CMS Doubling Down on Health IT; Patients

By Seema Verma, Administrator, Centers for Medicare & Medicaid Services

Americans enjoy the benefits of the best healthcare providers and innovators in the world. Yet while the volume of care consumed by American patients has not increased dramatically comparative to similar economies, the cost of care in the United States has accelerated at an alarming pace. Healthcare costs continue to grow faster than the U.S. GDP, making it more difficult with each passing year for CMS to ensure healthcare to not only its beneficiaries of today, but generations of beneficiaries in the future.

We believe at CMS that a major cause for the cost inefficiency of healthcare is attributable to a failure in the past to make the system about the patient and for the patient. It is the system that has become the centerpiece of policy debates, and it is the system that has become more about sustaining itself than serving patients. If the patient truly is what our healthcare system seeks to serve, then the patient must be the focal point of all policies and private industry decision-making.

CMS is committed to leveraging innovation to truly empower patients with their own data, decisions, and care. Evidence of this commitment can be found in a government-wide initiative launched by CMS and the White House Office of Innovation in March called MyHealthEData— designed to achieve true patient control and interoperability of their health records, and to enable patients to share their data with technology innovators and researchers to accelerate public health. See our new video for a simple explanation of MyHealthEData.

At CMS we are putting patients first, and we are moving to break down silos of patient information that is being captured by the system, and depriving the patient the access to the best quality, and most affordable care. Sustaining our exceptional healthcare depends now more than ever on driving down costs, and a major part of the CMS strategy to drive down costs depends on smart and innovative use of information technology (IT).

Through MyHealthEData, CMS envisions a future in which all patients have access to their own health data and use it to make the right decisions for themselves and to get the best value. We see health IT systems that work seamlessly with each other, and a government that supports secure data sharing and emerging technologies so that healthcare in America is better and less expensive.

To achieve these goals, CMS fully acknowledges that we cannot operate in a “way-we-have-always-done-it” manner and hope for different results. That is why CMS created the new role of CMS Chief Health Informatics Officer (CHIO) and has begun the process of filling this new role with a leading healthcare IT talent. The CHIO will drive health IT and data sharing to enhance healthcare delivery, improve health outcomes, drive down costs, and empower patients. Through this new function, CMS will effectively engage stakeholders from all parts of the healthcare market, including our Federal partners and industry leaders.

As CMS Administrator, I am deeply committed to programs, policies, and systems that put patients first. It’s 2018—most doctors are using electronic health records (EHRs) and most patients have access to the Internet and a smartphone, providing many ways to view healthcare data securely. Patients should expect health IT that enhances their care coordination instead of disrupting it. Their information should automatically follow them to all of their healthcare providers, so that everyone stays informed and can provide the best treatment. Patients also should know how much a health service costs so they can decide whether they want it, and “shop around” for where to get it.

Another reason behind our decision to create a CHIO role is that today at CMS, we are focused on data, not only to inform our strategy, but also to promote patient choice and drive down cost. We are evaluating the data we have and how best to apply it to our mission. We also are thinking about an Application Programming Interface (API) strategy across the entire agency that will allow us to securely provide data so that software developers, researchers, and others can design useful products (such as apps) powered by it, just as so many companies do to enhance their customer experience.

If we can solve these health IT challenges, not only will patients benefit, but so too will providers and payers. We are closer than ever to realizing these goals, but we are not there yet.

The truth is, as the largest healthcare payer in the country, CMS should have had a CHIO function long ago. Despite today’s amazing technology and decades of promises, we are not where we should be. The CHIO role will enhance my leadership team, working across CMS, with federal partners including the U.S. Digital Service, and alongside private industry and researchers to lead innovation and help inform CMS’s health IT strategy. The challenge is great, but so is the reward—building the next generation of interoperable health systems for millions of Americans and affecting national and global health IT for good.

We now have the momentum and focus to make this happen.

Although we will refine specific responsibilities, we anticipate the CHIO role will help drive forward the many health IT initiatives we have begun this year, including the Medicare Blue Button 2.0 program—a universal digital format for personal health information—and our overhaul of the CMS EHR Incentive Programs to focus on interoperability.

