CMS Seeks to Implement New Quality Measures
Wednesday, December 23rd, 2020

CMS is evaluating the possibility of including 20 quality measures to a few of Medicare’s quality and value-based payment programs.

To apply, the department said, all but three of the recommended steps would have to be gathered online, either via electronic health reports or staff feedback. The shift to digital measures is following the Meaningful Measures Framework of the Department, an effort initiated in 2017 that focuses on addressing administrative burdens. Performance measurement, while providing little benefit to doctors or patients, has long been criticized for being burdensome on workers.

The 20 recommended initiatives are part of the annual rule-making phase of CMS, where the department chooses a list of measures that are then evaluated by the collaboration of measure applications of the National Consistency Council, a group of health experts providing suggestions about what CMS should pick for its services. CMS receives input on steps they have in the list that goes to NQF from specialty societies and other stakeholders.

Feedback on the proposed steps would be approved by the NQF by the sixth of January.

Ten of the suggested measures are for the Merit-based Incentive Payment System this year. Several of these measures are cost-related, and one is an impact indicator reported by patients.

A trio of the measures, including one that monitors coronavirus vaccination among healthcare workers, are linked to COVID-19.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

Deerfield Healthcare Technology Acquisitions Corp.
Friday, December 18th, 2020
Insights2020 Free State of the Practice Template
Wednesday, December 16th, 2020

Humana Prepares to Launch New Value-Based Program
Wednesday, December 16th, 2020

Humana recently declared an extension of its value-based program expansion with the forthcoming implementation of the Primary Care First (PCF) model. The initiative will expand the availability of coordinated primary care to beneficiaries of some Humana Medicare Advantage services and aims to enhance the quality of treatment and patient safety, minimize the cost of care, and relieve the financial load of primary care agencies.

At the Centers for Medicare & Medicaid Services (CMS) Innovation Center, the PCF model was created to encourage primary care practitioners to migrate to value-based care and to determine whether this new payment model of Original Medicare would improve productivity and minimize costs. Humana will supply a related model for the Humana Medicare Advantage Preferred Provider Organization and Health Maintenance Company policy to participating primary care agencies currently in the network, as a newly approved CMS payer partner and the first insurer in the nation to have its own variant of the PCF model.

The Humana PCF model is scheduled for launch on July 1, 2021. A prospective capitated incentive, which takes into account the achievement of metrics based on quality and results, will be granted to participants every month.

To read more about Humana’s upcoming value-based program, please visit the following link:https://www.businesswire.com/news/home/20201210005023/en/Humana-Announces-New-Primary-Care-Value-Based-Model.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

EHR Optimization Saved Medical Practices During the Pandemic
Friday, December 4th, 2020

The COVID-19 pandemic impacted the operations and finances of nearly 97% of medical practices in the U.S. It revealed a stark contrast between the resilience of healthcare providers focused on value-based care versus those who focused on the traditional fee-for-service (FFS) model.

Physician practices still using FFS suffered heavy financial losses when in-person patient volume dropped by 60% on average at the start of the pandemic. The providers that experienced minimal disruption to their operations were the early adopters of the principles and latest technology of value-based care in their long-term business strategy.

Successful implementation of value-based care requires a robust electronic health record (EHR) that supports data collection, clinical decision-making tools, and multidisciplinary care management. Even though the use of EHRs is widespread in the U.S., most EHRs in their current form don’t support value-based care.

EHR optimization is an ongoing process of improvement that affects all aspects of a healthcare organization practicing value-based care. Medical practices that lean into EHR optimization can see more effective patient care plans, decreased physician burnout, and increased ROI. The most common optimizations include:

  1. Workflow and business process improvement for more efficiency
  2. Clinical decision support to achieve better clinical outcomes and improve quality of care
  3. Identification of areas where cost savings are possible

Major stakeholders agree on the role and value of EHRs in transforming the U.S. health system to value-based care. Physicians and patients now feel increased comfort with telehealth and like the safety of virtual engagement during the pandemic. Payers are looking for physician partners who can conduct value-based care with measurable outcomes. EHR optimization is a big step towards realizing industry-wide change.

This update is provided by CareOptimize, a healthcare management consulting firm. We offer managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

CMS Nails Down Its Stark Law Changes
Wednesday, December 2nd, 2020

Recently, the Centers for Medicare and Medicaid Services added the finishing touches to its Physician Self-Referral Rule revisions, commonly referred to as the Stark Law. The law forbids a doctor from referring a patient for several forms of services to a provider owned by the doctor, under their employment, or otherwise getting payment from them.

The old federal rules were meant for reimbursing providers on a fee-for-service basis, in which further services were supplied as a financial reward. These federal regulations have weighed down hospitals with increased operating expenses and obstructed the transition towards value-based compensation. The healthcare sector, nevertheless, is proceeding steadily toward financial reimbursement systems related to value.

CMS’ move comes as self-referral does not have the same risks as before since providers are increasingly more responsible for patients’ total cost of care. Lack of clarity in the Stark legislation, however, has caused many providers to stay put, afraid of breaking the law even with favorable agreements, which may have critical and expensive implications.

The law finalizes several of the draft policies from the October 2019 notification of planned rulemaking. All the provisions in the revised Stark law are expected to be in effect within sixty days from the Federal Register display date, unless stated otherwise.

To read more, please visit https://www.healthcarefinancenews.com/news/cms-finalizes-changes-stark-law-hindered-physician-referral.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.