This past November 16 CMS published the agency's final 2018 MACRA (Medicare Access and CHIP Reauthorization Act) rule (at 661 federal register pages). MACRA, authorized in 2015, formulates how approximately 1.5 million Medicare Part B physicians and other eligible clinicians are reimbursed. Annual MACRA proposed and final rule making is closely monitored since the law's MIPS (Merit-Based Incentive Payment System) and Advanced Payment Model (APM) pathway are the two formulas CMS uses to annually update Fee for Service Medicare Spending (Part A and Part B) and how eligible clinicians under Medicare Advantage (Part C) can participate in MACRA's payment updates or rewards.
During this 24 minute conversation Ms. O'Brien discusses the MIPS two threshold exclusions, MIPS quality and cost components, the composite performance score (CPS), the Advanced APM (AAPM) pathway, the anticipated 2018 Medicare Advantage (MA) AAPM demonstration and criticisms of MACRA implementation, specifically MedPAC's.
Ms. Kristen O'Brien serves as Counsel at the law firm, Olsson, Frank and Weeda (OFW), in their Health Industry and Regulatory Practice. Prior to OFW, she served as Senior Legislative Counsel with the American Medical Association and prior still worked in private practice. Ms. O'Brien's experience also includes serving as professional staff for the Senate Finance Committee under Former Committee Chair, Senator Max Baucus (D-MT), where she worked on health and environmental issues as well as financial reform. Ms. O'Brien received her J.D. cum laude from Georgetown University Law Center and her undergraduate from Cornell University that included study at the London School of Economics.