I look forward to meeting qualified CHIO candidates who wish to step up to this challenge and join the team that will lead CMS health IT over the “finish line” so that we can drive down costs and save lives. The time is now to realize the true potential of health IT for America’s patients.

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Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter CMS Administrator @SeemaCMS@CMSgov, and @CMSgovPress

Working Together for Value

June 20, 2018 

By Seema Verma, Administrator, Centers for Medicare & Medicaid Services

Working Together for Value

Over the past year, the Centers for Medicare & Medicaid Services (CMS) has engaged with the provider community in a discussion about regulatory burden issues. This included publishing a Request for Information (RFI) soliciting comments about areas of high regulatory burden. One of the top areas of burden identified in the over 2,600 comments received was compliance with the physician self-referral law (often called the “Stark Law”) and its accompanying regulations.  In response to these concerns, CMS undertook a review of the existing regulations to determine where the agency could consider potential areas for burden reduction. In coordination with HHS Deputy Secretary Eric Hargan, CMS is now soliciting specific input on a range of issues identified with the Stark Law to help the agency better understand provider concerns and target its regulatory efforts to address those concerns.

The Stark Law was enacted in the 1980s to help protect Medicare and its beneficiaries from unnecessary costs and other harms that may occur when physicians benefit from referring patients to health care entities with which they have a financial relationship. The law prohibits a physician from making referrals for certain health care services to an entity with which he or she (or an immediate family member) has a financial relationship. There are statutory and regulatory exceptions, but in short, a physician cannot refer a patient to any service or provider in which they have a financial interest.

Stark also prohibits the entity from filing claims with Medicare for services resulting from a prohibited referral and Medicare cannot pay if the claims are submitted. In its current form, the physician self-referral law may prohibit some relationships that are designed to enhance care coordination, improve quality, and reduce waste.

To achieve a truly value-based, patient-centered health care system, doctors and other providers need to work together with patients. Many of the recent statutory and regulatory changes to payment models are intended to help incentivize value based care and drive the Medicare system to greater value and quality. This has been a priority of CMS and HHS and is reflected in many of our current ongoing initiatives. Medicare’s regulations must support this close collaboration. The Stark Law and regulations, in its current form, may hinder these types of arrangements. To help better understand the impediments to better coordinated care caused by existing regulatory efforts, this RFI seeks to obtain input about how to address those concerns.

We invite you to share your ideas and suggestions as we work together for coordinated care and a better health care system for all Americans. The RFI can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection/.

CMS Opioids Roadmap

June 11, 2018

CMS Opioids Roadmap

Although some progress has been made in efforts to combat the opioid epidemic, the latest data from the Centers for Disease Control and Prevention indicate the crisis is not slowing down. However, it is important for our beneficiaries across the country to know that the Centers for Medicare & Medicaid Services (CMS) is exploring all of our options to address this national crisis.

As evidence of our commitment to the health and well-being of patients, CMS is publishing a roadmap outlining our efforts to address this issue of national concern. In this roadmap, we detail our three-pronged approach to combating the opioid epidemic, focusing in on prevention of new cases of opioid use disorder (OUD), the treatment of patients who have already become dependent on or addicted to opioids, and the utilization of data from across the country to target prevention and treatment activities.

Current estimates show that over two million[i] people suffer from opioid use disorder, with a prevalence in Medicare of 6 out of every 1,000 beneficiaries.[ii] In order to decrease that number, it is crucial that Medicare beneficiaries and providers are aware that there are options available for both prevention of developing new cases of OUD and the treatment of existing cases. CMS is working to ensure that beneficiaries are not inadvertently put at risk of misuse by closely monitoring prescription opioid trends, strengthening controls at the time of opioid prescriptions, and encouraging healthcare providers to promote a range of safe and effective pain treatments, including alternatives to opioids. We are also working on communications with beneficiaries to explain the risks of prescription opioids and how to safely dispose of them, so they are not misused by others. These are just some of the ways we are looking to protect and care for people with Medicare.

