Value-Based Payments May See a Bright Future
Friday, January 29th, 2021

President Joe Biden is quickly launching his health roadmap, starting with addressing the pandemic. He has also stated that during his term, he intends to dip into qualifying for Medicare and Medicaid, unexpected billing, prescription costs, value-based treatment, and more.

The bulk of the job will be handled by the regulation of HHS and CMS, which means that in 2021, providers are in for a range of regulatory shifts that are expected to have a major effect on operations. Policies that influence current value-based pricing mechanisms and potential chances for the new administration and vendors themselves to move away from fee-for-service are likely to be shared priorities.

During the health crisis, the fact fee-for-service was not the perfect healthcare funding model was revealed. Along with neighborhoods shutting down, many providers were forced to do the same, resulting in income declines of fifty percent and more. Value-based contract providers were better able to cope with the drop in patient numbers and build new, even original, pathways of treatment, telehealth, for instance.

Value-based arrangements do not depend on the number of people served or facilities delivered, ensuring that even though volumes might be minimal or hospitals moved to virtual treatment methods, providers still get their reimbursements.

Leaders are liable to take a greater interest in value-based contracts and the versatility they provide to create stronger organizations going forward. With the introduction of novel value-based pricing frameworks for suppliers to try, the existing administration will likely provide full support.

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 Seeks to Grow Purchasing Model Based on Home Health
Monday, January 25th, 2021

Earlier this month, the federal government announced via email that it plans to extend the Home Health Value-Based Purchase Model (HHVBP) through rulemaking starting no earlier than January of next year. The model is now being applied in nine states and has led to an overall increase of nearly five percent in service ratings for home health providers and more than $140 million in annual savings from Medicare.

The HHVBP model has been part of the broader, ongoing transition from volume to value-based care by the federal government. CMS launched the initiative in 2016 to incentivize home health providers to better the quality of care and decrease spending on Medicare.

HHVBP is compulsory in select states where incentives are adjusted based on quality results compared to peers in the state for Medicare-certified home health agencies. Florida, Iowa, Maryland, North Carolina, Tennessee, and Washington are among these states.

For example, in 2018, home health providers involved in the model achieved a median of three percent Medicare rate change (up and down) based on average results across 20 quality measures, including hospital-free utilization of emergency rooms, oral medication management, and urgent care hospitalizations during the first 60 days of home health care.

The maximal positive and negative payout adjustment has been raised by CMS each year, with the peak adjustment at six percent for the most recent performance period. Next year, the department plans to lift to eight percent the maximum positive and negative adjustment.

To read more, visit https://revcycleintelligence.com/news/cms-to-expand-home-health-value-based-purchasing-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.

CMS Makes Changes to Medicare Physician Fee Schedule Rates
Friday, January 15th, 2021

CMS updated the 2021 Medicare Physician Fee Schedule prices after a COVID-19 stability bill relaxed budget neutrality cuts finalized in a rule introduced last month.

The 2021 Consolidated Appropriations Act, enacted by Congress in December, enacted a 3.75 percent rise in Medical Care Plan payments for all hospitals in 2021 to support physicians and other professionals in adjusting to changes in reimbursement for physician services this year.

Payments for the Healthcare Common Practice Coding System (HCPCS) code G2211 were then placed on hold by the $1.4 trillion COVID-19 stimulus bill for a three-year period, which also impacted the budget neutrality provision in the Physician Fee Schedule. G2211, an add-on code for the difficulties inherent in appraisal and administration visits, comprised nearly $3 billion, or three percent, of investment on the Medicare Provider Fee Schedule.

The delay in the implementation of the code would assuage the budget neutrality adjustment, and as a result, some clinicians will no longer face dramatic rate increases, as detailed in the 2021 Medicare Physician Fee Schedule final rule.

In the final rule, CMS decided to increase premiums for assessment and management services that promote chronic illness primary care and treatment, which prompted the budget-neutrality adjustment factor for 2021.

To read more, please visit https://revcycleintelligence.com/news/cms-recalculates-medicare-physician-fee-schedule-rates-for-2021.

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.

Time-Driven Costing Boosts Healthcare Revenue
Thursday, January 14th, 2021

In healthcare, time-driven costing is a technique that measures the cost of resources spent as a patient progresses through the continuum of treatment. Along with the need to manage increasing costs and scarce resources, such as nurses, the approach has gained traction among hospital leaders, particularly in the face of new value-based reimbursement models.

The introduction of time-driven costs in healthcare has been problematic, despite the attraction of efficient assessment and control of costs. Past attempts, such as those in the 1990s, have failed or only partly succeeded due to the significant capital commitment needed and the complexities of the healthcare system.

Recent efforts have been made to introduce a time-driven expense approach backed by data analytics. Extracting information from the electronic health record to combine clinical information with payroll and time-keeping statistics, such as how many cases reached the ED and at what stage of the emergency severity index, creates a time-costing solution.

By executing a staffing-to-demand plan leveraging cumulative knowledge, sufficient ratios of nursing personnel and other providers is assured, and the health system is more effective at managing costs and services.

To read more, please visit https://revcycleintelligence.com/news/how-time-driven-costing-in-healthcare-boosts-staffing-revenue-cycle.

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.