The Medicare Access and CHIP Reauthorization Act of 2015 is fundamentally transitioning the U.S. Healthcare System from a Fee-For-Service model to a Fee-For-Value reimbursement model. MACRA encourages healthcare providers to utilize HIT, population health management, and care coordination in pursuit of The Triple Aim (Improving individual healthcare quality, improving population health , and reducing cost).
In order to best prepare our clients for CMS' transition from Fee-For-Service to Fee-For-Value physician reimbursement, we have prepared a summary of the Merit Incentive-Based Payment System (MIPS). The MIPS program will consolidate PQRS, Meaningful Use, and the Value-Based Modifier into a single reporting program in which CMS affecting ≈95% of physicians beginning in 2017.
Revenue at Risk: Understanding Financial Impacts of Quality ReportingBill Presley
Jodi Frei, Northwestern Medical Center Vermont, and I co-presented at the MUSE Executive Institute on Revenue at Risk: Understanding Financial Impacts of Quality Reporting. The Executive Institute featured many amazing CXO's discussing the changing landscape of revenue cycle management and how finance, quality, and IT departments are converging on revenue cycle.
Though pay for performance is the common theme, the logistics of programs including Value Based Purchasing (VBP), Inpatient Quality Reporting (IQR), Hospital Acquired Condition (HAC) Reduction Program, Readmission Reduction, MACRA, MIPS and APMs, are very different. In this session, the specifics of each Quality Program including reporting requirements, scoring methodologies, and associated incentives and penalties will be covered. In addition, tools to track performance and quantify financial risk will be shared.
Reimbursement in this era of health care reform is challenging. We all seek success under this new normal in health care. Optimizing revenue capture in a quality reimbursement model requires acquisition of new knowledge and the use of new tools and strategies. Join us in the conversation; share your strategies; learn from others.
The Alphabet Soup of Clinical Quality Measures ReportingBill Presley
CMS is transitioning to what the they call "a new and more responsive regulatory framework" for quality reporting and reimbursement. CMS goals are "…electronic health records helping physicians, clinicians, and hospitals to deliver better care, smarter spending, and healthier people". Over the next couple years, we will see a transformation of fee for service into value-based care models driven by the VBP, Quality Payment Program, MACRA, Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APM). Healthcare organizations will no longer be motivated by implementing and meeting Meaningful Use, but instead will be driven by value-based care and risk-based payment models that focus on quality outcomes for reimbursements.
In this Education Session we will review:
• How CMS is aligning clinical quality measures (CQMs) to reduce the reporting burden for healthcare organizations and providers. We will cover the vision and goals for achieving quality alignment for CMS.
• We will dive into the following CMS reporting programs and how they interact with each other: Value-Based Purchasing (VBP), Medicare Access and CHIP Reauthorization Act (MACRA), Merit-based Incentive Payments (MIPS), Hospital Inpatient Quality Reporting (IQR), The Joint Commission (ORYX), Outpatient Quality Reporting (OQR), and Alternative Payment Models (APM).
Riding the Rapids of Payment Reform: Downstream Effects of Quality Reporting ...Bill Presley
In this presentation, we highlighted how quality measurement programs impact reimbursement affecting your revenue. The revenue at risk in your organization. We focused on quality programs like Value-Based Purchasing (VBP), Merit-Based Incentive Program (MIPS) and Alternative Payment Models (APM) and their impact on Part A and Part B reimbursements.
It’s no surprise that reimbursement tied to quality performance is quickly becoming a reality for hospitals and physicians. CMS’ aggressive goals aimed at increasing the percentage of Medicare payments associated with quality versus quantity can be achieved through such programs as Value-based Purchasing and MACRA. This session will cover scoring methodologies, reporting requirements, reimbursement impact, infrastructure (and other resource needs), EMR tools and tactics, and workflow modifications.
Physician Payment Reforms: The Future of MIPS and APMs – Value-Based Payments...Epstein Becker Green
Epstein Becker Green Webinar with Attorney Lesley Yeung - Value-Based Payments Crash Course Webinar Series - May 16, 2016.
Topics include:
* An overview of the physician payment reforms included in the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”)
* A summary of the Merit-Based Incentive Payment System (“MIPS”) and Alternative Payment Models (“APMs”) Proposed Rule (publication is expected in the spring of 2016)
* Opportunities for provider engagement with the Centers for Medicare & Medicaid Services to shape physician payment reform efforts
http://www.ebglaw.com/events/physician-payment-reforms-the-future-of-mips-and-apms-value-based-payments-crash-course-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
An actionable summary of the MIPS Merit-Incentive Based Payment System, MACRA (or the Quality Payment Program), and how to approach value-based healthcare.