CMS also recognizes that the opioid epidemic has affected people covered by Medicaid across the country in different ways – an estimated 8.7 out of 1,000 Medicaid beneficiaries are impacted by OUD. We believe one crucial effort to help on the treatment front is encouraging states to tailor programs to their populations by taking advantage of flexibilities that are available through Medicaid Section 1115 substance use disorder (SUD) demonstrations that improve OUD treatment.  CMS has worked with seven new states since October 2017 to approve waivers to tackle the opioid epidemic in their state. With each state having a unique population, we recognize the challenges that states face in creating programs to help, and we are committed to providing the support necessary to help states achieve positive results for their populations.

Beyond Medicare and Medicaid, CMS is also looking across our other programs to use all the tools at our disposal to address the opioid crisis. We are working to ensure that the private plans offering coverage on the Health Insurance Exchanges also provide options for treating OUD, and we are examining our quality standards across our programs to encourage providers to follow best practice guidelines related to opioid misuse diagnosis and treatment. Further, while we have initiatives specific to Medicare and Medicaid, we are also reviewing all of our programs to find solutions that are working at the local level with states, providers, and payers so that we can disseminate successful ideas as quickly as possible to help our partners know that they do not have to solve this alone.

CMS believes we can make progress in addressing the many aspects of the opioid epidemic in partnership with states and other stakeholder organizations. Every day this crisis claims the lives of loved ones and, in many areas in our country, we have yet to turn the tide. This roadmap is only a start, and as we begin to implement many of our plans and programs, it will continue to evolve. But the roadmap is also a demonstration of CMS’ commitment to explore and offer viable options to address the crisis, to share the information we collect with other agencies and organizations, and to protect our beneficiaries and communities affected by the crisis.

[i] https://www.hhs.gov/opioids/about-the-epidemic/index.html

[ii] https://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/Downloads/CMS-Opioid-Misuse-Strategy-2016.pdf

A New Era of Accountability and Transparency in Medicaid

By: Administrator, Seema Verma, Centers for Medicare & Medicaid Services

In his first 500 days in office, President Donald J. Trump has achieved results both at home and abroad for the American people, working to ensure government is more accountable to the American people. One of the many promises the Trump Administration has made and kept is improving accountability and transparency in Medicaid.

Medicaid provides healthcare for more than 75 million Americans, including many of our most vulnerable citizens, at an annual cost of over $558 billion. It has grown significantly over the years, consuming an every greater share of our public resources – from 10 percent of state budgets in 1985 to nearly 30 percent in 2016. Medicaid should improve the lives of those it serves by delivering high quality health care and services to eligible individuals at a maximum value to American taxpayers. As the administrators of the program, states, along with their local healthcare professionals who care for their neighbors, know best the unique healthcare needs of their community. Our success on delivering on Medicaid’s promise hinges on the critical role they play in managing the precious state and federal resources with which we are entrusted.

That’s why we have committed to resetting the state-federal partnership by ushering in a new era of state flexibility. We’ve approved groundbreaking Medicaid demonstration projections, including reforms to test how Medicaid can be designed to improve health outcomes and lift individuals from poverty by connecting coverage to community engagement. We are streamlining our internal processes and breaking down regulatory barriers that force states to commit too much of their time and resources to administrative tasks rather than focusing on delivering better care.

But with that commitment to flexibility must come an equal pledge to improve transparency and accountability. Too often we have struggled to articulate our collective performance in executing on our immense responsibility. This is best reflected in the fact that Medicaid is responsible for approximately half of the nation’s births, yet no one will argue that we are achieving the birth outcomes our future generations deserve. As we return power to states, we must shift our oversight role at CMS to one that focuses less on process and more on holding us all collectively accountable for achieving positive outcomes.

That is precisely why, last November, I announced that we would create the first ever CMS Medicaid and CHIP Scorecard to increase public transparency about the programs’ administration and outcomes. The data offered within the Scorecard begins to offer taxpayers insights into how their dollars are being spent and the impact those dollars have on health outcomes.  The Scorecard includes measures voluntarily reported by states, as well as federally reported measures in three areas: state health system performance; state administrative accountability; and federal administrative accountability. As states continue to seek greater flexibility from CMS, the Scorecard will serve as an important tool in ensuring that CMS is able to report on critical outcome metrics.

