The Centers for Medicare & Medicaid Services (CMS) recently announced that healthcare groups and physicians have until the 5^th of October to contest their success score for their 2019 Merit-based Incentive Payment System (MIPS) if they disagree with the amount reported by the Centers for Medicare & Medicaid Services.

CMS recently posted success ratings on the website of the Quality Payment Program (QPP) for physicians and those involved in MIPS, which can be accessed through the portal. The score governs 2021 Medicare payments to doctors and healthcare organizations, who are given an adjustment that’s either positive, negative, or neutral.

MIPS-eligible physicians, associations, and virtual entities — including those who engage in an alternative payment model (APM)—can request a summary by visiting the QPP website.

It is necessary for physicians and groups to review their 2019 performance feedback reports and 2021 payment adjustment scores for accuracy. As a result of the pandemic, CMS introduced a policy aimed at keeping physicians harmless from payment changes if they did not apply 2019 MIPS data.

CMS has also announced the option of opting out of the 2020 MIPS program in full or in part. In order to do so, a request for hardship on the QPP website must be made before December 31, showing the hardship is tied to the pandemic.

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.

Electronic health records (EHR) assist in the process of collecting patient data and record keeping. However, an EHR has broader implications. Based on what the objectives are, an EHR has the power to alter your entire practice’s workflow, structure, and cultural process. That’s why choosing an EHR that complements and enhances your office operations is so vital.

If you feel your existing EHR isn’t adding value, it may be time to opt for another solution. Moving over to a new EHR is often an extended process. Once all the data has been entered into the new system, your staff must be trained on how to use the different functions and features. This training can take several weeks. Long term needs and goals should drive the process of switching to a new EHR. This lessens the odds of spending the time to transition to a new EHR only to realize that the new solution is ultimately not one that is adapting to the distinct needs of your practice.

Make sure to remain connected with your patients throughout the process as they become familiar with the new EHR, and provide feedback. Identify any problem areas quickly, and take the steps to rectify them, when possible. Patient feedback also shows while you are focused on creating an efficient and effective office, your system also has your patients in mind. You want an EHR solution that follows your new EHR targets for better productivity and delivers as much value to patients as it does to you.

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.

EHRs could be modified, for instance, to integrate features that tackle the 4Ms by incorporating reminders and fields in the EHR for clinicians to implement standardized treatment, target documentation, or revisit medicines known to affect mobility and mentation (the prevention, identification, and management of mental illnesses like delirium and depression). According to the JAMIA study, however, there may be a lack of awareness among clinicians on ways to integrate certain needs for older adults.

The JAMIA findings may suggest that hospitals do not rely on EHR optimization to improve older adult care, while the bulk of the inpatient population is actually older adults. Applying policy and realistic initiatives that concentrate on improving care for this age group may help tackle this problem.

To read more, please visit https://ehrintelligence.com/news/older-population-often-overlooked-during-ehr-optimization.

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.

Healthcare’s “value movement” is a concept just about everyone comprehends. It’s easier to compensate someone for the value they’re making versus simply doing the job. A situation of affordability sparked value-based care, with the Affordable Care Act contributing heavily. Today, among the few programs that have near-universal political support, value-based care is one. When efficaciously enforced, clinicians are spurred to care for the entire person and tackle the risk factors so essential to the quality of life of patients.

Many value systems are still developed on a fee-for-service basis, where doctors are constrained in what they can do with the conventional method of billing and coding. What’s more, these programs too often measure processes rather than results (for example, checking blood pressure versus improving it and cutting down on hospitalizations). It’s not clear whether calculated actions would result in the true desired outcome of less expensive, more sustainable healthcare, and those acts say little about the experiences of actual patients.

A typical primary care doctor sees about thirty patients daily, generating around $600,000 in a year at $80 a visit. This individual is trying to keep patient visits short, there is a ton of paperwork they need to take care of, and, after covering the costs of running the practice, they are hoping to take home a portion of what specialists earn. There is minimal benefit resulting from value-based care payouts, regardless of their PCP skills.

What if the individual assumed “full” risk for these patients? If the doctor took the reins and was responsible for everything about their patients? Things shift radically. Presuming the payor negotiations have been taken care of, this same doctor may have somewhere around $12 million (average $500 per patient per month), about twenty times the money. There is the danger the $12 million is expended, and the doctor incurs a loss. But primary care is worth more than five percent ($600,000 of the $12 million) of overall costs collected by the doctor in the fee-for-service environment because PCPs will redefine the “downstream” treatment use. To stop wasting the other 95 percent of preventable, avoidable, and wasteful treatment, everything now becomes how to maximize patient health. It’s about working with patients, encouraging them to do what’s needed to have a positive effect.

To read more, visit https://www.linkedin.com/pulse/full-risk-capitation-model-why-make-change-christopher-chen/.

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.

