10 Medical Practice Issues to Watch in 2019

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2019 will be another busy year in healthcare. Highlighted below are ten laws and regulations that will be critical for medical practices in the new year.

  1. Participation in voluntary Medicare alternative payment models (APMs) has been relatively static in recent years. Secretary Azar and the Department of Health and Human Services (HHS) are looking to increase participation in risk-based APMs by making performance-based risk a mandatory component of new APMs in 2019.

  2. The Merit-based Incentive Payment System (MIPS) stakes are raised in 2019. MIPS performance determines if clinicians receive a positive or negative payment adjustment of up to 7 percent in the 2021 payment year. For more information on what’s new with MIPS in 2019, see this article: 2019 Quality Payment Program – Final Rule.

  3. HHS has promised to review the Stark Law and Anti-Kickback Statute and other such rules against fraud and abuse. It can be expected that rules to expand exceptions and protect value-based arrangements will be proposed in 2019, though influential reform will likely require the involvement of Congress. These updated rules will benefit providers willing to take performance-based risks.

  4. Legislators will likely continue their efforts to reduce regulatory burdens on medical practices participating in government healthcare programs this year. The “Patients Over Paperwork” initiative by the Centers for Medicare & Medicaid Services exemplifies the intention to increase quality patient-focused care. The promised regulatory relief has been moderate at best, thus far, according to a poll of Medical Group Management Association members. However, this issue remains high priority going into 2019.

  5. Further anticipated efforts for 2019 include those to empower patients by giving them improved access to healthcare cost information. This will reduce the surprise and sticker shock of receiving hospital bills that has received media attention in the past.

  6. The requirements of the 21st Century Cures Act are expected to be met when the Office of the National Coordinator for Health Information Technology (ONC) releases regulations to improve data sharing between healthcare entities. The goal is to develop a framework that allows the movement of data between health information exchange entities. This includes specifications for the use of apps to efficiently and securely move administrative and clinical data between providers and patients via their Electronic Health Records.

  7. HIPAA enforcement is likely to increase audits and fines in 2019. Medical practices are targets for cybersecurity attacks because of the patient, clinical, and financial data they possess. Many times medical practices do not have adequate protection against such attacks. Comprehensive risk assessments highlighting weak areas should be done to protect data. Yeo & Yeo Technology has experience in conducting these Security Risk Assessments (SRAs) for healthcare practices. Contact YYTECH with questions or to schedule an SRA for your practice. YYTECH Security Risk Assessment.

  8. Congress is looking to reduce Medicare drug prices in 2019. One proposal seeks to implement a new International Price Index to lower the price of physician-administered drugs in Part B. It also proposes to introduce new vendors to supply drugs to practices and set a flat fee for drug administration cost. CMS would like to increase the flexibility of Part D drug plans to negotiate prices in protected classes.

  9. Continued efforts will be made to equalize Medicare payments for the same services across clinical sites. This policy was expanded in 2018 by reducing payment for clinic visits at hospital outpatient departments. Site-neutral payments are supposed to save patients and the government money as well as increase market competition.

  10. “Medicare for all” was a key platform for many in the 2018 elections. Though it is unlikely that any major health reform bill will be passed soon, universal healthcare will most likely be a point of debate as presidential contenders campaign for the 2020 primaries.

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