The first version of the Scorecard is foundational to CMS’s ongoing efforts to enhance Medicaid and CHIP transparency and accountability. We’ve begun this initiative by publishing selected health and program indicators that include measures from the CMS Medicaid and CHIP Child and Adult Core Sets along with federal and state accountability measures. For the first time, we are publicly publishing measures that show how we are doing in the business of running these immense programs, including things like how quickly we review state managed care rate submissions or approve state section 1115 Medicaid demonstration projects. Our stakeholders, including beneficiaries, providers, and advocates, deserve to have this information available to them.

And we’re just getting started. Public reporting of meaningful quality and performance metrics is an important and ongoing responsibility of states and the federal government given Medicaid’s vital role in covering nation’s children and as the single greatest payer for long-term care services for the elderly and people with disabilities.

That’s why, in future years, the Scorecard will be updated annually with new functionality and new metrics as data availability improves, including measures that focus on program integrity as well as opioid and home and community-based services quality metrics. Over time, we plan to add the ability for users of the Scorecard to generate year-to-year comparisons on key metrics, as well as to compare states on measures of cost and program integrity. While some variation may be inherent based on geographic, population, reporting or programmatic differences, the public should have access to information that allows them to understand how and why costs and outcomes can vary from state to state for the same populations. Then we can begin to ask important questions about what may really be driving differences in quality and efficiency.

CMS recognizes that continued insight from our state partners is a critical component in the maintenance of the Scorecard. I want to thank all the states for their assistance in the creation of this first iteration, particularly the 14 states that served on the National Association of Medicaid Director’s workgroup over the last six months. Many of the measures are only possible because of the commitment from states to collect and report on these important metrics.  Through this partnership with states, CMS will continue to advance policies and projects that increase flexibility, improve accountability and enhance program integrity and are designed to fulfill Medicaid’s promise to help Americans lead healthier, more fulfilling lives.

Quality Payment Program Exceeds Year 1 Participation Goal

By: Administrator, Seema Verma, Centers for Medicare & Medicaid Services

Quality Payment Program Exceeds Year 1 Participation Goal 

I’m pleased to announce that 91 percent of all clinicians eligible for the Merit-based Incentive Payment System (MIPS) participated in the first year of the Quality Payment Program (QPP) – exceeding our goal of 90 percent participation. Remarkably, the submission rates for Accountable Care Organizations and clinicians in rural practices were at 98 percent and 94 percent, respectively. What makes these numbers most exciting is the concerted efforts by clinicians, professional associations, and many others to ensure high quality care and improved outcomes for patients.

Meeting the Challenges Ahead

Even with this high rate of participation, we are committed to removing more of the regulatory burdens that get in the way of doctors and other clinicians spending time with their patients. After only eight months, we’ve made significant progress through our Patients over Paperwork initiative: streamlining our regulations, increasing efficiencies, and improving care for patients. At the same time, we continue to put patients first by protecting the safety of our beneficiaries and strengthening the quality of healthcare they receive.

For example, we reviewed many of the MIPS requirements and developed policies for 2018 that continue to reduce burden, add flexibility, and help clinicians spend less time on unnecessary requirements and more time with patients.

In particular we have:

  • Reduced the number of clinicians that are required to participate giving them more time with their patients, not computers.
  • Added new bonus points for clinicians who are in small practices, treat complex patients, or use 2015 Edition Certified Electronic Health Record Technology (CEHRT) exclusively as a means of promoting the interoperability of health information.
  • Increased the opportunity for clinicians to earn a positive payment adjustment.
  • Continued offering free technical assistance to clinicians in the program.

Under the Bipartisan Budget Act of 2018 we have additional authority to continue our gradual implementation of certain requirements for three more years to further reduce burden in areas of MIPS.

We’re also eager to improve the clinician and patient experience through our Meaningful Measures initiative so that clinicians can spend more time providing care to their patients and improving the quality of care their patients receive. Within MIPS, we are adopting measures that improve patient outcomes and promote high-quality care, instead of focusing on processes.

Working with the Healthcare Community

We want to express our gratitude to all of the clinicians who collaborated with us as part of the voluntary Clinician Champions Program and the Clinician Voices initiative. We also want to thank all of you who participated in our various listening sessions and user groups throughout the year. Your input and feedback opened a dialogue, highlighted opportunities for improvement, and helped us identify ways to continue to reduce burden within the Quality Payment Program.

