CMS Launches Value-Based Care Model Second Round
Tuesday, March 30th, 2021

The Centers for Medicare and Medicaid Services (CMS) has begun accepting applications for the second cohort of the Primary Care First (PCF) value-based payment program, which aims to reduce costs while improving care quality.

The PCF model would investigate whether moving from fee-for-service to Medicare performance-based compensation could improve patient quality and lower total Medicare costs as the healthcare industry transitions toward value-based care delivery.

Participating practices in qualifying areas will be credited with better health outcomes through the model’s performance-based payment changes. Furthermore, unlike conventional fee-for-service practices, these practices would have greater flexibility in tweaking their treatment delivery methods to meet the demands of specific patient groups.

Primary Care First is focused on the concepts of the current Comprehensive Primary Care Plus (CPC+) model architecture, which concentrates on incentivizing good health results, prioritizing the doctor-patient partnership, and improving care for patients with diverse chronic needs. It was developed with feedback from primary care clinician stakeholders.

The model aims to enhance advanced primary care for both practices and patients by basing Medicare rates on quality of care rather than quantities of resources. To increase patient outcomes, performance-based payments would allow practices to emphasize patient-provider partnerships, patient engagement, and care management.

The PCF model comprises a portion of the HHS Primary Care Initiative, which was announced in April 2019, which seeks to reduce administrative pressures and healthcare expenses while boosting care quality.

To read more, please visit https://revcycleintelligence.com/news/cms-starts-primary-care-first-value-based-payment-model-second-wave.

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.

Important Value-Based Reimbursement Models Put on Hold
Friday, March 26th, 2021

According to a series of updates offered on model webpages, the current administration has decided to suspend several popular CMS Innovation Center (CMMI) value-based reimbursement models to analyze model information.

The Geographic Direct Contracting Model and the Kidney Care Choices Model are two of the several value-based payment models affected.

The administration is updating the models, according to the updates on the corresponding webpages, and will divulge more detail as it develops. For the Primary Care First Model, this ensures the alternative for the Seriously Ill Population will not be available in April, as originally planned.

A separate clarification was recently issued for CMS’ biggest value-based payment model, the Medicare Shared Savings Program, which has pushed back the application deadline for accountable care organizations (ACOs) interested in participating beginning in January of next year. The latest deadline for ACOs to send participating provider lists to CMS is August.

The Biden administration hasn’t said how long CMMI will study the models or if those that haven’t launched yet will do so in 2022, as expected. This does not suggest the models will disappear, however. It’s common for the administration to continue to examine the models closely to ensure provider issues, such as perceived duplication and case management, are resolved.

To read more, please visit https://revcycleintelligence.com/news/biden-administration-pauses-key-value-based-reimbursement-models.

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.

Clinician Burnout Reduction May Be Tied to Better EHR Optimization
Monday, March 22nd, 2021

Documentation burden is a common problem with modern electronic health record systems. EHRs have been linked to many benefits, from improving care quality and reducing prescription errors to facilitating biomedical research, but documentation burden is contributing to clinician burnout.

While several solutions have been proposed, most are in the prototype phase. In the short term, simplifying and improving flowsheet functionality may be the best means of addressing the issue. That’s the main finding of information published this month in the Journal of Medical Internet Research.

Flowsheets are structured instruments in EHR programs that help to record longitudinal patient information in a format resembling a grid, such as tests, evaluations, and routine treatment. A healthcare professional may type in numerical values such as blood pressure or temperature or select values from given lists in each flowsheet entry.

The comments (if any) are concealed behind an icon inside the flowsheet entry by contrast. Free text comments are voluntary, but some physicians find them helpful and go out of their way to include them. These comments may introduce a documentation burden stemming from limitations in the existing EHR functionality, the data showed. Given that flowsheet comments are made accessible in a manner not always obvious, their content can be leveraged to design more effective strategies for efficiently recording them.

The sophistication of EHR programs, the rise in the volume of data gathered, and the difficulty of prioritizing information spread around many locations in an EHR system all add to the burden of reporting.

The US Department of Health and Human Services has published strategies to minimize the pressure of using health information technology (including EHRs), recognizing the sources of documentation burden are myriad and nuanced, requiring EHR providers, regulatory authorities, insurers, and healthcare organizations themselves to resolve them on various levels. One of the proposed solutions is to streamline Medicare Physician Fee Schedule final rules to ease reporting standards for diagnosis and administration.

To read more, please visit https://www.healthcarefinancenews.com/news/optimized-ehr-flowsheets-found-reduce-clinician-burden-burnout.

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.