In order to best prepare our clients for CMS' transition from Fee-For-Service to Fee-For-Value physician reimbursement, we have prepared a summary of the Merit Incentive-Based Payment System (MIPS). The MIPS program will consolidate PQRS, Meaningful Use, and the Value-Based Modifier into a single reporting program in which CMS affecting ≈95% of physicians beginning in 2017.
Revenue at Risk: Understanding Financial Impacts of Quality ReportingBill Presley
Jodi Frei, Northwestern Medical Center Vermont, and I co-presented at the MUSE Executive Institute on Revenue at Risk: Understanding Financial Impacts of Quality Reporting. The Executive Institute featured many amazing CXO's discussing the changing landscape of revenue cycle management and how finance, quality, and IT departments are converging on revenue cycle.
Though pay for performance is the common theme, the logistics of programs including Value Based Purchasing (VBP), Inpatient Quality Reporting (IQR), Hospital Acquired Condition (HAC) Reduction Program, Readmission Reduction, MACRA, MIPS and APMs, are very different. In this session, the specifics of each Quality Program including reporting requirements, scoring methodologies, and associated incentives and penalties will be covered. In addition, tools to track performance and quantify financial risk will be shared.
Reimbursement in this era of health care reform is challenging. We all seek success under this new normal in health care. Optimizing revenue capture in a quality reimbursement model requires acquisition of new knowledge and the use of new tools and strategies. Join us in the conversation; share your strategies; learn from others.
The Alphabet Soup of Clinical Quality Measures ReportingBill Presley
CMS is transitioning to what the they call "a new and more responsive regulatory framework" for quality reporting and reimbursement. CMS goals are "…electronic health records helping physicians, clinicians, and hospitals to deliver better care, smarter spending, and healthier people". Over the next couple years, we will see a transformation of fee for service into value-based care models driven by the VBP, Quality Payment Program, MACRA, Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APM). Healthcare organizations will no longer be motivated by implementing and meeting Meaningful Use, but instead will be driven by value-based care and risk-based payment models that focus on quality outcomes for reimbursements.
In this Education Session we will review:
• How CMS is aligning clinical quality measures (CQMs) to reduce the reporting burden for healthcare organizations and providers. We will cover the vision and goals for achieving quality alignment for CMS.
• We will dive into the following CMS reporting programs and how they interact with each other: Value-Based Purchasing (VBP), Medicare Access and CHIP Reauthorization Act (MACRA), Merit-based Incentive Payments (MIPS), Hospital Inpatient Quality Reporting (IQR), The Joint Commission (ORYX), Outpatient Quality Reporting (OQR), and Alternative Payment Models (APM).
Riding the Rapids of Payment Reform: Downstream Effects of Quality Reporting ...Bill Presley
In this presentation, we highlighted how quality measurement programs impact reimbursement affecting your revenue. The revenue at risk in your organization. We focused on quality programs like Value-Based Purchasing (VBP), Merit-Based Incentive Program (MIPS) and Alternative Payment Models (APM) and their impact on Part A and Part B reimbursements.
It’s no surprise that reimbursement tied to quality performance is quickly becoming a reality for hospitals and physicians. CMS’ aggressive goals aimed at increasing the percentage of Medicare payments associated with quality versus quantity can be achieved through such programs as Value-based Purchasing and MACRA. This session will cover scoring methodologies, reporting requirements, reimbursement impact, infrastructure (and other resource needs), EMR tools and tactics, and workflow modifications.
Physician Payment Reforms: The Future of MIPS and APMs – Value-Based Payments...Epstein Becker Green
Epstein Becker Green Webinar with Attorney Lesley Yeung - Value-Based Payments Crash Course Webinar Series - May 16, 2016.
Topics include:
* An overview of the physician payment reforms included in the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”)
* A summary of the Merit-Based Incentive Payment System (“MIPS”) and Alternative Payment Models (“APMs”) Proposed Rule (publication is expected in the spring of 2016)
* Opportunities for provider engagement with the Centers for Medicare & Medicaid Services to shape physician payment reform efforts
http://www.ebglaw.com/events/physician-payment-reforms-the-future-of-mips-and-apms-value-based-payments-crash-course-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
An actionable summary of the MIPS Merit-Incentive Based Payment System, MACRA (or the Quality Payment Program), and how to approach value-based healthcare.