We deeply appreciate the contributions professional associations, consumer advocates and other important stakeholders have made to help engage their members and prepare them for success. We also want to acknowledge the networks supporting the free technical assistance available to clinicians, specifically the Small, Underserved, and Rural Support initiative, Quality Innovation Networks, and the Transforming Clinical Practice Initiative, who worked tirelessly to help clinicians familiarize themselves with the program so they can successfully participate. Together with our stakeholders and technical assistance networks, we hosted over 6,000 Quality Payment Program events last year. We used these events to describe requirements, offer tips, listen to you, and act on your feedback.

And, we’re proud to announce that our free technical assistance received a 99.8 percent customer satisfaction rating by over 200,000 clinicians and practice managers. The technical assistance networks also responded to 98.7 percent of initial referrals for additional support from the Quality Payment Program Service Center and Centers for Medicare & Medicaid Services (CMS) Regional Offices within 1-business day. We believe that there is an obligation to respond quickly, so clinicians can spend less time trying to figure out the program and more time with their patients.

Additionally, our Quality Payment Program Service Center complemented the technical assistance effort by fielding more than 130,000 inquiries and delivering world class customer support.

Better yet, all of the free and customized support from the technical assistance networks and the Quality Payment Program is still available to clinicians in the 2018 performance year!

Moving Forward Together

While we’re proud of what has been accomplished, there is more work to be done. CMS remains committed to listening to the healthcare community and exploring ways to reduce clinician burden, strengthen quality, introduce new payment models, develop meaningful measures including for patient safety, and promote interoperability. We look forward to continuing to hearing from you to make sure that we focus on patients, not paperwork.

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CMS Encourages Eligible Suppliers to Participate in Expanded Medicare Diabetes Prevention Program Model

By CMS Administrator Seema Verma

Nationally expanded performance-based payment model now enrolling service suppliers

The Centers for Medicare & Medicaid Services (CMS) in April expanded the Medicare Diabetes Prevention Program (MDPP), a national performance-based payment model offering a new approach to type 2 diabetes prevention in eligible Medicare beneficiaries with an indication of pre-diabetes. For the first time, both traditional healthcare providers and community-based organizations can enroll as Medicare suppliers of health behavior change services. This innovative model promotes patient-centered care and continues to test market-driven reforms to drive quality of care and improve outcomes for America’s seniors, more than a quarter of whom have type 2 diabetes.

CMS recognizes that prevention is a critical part of creating an affordable healthcare system that puts patients first, and we encourage eligible suppliers to partner with us on this shared goal by participating in the national expansion of the MDPP.

As the CMS Innovation Center’s first preventive services model test to expand nationally, the MDPP is a key example of how we’re putting innovation to work. The model launched in 2012 as a small, voluntary model test at 17 sites across the country in partnership with the YMCA-USA, Centers for Disease Control and Prevention (CDC), and other public and private partners. Now, CMS is expanding this set of services nationwide based on promising results. In the initial model test, 45 percent of beneficiaries met the 5 percent weight loss target, which translates to a clinically meaningful reduction in the risk of developing type 2 diabetes.

Through the MDPP, trained community health workers and other health professionals empower beneficiaries at high risk of developing type 2 diabetes to take ownership of their health through curriculum-driven coaching and proven behavior change strategies for weight control. As a new preventive service for qualifying Medicare beneficiaries, MDPP services are available without a referral or co-payment.

The MDPP is not only a good value for our beneficiaries. Investing in prevention through performance-based payments and market-based incentives, this promising model will save the Medicare program more than $180 million by keeping beneficiaries healthy and averting new cases of diabetes[i].

One of the critical innovations in the MDPP is its approach to care delivery: For the first time, community-based organizations can enroll in Medicare to provide evidence-based diabetes prevention services after achieving preliminary or full recognition through the CDC. These organizations can enroll in Medicare to become an MDPP Supplier today, and CMS will continue to accept supplier applications on a rolling basis. Eligible organizations can begin the screening and enrollment process to become an MDPP Supplier by using the Provider Enrollment Chain and Ownership System (PECOS) or submitting the paper CMS-20134 Form. For information on the steps to enrollment, please refer to the MDPP Enrollment Fact Sheet.

