Company Goes At-Risk for its Reimbursement Alongside Providers Who Face Medicare Payment Adjustments Beginning in 2019
athenahealth, Inc. (NASDAQ:ATHN), a leading provider of cloud-based services and mobile applications for medical groups and health systems, today announced its Merit-Based Incentive Payment System (MIPS) Guarantee, which aims to shield healthcare providers and practices from downward payment adjustments under the proposedMedicare reimbursement program of the same name. The guarantee comes months ahead of the Centers for Medicare and Medicaid Services’ (CMS) release of the final MACRA rule and amidst mounting debate over reimbursement change and complexity.
“At a time when nearly all providers across the U.S. are expected to keep up with ever-changing reimbursement rules and an estimated 45 percent of those who bill Medicare Part B are facing payment cuts under the MIPS program, we’re looking to lift the burden,” said Jonathan Bush, chief executive officer, athenahealth. “The complexity of government reimbursement is just too onerous; and, it’s not something providers or practice staff should have to master. Because of our national network, our quality management and payer rules engine, our team of experts, and our track record of client success as part of other government-run programs, we believe we can free the industry of reimbursement cuts associated with MIPS. And if we can’t, we’ll put our money where our mouth is and reimburse clients up to the penalty amount.”
athenahealth’s MIPS Guarantee continues a history of industry-leading guarantee programs offered by the company for government-mandated quality reporting, including a 97.6% 2015 Meaningful Use (MU) attestation rate and 98.9% avoidance of Physician Quality Reporting System (PQRS) and Value Modifier (VM) penalties in 2016.
What is MIPS?
Part of the new Medicare physician payment system established by the Medicare Access and CHIP Reauthorization Act (MACRA), MIPS streamlines existing quality reporting programs and links fee-for-service payments to quality and value by commanding 4 percent Medicare payment adjustments. An estimated 90% of eligible clinicians billing Medicare Part B will qualify for MIPS and are required to participate in the program by 2017, with payment adjustments set to take effect in 2019.
What is athenahealth guaranteeing?
athenahealth’s network-enabled athenaOne® services will feature workflows and native intelligence designed to manage quality, collect data, and handle reporting for MIPS, minimizing work and risk for practices of all sizes and specialties. Under athenahealth’s MIPS Guarantee, new practices using athenaOne are guaranteed to perform at or above the national performance threshold set by CMS and avoid payment penalties to their Medicare Part B fee schedule. athenahealth will cover penalties for those practices that are not successful subject to certain limitations.[1]
“Before the ink has even dried on the MIPS Guarantee, athenahealth is sticking its neck out for providers and extending the reach of what has become our company’s unique hallmark: partnership, and aligned incentives,” continued Bush. “MIPS represents CMS’ unsubtle change in approach from “carrot” to “stick.” athenahealth is standing up to potentially bear the brunt of that stick’s whack, going at risk ourselves to manage the administrative technocracy so that doctors can be doctors. With so much uncertainty about how the MIPS program will unfold and what consequences it will have on health care, this is the boldest expression of athenahealth’s commitment to providers yet: we only succeed when they succeed. CMS has been unable to commit to a firm timeline for implementation, but athenahealth’s line in the sand is clear: We will help providers of all sizes and specialties clear this latest hurdle as we continue our work in service of an even larger goal, to unbreak healthcare.”
To learn more about athenahealth’s MIPS Guarantee, please visit www.athenahealth.com/guarantee/mips
1 The MIPS 2017 Guarantee is only available to new athenaOne Clients that are live on athenaNet by June 30, 2017, or clients who upgrade to athenaOne and are live on all athenaOne services by that date. Client must agree to Guarantee terms in an effective services agreement between Athena and Client. If all conditions in the Guarantee terms are met, and our athenaOne clients experience a MIPS payment penalty (downward fee adjustment) based on MIPS Performance during the applicable Reporting Year, Athena will provide monthly service credits to Client through the end of the relevant MIPS year, provided that the amount of any such Credit shall not exceed Client’s total monthly athenaOne Service Fee with respect to such month; provided that if the agreement between the parties expires or terminates prior to Client receiving the full Credit amount, the Client shall forfeit the remainder of the Credit amount; and provided that the Credits will be the Client’s sole and exclusive remedy with respect to any downward payment adjustment to Client’s Medicare fee schedule during the applicable MIPS year. Additional conditions apply and Clients should review the Guarantee terms in their services agreement.