Federal civil
rights laws and does not discriminate on the basis of race,
color, national origin, age, disability, or sex.
Spanish (Español)
[Name of coveredentity] cumple con las leyes federales de
derechos civiles aplicables y no discrimina por motivos de
raza, color, nacionalidad, edad, discapacidad o sexo.
French Creole (Haitian Creole)
[Name of covered entity] konfòmaklwasoudwasivil Federal
kiaplikabyo e li pa fèdiskriminasyonsoubazras, koulè,
peyiorijin, laj, enfimiteoswasèks.
10. ACA HEALTH INSURANCE
Average increase is 25 percent
Carriers pulling out of the market
1.4 million people will be lose their plan
11. ACA HEALTH INSURANCE
Risk Corridor completely ineffective
Insurers requested $2.87 billion
Government paid $362 million
17 of 23 approved healthcare cooperatives
folded
3 of the 5 largest insurers have decided to
significantly pull back
United, Aetna and Humana
12. ACA HEALTH INSURANCE – EXPECTED BEHAVIOR
Consumers picking higher deductible plans
or no plans
Employees moving to jobs with health
insurance coverage
Narrow Networks
13. ACA HEALTH INSURANCE - ALTERNATIVES
Increase outreach for self paying customers
Create and nurture networks
Be creative with benefit plans
Life Insurance
Long Term Care
14. MACRA
Merit Based Incentive Payment System
(MIPS)
Modified fee-for-service model
Expected Model for Majority
Alternative Payment System (APM)
15. MACRA – MIPS COMPONENTS
Quality RepAlternative
Payment System
(APM)orting (PQRS)
Resource Use or Cost
(Value-based Modifier)
Advancing Care
Information (MU)
Clinical practice
improvement activities
MIPS
16. MACRA – CHRONIC CONDITIONS
Diabetic Care
Identify Patients
Annual Requirements
Education
Vision
Foot Care
Nutrition
Weight Loss
Documentation
17. MACRA - QUALITY REPORTING BASICS
• 50% in of total MIPS score in 2019, phases down to 30% in 2022
• Full-year reporting period
MIPS weight
• 6 measures required out of 200 available, reported by physicians
• Include one cross-cutting measure, one outcome measure (if outcome
measure not available, substitute with choice of another “high priority”
measure)
• 3 population health measures from former VBM calculated by CMS
administratively via claims (groups of 10 or more only)
Measures
• Each measure worth up to 10 points
• 90 total points for groups >10
• 80 total points for smaller groups (all-cause hospital readmission measure not
applied)
• Distribution of points for each measure based on performance benchmarks
(80% for claims reporting, 90% for registry reporting)
Scoring
• Up to 4 bonus points may be added for reporting on outcome and high priority
measures
• 1 bonus point possible for each measure captured and reported through
CEHRT
• Total bonus points capped at 5% of those used to calculate the quality score
Bonus points
18. MACRA - COMPLIANCE (MEANINGFUL USE)
50 point base score threshold still 100%
Security attestation required
Measures reduced
Exclusions eliminated
Full year reporting
23. RESOURCES
Taino Consultants Inc.
www.tainoconsultants.com
Drdelgado@tainoconsultants.com
Diabetic Centers for excellence
Lavern Dowell
People Helping People
josedelgado@tainoconsultants.com
Stat Medical
Telephone 904-824-4990
www.statmos.com
Vassallo Health Center
Telephone 904-797-7722