Are you ready for MACRA? If not, you're not alone. According to the Deloitte Center for Health Solutions 2016 Survey of U.S. Physicians, 50 percent of physicians surveyed say they have never heard of the law, and 32 percent recognize it by name but are not familiar with its requirements. Those responses are alarming, and mean providers are going to need help.

For those who do not know about MACRA: it is the Centers for Medicare & Medicaid Services (CMS) Medicare Access and CHIP Reauthorization Act of 2015. MACRA is a Medicare payment law intended to drive healthcare payment and delivery system reform for clinicians, health systems, Medicare, and other government and commercial payers. MACRA is intended to create a path toward a new Medicare payment system that will more closely align payment with quality and outcomes. It offers financial incentives for healthcare professionals to participate in risk-bearing, coordinated care models and moves away from the traditional fee-for-service system. Providers participating under the Medicare fee schedule will generally choose between participating in Alternative Payment Models (APMs) or receiving payment based on individual performance under the Merit-Based Incentive Payment System (MIPS).

Since quality is the primary driver under MACRA, providers will need to begin reporting quality measures through participation in either MIPS or APMs. Though many providers are concerned about MACRA, especially smaller practices that don't have the resources that may be required for MACRA, some good news arrived in September when the CMS announced that it is offering more flexibility for implementation. Providers can "Pick Your Pace" by selecting one of four tracks for 2017 implementation, with the understanding that participation at any level would avoid a negative adjustment.

As you look ahead at preparing for MACRA, a few tips to consider:

Leverage comparative data to create meaningful benchmarks to accurately prioritize business initiatives.

Stay informed of what professional associations and others are doing to help providers.

Bottom line: Staying apprised of all-things MACRA, taking advantage of tools, data and other information will help as you prepare your practice for this change.

For more information on this important, upcoming change follow:

NCDS is prepared to assist you make the transition to MACRA. Contact Nicolette Jordan at 888-876-8833 ext. 43 or to initiate your MACRA Action Plan today!


Aetna (AET.N) and Humana (HUM.N) would consider all available options for their proposed $34 billion merger, the two U.S. health insurers said on Tuesday, a day after a court ruled against the deal due to fears it would lower competition.

The deal would "substantially lessen competition" in the sale of Medicare Advantage plans in 364 counties in 21 U.S. states and on the Obamacare exchange in three Florida counties, the U.S. District Court for the District of Columbia ruled on Monday.

"We continue to believe a combined company will create access to higher-quality and more affordable care, and deliver a better overall experience for those we serve," Aetna Chief Executive Officer Mark Bertolini and Humana Chief Executive Offer Bruce Broussard said in a joint statement on Tuesday.

Aetna spokesman T.J. Crawford said on Monday that the company was considering whether to appeal the court's ruling.

Analysts, however, do not expect an appeal to be successful.

Leerink Partners analyst Ana Gupte said an appeal was unlikely to pass muster under the Trump Administration.

"We see the new Trump Administration as focused on deregulation and driving down prices through competitive intensity in Medicare Advantage," Gupte said in a client note.

The court ruling also casts doubt on Anthem Inc's (ANTM.N) proposed $54 billion deal to buy fellow health insurer Cigna Corp (CI.N).

The U.S. Justice Department filed a lawsuit last July to block the two deals, arguing they would lead to higher prices. A court ruling on the Anthem-Cigna deal is pending.

Analysts believe it is unlikely that Humana would extend the deadline to close the merger beyond the agreed date of Feb. 15.

Humana is among the top players in the profitable Medicare Advantage business, which, Gupte said, could attract takeover interest in the company from insurers including Cigna and Anthem.

Aetna's shares were down nearly 2 percent on Tuesday, while Humana dropped 1.5 percent. Anthem and Cigna were up 0.7 percent.

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NCDS Perspective: We reported on this potential merger several months back and NCDS is very pleased to see this outcome. With the new administration blocking this merger we avoid a huge, mega corporation which would take away the competition that drives down prices for patient insurance. The lack of competition, prospect for increased prices, as well as the challenge to provide adequate claims processing for providers and customer service to all of the patients under those two plans were at risk. This legislation is a positive step for both consumers and providers and we look forward to more achievements like this one in 2017!


As 2017 comes, here are some major things to look forward in US healthcare space:


Physicians and payers alike believe MACRA to be transformative, overhauling the way providers will get paid in America. Since this is going to be the first performance year for Merit-Based Incentive Payment System under MACRA, it is important that physicians are educated, aware, and understand the gaps between what they already do, and what MACRA requires them to do.