Diabetes exerts an unacceptable toll on our beneficiaries, their families, and the Medicare program, which spends more than $104 billion every year treating patients with this preventable disease. The Medicare Diabetes Prevention Program is leveraging innovation to bring valuable preventive services to our beneficiaries, and I urge eligible organizations across the country to enroll today in this exciting performance-based payment opportunity.

[i] Federal Register. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2018; Medicare Shared Savings Program Requirements; and Medicare Diabetes Prevention Program; Final Rule. November 15, 2017. [pg. 53355 – 53356] https://www.gpo.gov/fdsys/pkg/FR-2017-11-15/pdf/2017-23953.pdf

 

 

 

 

 

 

Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Funding Opportunity: Measure Development for the Quality Payment Program

CMS Blog

https://blog.cms.gov/2018/03/02/medicare-access-and-chip-reauthorization-act-of-2015-macra-funding-opportunity

March 2, 2018
By Kate Goodrich, MD
Director, CMS Center for Clinical Standards and Quality & CMS Chief Medical Officer

 

Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Funding Opportunity:Measure Development for the Quality Payment Program

CMS is pleased to announce a new funding opportunity for the development, improvement, updating, and expansion of quality measures for use in the Quality Payment Program. CMS will be partnering directly with clinicians, patients, and other stakeholders to provide up to $30 million of funding and technical assistance in development of quality measures over three years.

Cooperative agreements provide a unique opportunity for CMS to partner with external entities, such as clinical specialty societies, clinical professional organizations, patient advocacy organizations, educational institutions, independent research organizations, and health systems, in developing, improving, updating, and expanding quality measures for the Quality Payment Program. By giving external entities needed resources to help guide their measure-development efforts though this funding opportunity, CMS can leverage the unique perspectives and expertise of these external entities, such as clinician and patient perspectives, to advance the Quality Payment Program measure portfolio. The cooperative agreements will allow CMS to collaborate with stakeholders to address essential topics such as: clinician engagement, burden minimization, consumer-informed decisions, critical measure gaps, quality measure alignment, consumer-informed decisions, clinician engagement, and efficient data collection that minimizes health care provider burden.

The priority measures developed, improved, updated or expanded under the cooperative agreements will be aligned with the CMS Quality Measure Development Plan. The CMS Quality Measure Development Plan provides a strategy for filling clinician and specialty area measure gaps and for recommendations to close these gaps in order to support the Quality Payment Program, and identifies the following initial priority areas for measure development: Clinical Care, Safety, Care Coordination, Patient and Caregiver Experience, Population Health and Prevention, and Affordable Care. The gap areas include, but not limited to: Orthopedic Surgery, Pathology, Radiology, Mental Health and substance use conditions, Oncology, Palliative Care, and Emergency Medicine.

More broadly than the CMS Quality Measure Development Plan, which is specific for the Quality Payment Program, CMS measures work is guided by the Meaningful Measurement framework which identifies the highest priorities for quality measurement and improvement. The Meaningful Measure Areas serve as the connectors between CMS goals under development and individual measures/initiatives that demonstrate how high quality outcomes for our Medicare, Medicaid, and CHIP beneficiaries are being achieved. They are concrete quality topics which reflect core issues that are most vital to high quality care and better patient outcomes.

Through these cooperative agreements, CMS aims to provide the necessary support to help external entities expand the Quality Payment Program quality measure portfolio with a focus on clinical and patient perspectives and minimizing burden for clinicians. Focusing on patient perspectives will ensure measures focus on what is important to patients and drive the improvement of patient outcomes. To accomplish this, the cooperative agreements prioritize the development of: outcome measures, including patient reported outcome and functional status measures; patient experience measures; care coordination measures; and measures of appropriate use of services, including measures of overuse.

For more information, search for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Funding Opportunity: Measure Development for the Quality Payment Program on Grants.gov or visit our website, https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html.

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Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter CMS Administrator @SeemaCMS, @CMSgov, and @CMSgovPress.

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