Welcome to the new week and your Monday

NCMS Morning Rounds.

Jan. 13, 2020

NCMS Legislative Update

The NC General Assembly will reconvene tomorrow for what is anticipated will be just a couple of days to address several outstanding bills and, perhaps, the state budget. Legislators adjourned last year without overriding the Governor’s veto of their budget bill, so many state programs currently are being funded thanks to legislation that allows funding at the previous budget’s levels.

Without a new budget, money to implement the state’s long-awaited transition to Medicaid managed care, has not been allocated and the NC Department of Health and Human Services (NCDHHS) has suspended implementation until the funding does become available.

We will be closely monitoring all legislative activity this week and will report on any significant action that may impact your practice in this week’s NCMS Morning Rounds and in our Political Pulse video update on Friday.

As noted in your 2020 NCMS calendar (you receive one when you renew your NCMS membership), our Legislative Cabinet will meet this Wednesday evening at the NCMS Center for Leadership in Medicine. NCMS members are welcome to attend any of the meetings listed in the calendar, but times and locations do change, so please call the NCMS (919-833-3836) to confirm the details before the meeting.

Reminder: NC Medical Board’s New Reporting Requirement

Recent changes to the NC Medical Practice Act establish a new requirement for licensees to report to the NC Medical Board (NCMB0 any instances of sexual misconduct or prescribing misconduct by a person licensed by the Board. To assist licensees with fulfilling this obligation, the NCMB has created a new reporting form on the Board’s website.

Specifically, licensees are required to report:
1. Any sexual misconduct by a licensee of the Board
2. Any fraudulent prescribing, drug diversion or theft of controlled substances by a licensee of the Board.

Medical professionals need not have definitive evidence of misconduct to make a report. The law specifies that licensed medical professionals should submit a report if they “reasonably believe” that misconduct has occurred. Licensees who report suspected misconduct in good faith are granted civil immunity.

The NCMB has developed FAQs on the new reporting requirement and a resource page to help in understanding and complying with the requirement.

Medicare Payment Bonuses Widespread But Modest

The Centers for Medicare and Medicaid Services (CMS) recently reported that 98 percent of the eligible clinicians who participated in the 2018 Merit-based Incentive Payments System (MIPS), part of the Quality Payment Program implemented back in 2015 when Congress passed the Medicare Access and CHIP Reauthorization Act or MACRA, will receive a positive payment adjustment this year.

For the 2018 performance year, CMS reports:
• 98 percent of eligible clinicians participating in MIPS will receive a positive payment adjustment in 2020.
• 97 percent of eligible clinicians in rural practices will receive a positive payment adjustment, compared to 93 percent in 2017. For small practices, 84 percent of eligible clinicians received a positive payment adjustment, an increase from 74 percent in 2017.

CMS also notes that positive payment adjustment will remain modest in part because, under the MACRA law, the positive and negative payment adjustments must be budget neutral. This means that the funds available for positive payment adjustments are limited to the estimated decrease in payments resulting from the negative payment adjustments. But because the thresholds have been lower, many providers have qualified.

As the program matures, CMS expects the increases in the performance thresholds in future program years will create a smaller distribution of positive payment adjustments for high performing clinicians who continue to invest in improving quality and outcomes for beneficiaries and positive adjustments will increase. However, it’s also important to note that Congress provided $500 million for the first six years of the law to fund additional adjustments for exceptional performance. These adjustments are not budget neutral, allowing exceptional performers to achieve higher positive adjustments.

For those clinicians who will receive negative payment adjustments, CMS promised to continue to try to reduce reporting complexity and burden, encourage meaningful participation and improve patient outcomes. CMS also reiterated its commitment to providing technical assistance to solo practitioners, small practices and clinicians in rural areas through the no-cost Small, Underserved, and Rural Support initiative.

For more information review the 2020 MIPS Payment Adjustment Fact Sheet for more details and answers to frequently asked questions.

Here is the Advisory Board Forum’s take on the 2018 MIPS results: 98% of MIPS Clinicians Received a Bonus for 2020—But Don’t Expect a Big Payout

In the News

One-on-One With Trump’s Medicare and Medicaid Chief Seema Verma, PBS NewsHour and Kaiser Health News, 1-3-20

Learning Opportunity

Mark your calendar for the 2020 North Carolina Prevention Conference to be held in Raleigh, May 5-6. Registration opens on Feb. 1. The gathering is an opportunity for in the substance use prevention community to learn and collaborate on the latest trends, topics, best practices and community strategies. This year a youth track designed to empower youth and equip adults with the tools to support youth in community change strategies is included. Learn more.