Quality and Outcome Framework (QOF) is a voluntary annual incentive programme for GPs in England, detailing practice achievement results. The primary objective of QOF is to drive the quality of primary care and reduce variations in the quality of care amongst GPs
MIPS APM for ACOs: A Hybrid Reimbursement ModelCitiusTech
CMS announced the Quality Payment Program (QPP) final rule in October 2017, stating how it plans to implement the clinician payment changes to QPP, mandated under the Medicare Access and CHIP Reauthorization (MACRA) act. The implementation of the MACRA act impacts different type of organizations, one such being the Accountable Care Organizations (ACOs). ACOs are evaluated for payments on the basis of quality care and the cost factors associated in achieving their quality goals. Post MACRA implementation, all clinicians will receive payments as per the MIPS (Merit based incentive payments) and Advanced APMs (Advanced alternative payment models). ACO’s can register as APM entities and are eligible to receive payments under Advanced APMs. There is a third category of APM entities which participate in Advanced APMs models but do not meet the threshold of payments and patients set by CMS. Such entities fall into a category that is straddling the line between APM and the MIPS track, called MIPS APM (partially qualifying APM participants). This document discusses about the reporting, scoring and payments for the MIPS APM entities
Mastering MACRA: A Beginner’s Guide to New Reimbursement ModelsCureMD
MACRA is 2 years of work, signed into law in April 2015
Extends the Children’s Health Insurance Program (CHIP) for two more years
Requires Medicare to move away from SSN based Medicare ID numbers
Includes new funding for development and testing of performance measures
Enables new programs and requirements for data sharing
Establishes new federal advisory groups.
(Click the download button for a high-resolution view)
The healthcare transformation from fee for service to fee for outcomes just got an adrenaline shot in the arm April 27th when the Department of Health and Human Services surprised many in the market by announcing a Quality Payment Program, a proposed set of new rules to take effect in 2019 based on key provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
The Latest Regulations, Simplified: MU, PQRS & MIPSathenahealth
Changing governmental regulations for the advancement of healthcare is more than difficult and we have simplified these changes to keep you up to date.
Healthcare Consumerism and Cost: Dispelling the Myth of Price TransparencyHealth Catalyst
The world of healthcare costs is confusing and messy for both patients and providers. Many providers don’t fully understand their costs and therefore struggle to meet the increasing pressure for greater price transparency for consumers. With price transparency rules finalized and implementation looming, many providers are racing against the clock to adapt business practices to meet regulations and communicate the implications to consumers. And each organization’s financial health depends on transparency, as uncertainty about costs keeps many patients from seeking care.
Deb Gordon, seasoned healthcare executive and author of the book, “The Health Care Consumer’s Manifesto: How to Get the Most for Your Money,” and Pat Rocap, Director of Cost Management Services at Health Catalyst, examine the relationship between cost and pricing as the path to transparency for consumers. Deb and Pat provide expert analysis and practical advice to help you become a savvier provider and consumer when it comes to healthcare pricing and spending.
- The implications of federal price transparency regulations.
- The connection between healthcare costing and pricing.
- How to start your organization’s journey to understand costs and why it matters.
- Why price transparency is important to both patients and providers.
Medicare Access and Chip Reauthorization Act (MACRA) is the law that changes how Providers are to be reimbursed. One of the key characteristics is that it rewards Providers based on value and not volume.
PYA Principal Carol Carden and Senior Manager Angie Caldwell presented “Hot Topics in Physician Compensation” at the Kentucky Society of CPAs (KY CPA) Health Care Conference, May 18, 2016. The presentation explored the latest developments in physician compensation structure, as well as considerations related to stacking compensation elements, the role and impact of quality incentives, the latest in affiliation models, and population health initiatives.
Modern Physician-Hospital Affiliations in an Era of Increased Fraud and Abuse...PYA, P.C.
PYA Senior Manager Chris Beckham co-presented “Modern Physician-Hospital Affiliations in an Era of Increased Fraud and Abuse Scrutiny” with Ross Burris of Polsinelli at the American Health Lawyer Association’s (AHLA) Physicians and Hospitals Law Institute, February 8-10, 2016.
Big Data: Implications of Data Mining for Employed Physician Compliance Manag...PYA, P.C.
PYA Consulting Manager Kristen Lilly presented “Big Data: Implications of Data Mining for Employed Physician Compliance Management” during a webinar for the Georgia chapter of the Healthcare Financial Management Association (Georgia HFMA), March 31, 2016.
The presentation explored:
Public relations and litigation risk from the public dissemination of data by the government.
Internal use of broad spectrum analytics in employed physician compliance management.
Determination of risk tolerance and the customization of “outside the box” analytics.
Benchmarking, monitoring, and defining physician-focused risk area reviews.
Patient-Centered Medical Home: Navigating through Recognition and Rewardsathenahealth
Join athenahealth as we delve into Patient-Centered Medical Homes and the complications that come with navigating through the regulations to achieve level three recognition status.
