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a company that specializes in strategic healthcare initiatives such as mergers and acquisitions, management services organizations, private equity, succession planning, physician partnerships, and strategic planning. He can be reached at 

Articles

While analyzing the competition is an essential component of your strategy, most medical practices don't conduct this type of analysis systematically enough.

Are you working on a 2025 strategy?

Ryne Natzke is Chief Revenue Officer at TrustCommerce, a Sphere Company.

Practices have tools at their disposal that can help alleviate some of the problems that women face with health care affordability and access. 

How digital tools can alleviate health care access and affordability issues for women

Your monthly collection of insights from the Physicians Practice Pearls writers is available now!

Physicians Practice digital edition: Best states to practice

Nance Goldstein, MDc, ACC, PhD, partners with physicians as a leadership coach to find ways through today’s tough times and enjoy medicine more.

Her evidence-based work enables physicians to sail through the challenges of influencing others to deliver excellent care. Her clients learn simple, quick ways to lead high quality, thriving care groups – one conversation at a time. She’s an Affiliate Faculty at AriadneLabs (Brigham & Womens Hospital and Harvard’s Chan School of Public Health), as well as a scholar at Brandeis University WSRC. 

https://www.linkedin.com/in/nancegoldstein/

, curates recent research and stories of physicians making medical practice better – leadership that honors their purpose 

 improves their experience of practicing.

Her podcast offers conversations with seasoned women MDs talking about how they navigated the competing demands of practice, family and the rest of life.

She’d like to hear what troubles you in your practice. Email her: 

De-escalating situations and emotions can settle disagreements between staff members.

Messy Moments: Dial down the drama

Healthcare Reform | Physicians Practice offers medical practice news, expert insights on concerns physicians & medical practices face every day.

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 Podcast. In this podcast, we'll aim to bring you some of the most interesting, influential guests in the healthcare industry. If you have any ideas for podcast guests or topics, shoot us an email at 

Between the repeal of the Independent Payment Advisory Board (IPAB) and changes to the Quality Payment Program, it's fair to say the Bipartisan Budget Act of 2018 is a health care bill tucked inside of a budget bill.
In fact, Jennifer McLaughlin, senior associate director of government affairs for the Medical Group Management Association (MGMA), says there is a "laundry list" of items that affects the health care landscape included in the budget agreement (which passed the Senate by a vote of 71–28 and the House of Representatives, 240–186). While the organization is still going over the list, the changes to IPAB and the QPP (better known as MACRA – the Medicare Access and CHIP Reauthorization Act) are the biggest two.

In regards to MACRA, there were "small changes" that have the potential to make a big difference, McLaughlin says. In the QPP's Merit-based Incentive Payment System (MIPS), the Cost category continues to be a source of confusion for physician practices, she notes, because there hasn't been a ton of discourse coming from CMS about how it will be measured over time. The bill gives CMS more time to clarify, test, and develop episode-based cost measures.

"This bill gives the secretary of HHS three additional years before they have to move to full implementation of [Cost]. It also did away with what would have been a new scoring element for Cost in 2018, which was year-over-year improvement," says McLaughlin. The bill ensured that Cost would stay at 10 percent of physicians MIPS score through 2021. Originally, it was slated to go to 30 percent in 2019.

Later in the podcast, McLaughlin talks about the other major changes the Budget Act will enact on physician practices, which includes "the one negative [aspect] of an otherwise favorable bill." She also talks about the major legislative issues MGMA will be focusing on in the near future.

If you have any comments on this article email 

The Budget Act that passed Congress recently included "small changes" to MACRA with the potential to make a big difference, says one expert.

Analyzing Budget Act's Impact on MACRA 

Welcome to the Physicians Practice Pearls Podcast. In this podcast, we'll aim to bring you some of the most interesting, influential guests in the healthcare industry. If you have any ideas for podcast guests or topics, shoot us an email at 

The 2018 reporting year for the CMS Quality Payment Program (QPP) has arrived.

Some categories in the QPP's Merit-based Incentive Payment System (MIPS) pathway are based on full-year reporting, which means physicians eligible for the program cannot hold off on compliance any longer. They must understand the intricacies of this year's requirements, says American Medical Association President, David O. Barbe, MD. For instance, this year, the cost category of MIPS counts, unlike last year.

"[Cost] was 0 percent [of the total MIPS score] in 2017. It's now 10 percent in 2018…that was taken from the quality category, which has gone from 60 percent of the MIPS score to 50 percent," Barbe, who is also a family physician in Mountain Grove, Mo., says on the podcast. While MIPS doesn't have the "pick your pace" flexibility available last year, he says it should be an obtainable plateau for small practices.