2. Future of ACA

Repealing and replacing ACA was one of President-elect Donald Trump’s top priorities. However, as the complete repeal of ACA might not be the best idea due to various reasons. Donald Trump after meeting President Obama has taken a soft tone for ACA, but debating is on whether to repeal it or amend it according to GOP’s plan. The fate of Obamacare is still unclear.

3. Healthcare Costs

Predicted medical cost growth rate is estimated to be 6.5%, same as last year’s but has outrun general economic inflation in the U.S. This rise is primarily driven by the increased access to behavioral health and higher utilization of urgent care centers. 2017 will need new cost-saving strategies as well as overhauling of current strategies.

4. Technological Advancements

Lately, there have been several developments in technologies such as artificial intelligence, virtual reality, and wearable technologies that have not only been disruptive but also have the potential to change the face of healthcare in 2017 and transform the vision of population health management. Healthcare veterans believe that the road to population health is an unpaved but a long one, and is bigger than anything else.

5. Reorientations in pharmaceutical industry

There have been many regulatory and reimbursement changes for pharmaceutical companies lately, and with the onset of a new presidential term, there would be much more. President-elect Donald Trump has focused on a free drug market place, which could bring major changes in the US Healthcare space.

6. Increased partnerships and collaborations

2017 will witness a growth in partnerships, along with joint ventures, mergers, acquisitions, strategic alliances and clinical affiliations as well – with a joint goal to shift from pay-for-service to pay-for-performance.

7. Achieving higher value with lower costs

Whether value-based care is being achieved through an analytics-driven approach, new payment models or changes in federal regulations, the ultimate goal is to provide higher quality with lower costs that makes use of robust infrastructure and complete clinical skills to provide care services. This is, and will remain the essence of healthcare services.

We are charging headlong into the future, marching towards a new, different world. Healthcare industries need to adapt to these changes driving towards value in innovative ways and setting them as building blocks for upcoming changes. There may be some variables, fate of some issues uncertain; but this year has come with a million opportunities with the aim to deliver the best health outcomes.

For more information on these trends be sure to visit:


1. Make information transparent- Let patients know there will be a follow-up message after an appointment or episode of care, and be sure to follow through when the time comes.

2. Empower patients to take action- Send actionable text messages that allow patients to confirm appointments or reply “yes” to make a payment with their card on file.

3. Provide on-demand service- No one should have a longer wait time than face time with their physician.

4. Make personalization a priority- Personalization of messaging from providers makes patients more confident in their choice of provider. Opportunities for this include personalized follow-ups, which we refer to as "evidence-based messaging," or tailored direct messages they can understand and respond to.

5. Improve care coordination- Patients are frustrated when doctors and hospital staff are not on the same page with their patient information.

For additonal tips please visit:


Four days before the end of open enrollment, the Trump administration has reportedly killed media ads designed to encourage people to sign up for Obamacare coverage. The site remains opens.

The government is no longer being promoting enrollment, and has also ended other outreach efforts such as sending emails to consumers who started, but did not complete the enrollment process, according to Politico, who broke the story Thursday. Open enrollment is ongoing through January 31.

"My memory is Congress writes law, Exec branch administers," Slavitt tweeted. "If we had done this, there'd be a Congressional hearing."

Since Slavitt left office at the time of Trump's Jan. 20 inauguration, his former blog posts on the CMS website have been removed, without explanation. Linking to the sites brings up the message, "The page you are looking for no longer exists."

Kevin Counihan, who formerly headed the marketplace, told CNBC the move to end the ads was an "outrageous decision" to "sabotage open enrollment" in Obamacare. The administration's move comes less than a week after Donald Trump's inauguration as president. On Jan. 20, the president signed an executive order that signaled a policy change on the ACA's mandate for individuals and employers to get health insurance coverage, or face financial penalty. His pick for Health and Human Services secretary, Tom Price, is expected to follow through on that policy if he is confirmed and takes office.

An HHS spokesman was quoted by Politico as saying, "HHS has pulled back roughly $5 million of the final placement in an effort to look for efficiencies, where they exist." However Politico said the Obama administration had already paid for and scheduled the ads. An estimated 8.8 million people have signed up for coverage on the federal marketplace, a number that CMS reported is ahead of last year's figures.

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The Trump administration and the new Republican Congress are primed to make big changes in Medicaid and Medicare in 2017.
GOP leaders such as House Speaker Paul Ryan and HHS secretary-nominee Dr. Tom Price have announced they will target the two huge healthcare programs for major restructuring and budget savings. Medicare spending grew 4.5% to $646.2 billion in 2015, while Medicaid spending grew 9.7% to $545.1 billion that year, with states contributing about 40% of that sum.