The strength and versatility of Medicare Advantage has become increasingly evident in the age of COVID-19. When the pandemic began spreading across the country this spring, Medicare Advantage plans responded quickly and were among the first to take charge, identifying and introducing changes to policies and benefits.

Many Medicare Advantage programs quickly identified an exhaustive list of supplemental benefits addressing health social determinants, crucial in the response to COVID-19. Member outreach including meal deliveries, free masks, and regular communication were instituted to help address anxieties made evident early on.

By the time June was over, Medicare Advantage membership reached almost four million, an increase of more than ten percent from the first half of 2019 and up to eight percent from enrollment by the end of the same year. In the first half of the year, insurer Humana added well over 250,000 Medicare Advantage members and predicts more than 330,000 will join before the end of the year. Humana’s success in Q2 mirrors that of many payers as a result of lower utilization during the pandemic. That number is expected to rise in the last half of the year with rising utilization including an expected increase in elective surgeries.

Seniors have recognized the value in Medicare Advantage, as demonstrated by rising enrollment, which has almost doubled during the past years. Close to forty percent of the Medicare population are now enrolled in an Medicare Advantage plan. That number is anticipated only to increase as more seniors become old enough to qualify for Medicare.

To read more, please visit https://www.fiercehealthcare.com/payer/humana-posts-1-8b-q2-profit-as-insurers-continue-to-show-strong-financial-performance-amid.

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.

Primary care practices have had to contend with the possibility of closure due to the pandemic. The conundrum comes in figuring out the best way for physicians to save their practices while still providing patients optimum care. The answer may lie in value-based care.

Primary care is arguably more important than ever, yet it has become increasingly evident that the traditional fee-for-service model, based solely upon actual practice visits, has become untenable. The safest option for many patients is to stay at home to stay healthy, so these physicians and healthcare practices now find themselves facing an uphill battle to remain in operation.

Value-based practices have managed to keep their doors open, take care of their patients, and even prosper in these challenging times. Instead of concentrating solely on patients that walk into the practice, value-based care is more about ensuring patients remain healthy and out of the hospital. With value-based care, practices can, for example, reach out to a patient to contact them and evaluate their care beyond the doors of the practice as well as keep in touch in the event the patient does have to go to the hospital emergency room.

The key is breaking the misconception that fee-for-service is the perfect way to pay for primary care. Primary care should be about the value created, where care is more person-based than transactional.

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.

Per a recent study, Medicare Advantage Plans and other stakeholders indicated that during the coronavirus pandemic, CMS exemptions proved successful in allowing access to Medicare and Medicare Advantage telehealth. However, there are still hurdles to overcome.

After reviewing the data from 2017, the researchers discovered that, particularly in metropolitan areas, internet coverage was primarily targeted towards younger Medicare beneficiaries with income deemed medium to high. Standard Medicare beneficiaries were more likely to use the internet than beneficiaries of Medicare Advantage, in all the groups analyzed.

CMS provided several telehealth flexibility plans for Medicare and Medicare Advantage, including broadening coverage to Medicare telehealth visits, virtual check-ins, and e-visits, and finally, audio-only services.

Policies that shared risk-bearing payment structures assisted with the rapid adjustments of plans and providers to the pandemic. These models let Medicare Advantage plans employ telehealth services and grow in a brief time to current platforms.

Fee-for-service payment programs proved trickier for both traditional Medicare and Medicare Advantage patients as they navigated the adoption and expansion of telehealth.

Certain factors that increased the adoption and growth of virtual care included promoting home-based telehealth, removing the requirement for providers to have a previous relationship, and increasing the eligibility requirements for provider and service reimbursement.

To read more, visit https://healthpayerintelligence.com/news/covid-19-waivers-improved-medicare-advantage-telehealth-access.

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.

The telehealth boom as a result of the COVID-19 pandemic has sparked discussions on how to reach the smooth integration of telehealth into electronic health records. Some telehealth platforms provide agnostic integration with a number of EHR systems, whereas some EHRs have their own telehealth solution in-house.

What works for a certain system may not necessarily be the best solution for another. There are many considerations to take into account. when choosing an EHR provider or considering a move to another.

You may wish to begin by understanding whether the vendor for whom you are operating currently provides a unified solution, or have other solutions been developed along the way. Where do you begin, and is it a fully integrated platform versus one vendor with several platforms to offer? A trade-off study should also be considered: What do you lose in feature functions with a single vendor versus integration gain? The third consideration is the case of intended use: More specialized treatment may mean having to find a more specialized solution.

At CareOptimize, we offer a rich array of EHR utilities designed to assist clients and staff in increasing their productivity, including free utilities such as our Document Auto-Completion templates and the Coronavirus Crystal Report.

To read more, please visit https://www.healthcareitnews.com/news/when-integrating-ehr-and-telehealth-one-size-doesnt-fit-all.

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.