"There are opportunities for small practices, including the opportunity to form virtual groups, five bonus points for groups with 15 eligible providers or fewer….there's also favorable scoring in the quality category for small practices."

There are other accommodations for small practices, including the fact that CMS expanded the low-volume threshold for exclusion from MIPS reporting to groups with less than $90,000 in Part B allowed charges or fewer than 200 Part B beneficiaries. All this, Barbe says, makes MACRA ''about as favorable as it can be for small practices."

Later in the podcast, Barbe talks about why it's not a good idea to cut the MIPS program and start over, as the Medicare Payment Advisory Commission has 

. "We believe it's way too soon to abandon the program altogether. We still see opportunities for improvement and will work with CMS on those…but we're not ready to declare this a program that can't work or won't work for doctors or patients," he says.

In this podcast, AMA President David O. Barbe, MD talks about the accommodations that CMS has made towards small practices in MACRA.

AMA Pres: MACRA Has Been Made Favorable for Small Practices

Podcast. In this podcast, we'll aim to bring you some of the most interesting, influential guests in the healthcare industry. If you have any ideas for podcast guests or topics, shoot us an email at 

Pam Minichiello, principal consultant at the Massachusetts eHealth Collaborative (MAeHC), returns to the 

 Pearls podcast to discuss how practices have done in year one of the Medicare Quality Payment Program (QPP) and look ahead to year two.

, Minichiello had an optimistic outlook on how small practices would do in the QPP, more commonly known referred to by the acronym of the law which passed it into existence - the Medicare and CHIP Reauthorization Act (MACRA). One year later, she says the "pick your pace" flexibilities offered in MACRA's Merit-based Incentive Payment System (MIPS) pathway make it hard to thoroughly assess whether or not she still believes this. "It's really just [been] a test year," she noted on the podcast.

In working with small and medium-sized practices through her work at MAeHC, Minichiello did see some difficulties in year one and some encouraging signs. "The overall [advancing care information] portion of MIPS and MACRA align with the Meaningful Use objectives they're used to…That hasn't posed a lot of challenges. Where we are seeing the challenges is with quality data," she said. Quality, as she notes, is 60 percent of a physician's MIPS score in year one and similarly high in year two.

For year two (2018), Minichiello said the 

 should remove any doubts over whether or not CMS is committed to this program. "That final rule proves this is real, you have to consistently work towards this and work pretty aggressively," she said.

Later in the podcast, Minichiello talked about her experience in the field, helping small and medium-sized practices implement the Comprehensive Primary Care Plus (

+) initiative. She explained how CPC+ can help practices succeed in MACRA and provided insight on the difficulties of providing care management for patients of a certain age. 

Due to the "pick your pace" flexibility for year one of the Medicare Quality Payment Program, one expert says it's hard to evaluate how physicians did. 

Hard to Assess Year One of MACRA, Says Expert

. In this podcast, we'll bring you some of the most interesting and influential guests in healthcare. If you have any ideas for podcast guests or topics, email us at 

Last week, Tom Price, MD, resigned from his post as secretary of the U.S. Department of Health and Human Services (HHS) 

amid a scandal about his use of a private charter plane

. Don Wright, MD, the assistant secretary for HHS, was named the acting HHS secretary until the Trump administration nominates a permanent replacement.

With HHS in a state of limbo, what does this mean for Medicare and other programs affecting physicians? 

, Anders Gilberg, vice president of government affairs for the Medical Group Management Association (MGMA), to join us and discuss the ramifications of Price's departure. While Price's popularity among physicians wasn't universal, Gilberg says he understood their issues - especially the programs plaguing those who are in small practices.

"Whether you support or don't support Dr. Price, he practiced as a physician, so he can certainly relate [to physicians]….The fact he had real experience that he brought to his position in Congress as well as HHS was a good thing for physicians. If you set aside some of the more political elements, he was open to hearing what ailed the healthcare system and interested in that impact on physicians and patients," Gilberg says.

On the podcast, Gilberg also grades Price's brief tenure running HHS and outlines what he and MGMA would like to see out of his successor. In particular, he says Price's focus on cutting out administrative burdens on physicians should be a priority for whoever takes over at HHS. 

Gilberg also discusses CMS Administrator Seema Verma's 

 and what it could mean for continuity of important Medicare programs, such as implementation of the Quality Payment Program.

The MGMA’s Anders Gilberg discusses the impact of Tom Price resigning his post at HHS.

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