Republicans are likely to try to convert Medicaid from an entitlement program for low-income, elderly and disabled Americans to a capped program of fixed federal contributions to the states, either through flat block grants or per-capita contributions. They have not yet offered details on how those payments would be calculated or whether they would keep pace with medical inflation.

Ryan and other supporters of that approach argue it would encourage states to provide better healthcare at a lower cost by giving them greater flexibility in setting eligibility and benefits. Critics, including some state officials, fear it would force states to push poor people out of the program, eliminate important benefits, and cut already-low payment rates to providers. Conservatives have signaled that they see overhauling Medicaid's structure as a big federal cost-saver that could finance tax cuts and/or new healthcare tax credits to replace Obamacare's premium subsidies.

Meanwhile, Ryan's ACA replacement proposal would phase out the law's enhanced federal payments to the states to cover low-income adults, which would leave the future of the Medicaid expansion in grave doubt.

It's widely expected that the Trump administration will be receptive to states' Medicaid waiver proposals to impose more patient-responsibility requirements on beneficiaries, including premium payments, participation in work activities, and even benefit time limits. The Obama administration had taken a restrictive view of such requirements. At the same time, Ryan and Price want to turn Medicare into a “premium-support” system by 2024. That means the program would pay private plans and the traditional fee-for-service program a fixed amount per beneficiary. They also want to raise the eligibility age to 67.

The idea is to have traditional Medicare compete with private plans on equal terms and let beneficiaries choose between them, paying out of pocket for premiums that exceed the voucher amount. Federal payments would be based on a competitive bidding process, though no specific proposal has been released. Conservative lawmakers and policy experts say the premium-support model would make Medicare more efficient and improve quality of care, while critics deride it as a “voucher system” that would impose higher costs on seniors and reduce their benefits. But even some Senate Republicans have balked at pushing ahead in 2017 with this proposal to change the highly popular Medicare program while also taking on the challenging task of repealing and replacing the ACA.
The future of the CMS Innovation Center is in doubt under the GOP's plan to repeal the ACA. Some Republicans favor eliminating it. But others caution that it's needed to lead the rollout of the new Medicare value-based physician payment system, and that it could be useful in testing conservative healthcare models, including premium support.

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The national healthcare expenditure topped $3.35 trillion last year. What is driving healthcare prices so high? Diabetes topped the list with a cost of more than $100 billion in 2013.

Diabetes - In 2012, 9.3% of Americans, or 29.1 million people, had been diagnosed with diabetes. 1.4 million more Americans are diagnosed every year. Diabetes is the 7th leading cause of death in the U.S.

Heart Disease - Following behind diabetes for the most expensive health conditions is heart disease. In 2013, more than $88 billion was spent on costs associated with this disease. Heart disease, which includes strokes and other cardiovascular diseases, is the leading cause of death in the U.S. The Heart Foundation reports that in 2011, 787,000 Americans died from a cardiovascular disease.

Back and Neck Pain - Pain associated with the lower back and neck cost Americans $87.6 billion in 2013. It is estimated that 80% of Americans will suffer from back pain at some point in their lives. This pain could be caused by a variety of factors, such as an accident or injury, or from arthritis.

Hypertension - High blood pressure, or hypertension, accounted for nearly $84 billion in healthcare spending. High blood pressure can lead to heart disease, if left untreated. One in three Americans has hypertension. Unfortunately, only about half of Americans suffering from this condition have it under control, according to the Centers for Disease Control and Prevention.


Physicians beware: If you don't offer telehealth services you may start losing patients to those that do. American Well, a telehealth company that partners with dozens of health systems nationwide, said according to the results of their 2017 Consumer Study, 20 percent of respondents would switch their primary care physician to another one in their area if they offered telehealth visits. That amounts to 50 million Americans, American Well said.

Consumers are willing to try telehealth for many needs – from chronic conditions to post-discharge follow up," said Mary Modahl, chief marketing officer for American Well. "Health systems and provider groups must take note; if you haven't already, 2017 is the year to put a secure telehealth platform in place."

At his recent hearing before the Senate Health, Education, Labor and pensions Committee, Trump HHS Secretary nominee Tom Price called telemedicine "absolutely vital" and said it will give those in rural and underserved areas better access to care. He said the ability to use it should be accentuated but said how to pay doctors for those services is a challenge.

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