Medicare Rate Reimbursement Dramatically Reduces Healthcare Spending
Monday, March 15th, 2021

According to a recent study, if private payers reimbursed hospitals at Medicare rates, healthcare costs will be reduced by more than $300 billion this year. Data shows overall healthcare spending for the privately insured population in 2021 will drop by 41% from its current estimated total of just over $850 billion. Furthermore, employer payments to employee premiums and patient out-of-pocket spending will each be reduced by hundreds of billions of dollars.

Reduced reimbursements for outpatient treatment, where the gap in reimbursement rates between private payers and Medicare is the greatest, are responsible for almost half of the drop in healthcare costs, according to researchers.

In the meantime, reimbursements for hospital inpatient treatment are expected to account for nearly 30% of the overall reduction in healthcare costs, while reimbursements for outpatient office visits are expected to make up 14%.

In comparison to comparable nations, healthcare spending in the United States is almost twice as high per resident, with part of the rise due to greater payment rates negotiated by hospitals and other providers with private payers.

The gap between private payer reimbursement rates and Medicare reimbursement rates has widened through time. Medicare per capita spending rose at a more drawn-out rate than private payer spending between 2010 to 2019, according to research, rising at an average yearly rate of just over 1.5 percent versus almost 4 percent.

Higher rates and deductibles for employer-sponsored insurance plans resulted from the increased expenditure.

When opposed to current measures such as market neutrality, reducing private payer payment to Medicare premiums is the most efficient way to minimize healthcare costs.

To read more, visit https://revcycleintelligence.com/news/reimbursing-at-medicare-rates-to-cut-healthcare-spending-by-352b.

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.

Value-Based Payments Affected by Hospital Risk Stratification
Monday, March 15th, 2021

According to a new report, value-based fines for safety-net hospitals went down when hospitals in the Hospital-Acquired Condition Reduction Program (HACRP) were graded using social risk. During last year’s fiscal period, researchers analyzed efficiency results and hospital expense reports for more than 3,000 hospitals involved in the HACRP.

The study grouped hospitals into five categories by evaluating their “proportion dual,” or the ratio of patients participating in both Medicare and Medicaid, to determine the effect of HACRP social risk stratification on value-based fines. Proportion duel is a cause that has been linked to poor health results. Instead of the lowest-performing quartile overall, penalties were allocated to the hospitals in each quartile with the lowest performance.

Just over 30% of safety-net hospitals were penalized prior to stratification, versus 25% following stratification, resulting in a net savings of more than $30 million. Patients with particularly medically complicated conditions were most likely to be moved from penalized to non-penalized status at safety-net hospitals.

Post-stratification, public hospitals, hospitals in Medicaid extension states, and hospitals caring for the greatest number of patients with racial/ethnic minority groups or patients with disabilities were least likely to be penalized.

As CMS introduces value-based payment systems, social risk stratification can aid in the development of fair quality measures to ensure hospitals are not penalized solely for serving populations with higher poverty and social risk factors.

As a result, comparing all HACRP hospitals as a single entity could worsen health inequalities by denying Medicare funds to hospitals that care for more at risk patients.

To read more, please visit https://revcycleintelligence.com/news/hospital-risk-stratification-leads-to-equitable-value-based-payment.

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.

Value-Based Care for Mental Health
Wednesday, March 3rd, 2021

One in four seniors experience at least one mental health condition, and that number might very well double in the next decade. The best care for seniors involves taking care of both their physical and mental well-being, yet the mental health of older patients is seldom examined and treated.

There are many hurdles to mental health treatment, including the stigma associated with psychiatric disorders that may discourage people from reaching out. Depression is the most prominent mental health disorder among seniors, but within this demographic, anxiety is still very widespread.

Another deterrent is cost. The cost of treatment for mentally ill persons is high. Older patients with depression use as much as fifty percent or more treatment facilities than non-depressed seniors, with fifty percent higher costs.

Few older people undergo care, considering the high incidence of mental health conditions. Seniors are 40 percent less likely than younger adults to obtain or undergo mental health care, and elderly people with mental health problems often do not receive appropriate treatment.

It is crucial to devote ample time and energy to thoroughly resolve the mental health challenges of patients to glean a more comprehensive picture of their overall needs. A value-based approach to treatment encourages healthcare providers to concentrate on a patient’s physical as well as mental health needs. This model, on average, has physicians spending up to 45 minutes with a patient when necessary, more than double the usual doctor visit. This helps primary care doctors establish trustworthy patient relationships and have in-depth interactions that help recognize issues with mental health. Other critical components for bringing people the treatment they deserve include educating care staff members to recognize symptoms of mental health problems, as well as the use of psychological screeners.

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