Prepping for CCJR: Lessons Learned in Physician Alignment and Bundled PaymentsWellbe
With CMS’ recent announcement of its Comprehensive Care for Joint Replacement (CCJR) payment model and its plan to implement in seventy-five geographic areas, hospitals must be prepared to manage the entire episode of care from the time of surgery through ninety days after discharge. CCJR presents both opportunities and challenges for hospitals. In order to achieve success, organizations must manage their system of care delivery, ensure they are aligned with their physicians and post acute providers, and master the analytics necessary for driving high quality, low cost care.
MedAssets has worked with numerous providers to implement alignment models that bring hospitals and their physicians together, evaluate, identify, and implement changes to the care delivery system to improve quality and decrease cost across the continuum, and employ meaningful analytics for managing an episode of care.
Kevin Lieb, Senior Director for MedAssets’ Physician Alignment Solutions division, will share examples demonstrating how organizations have successfully implemented Episodes of Care. Mr. Lieb will also share examples from both hospital led and specialist led programs and provide lessons learned from these experiences.
This webinar will enable attendees to do the following:
• Identify alignment models within bundled payments and understand their applicability to your organization
• Understand the analytic capabilities necessary for success in a bundled payment environment
• Identify opportunities and strategies for cost reduction and quality improvement
About the Speaker:
Mr. Lieb has more than 20 years of healthcare-related experience focusing on quality improvement, market development and cost reduction initiatives for the hospital provider market. Mr. Lieb has worked for a number of well-known healthcare companies including GE Medical Systems, HCIA and LBA in Denver, Colorado. His responsibilities included healthcare consulting with a focus on process improvement and quality initiatives.
The Key to Transitioning from Fee-for-Service to Value-Based ReimbursementsHealth Catalyst
The shift from fee-for-service to value-based reimbursements has good and bad consequences for healthcare. While the shift will ultimately help health systems provide higher quality lower cost care, the transition may be financially disastrous for some. In addition, the shifting revenue mix from commercial payers to Medicare and Medicaid is creating its own set of challenges. There are, however, three keys to surviving the transition: 1) Effectively manage shared savings programs to maximize reimbursement. 2) Improve operating costs. 3) Increase patient volumes. With an analytics foundation, health systems will be able to meet and survive today’s healthcare challenges.
Quality and Outcome Framework (QOF) is a voluntary annual incentive programme for GPs in England, detailing practice achievement results. The primary objective of QOF is to drive the quality of primary care and reduce variations in the quality of care amongst GPs
MIPS APM for ACOs: A Hybrid Reimbursement ModelCitiusTech
CMS announced the Quality Payment Program (QPP) final rule in October 2017, stating how it plans to implement the clinician payment changes to QPP, mandated under the Medicare Access and CHIP Reauthorization (MACRA) act. The implementation of the MACRA act impacts different type of organizations, one such being the Accountable Care Organizations (ACOs). ACOs are evaluated for payments on the basis of quality care and the cost factors associated in achieving their quality goals. Post MACRA implementation, all clinicians will receive payments as per the MIPS (Merit based incentive payments) and Advanced APMs (Advanced alternative payment models). ACO’s can register as APM entities and are eligible to receive payments under Advanced APMs. There is a third category of APM entities which participate in Advanced APMs models but do not meet the threshold of payments and patients set by CMS. Such entities fall into a category that is straddling the line between APM and the MIPS track, called MIPS APM (partially qualifying APM participants). This document discusses about the reporting, scoring and payments for the MIPS APM entities
Mastering MACRA: A Beginner’s Guide to New Reimbursement ModelsCureMD
MACRA is 2 years of work, signed into law in April 2015
Extends the Children’s Health Insurance Program (CHIP) for two more years
Requires Medicare to move away from SSN based Medicare ID numbers
Includes new funding for development and testing of performance measures
Enables new programs and requirements for data sharing
Establishes new federal advisory groups.
(Click the download button for a high-resolution view)
The healthcare transformation from fee for service to fee for outcomes just got an adrenaline shot in the arm April 27th when the Department of Health and Human Services surprised many in the market by announcing a Quality Payment Program, a proposed set of new rules to take effect in 2019 based on key provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
The Latest Regulations, Simplified: MU, PQRS & MIPSathenahealth
Changing governmental regulations for the advancement of healthcare is more than difficult and we have simplified these changes to keep you up to date.
Healthcare Consumerism and Cost: Dispelling the Myth of Price TransparencyHealth Catalyst
The world of healthcare costs is confusing and messy for both patients and providers. Many providers don’t fully understand their costs and therefore struggle to meet the increasing pressure for greater price transparency for consumers. With price transparency rules finalized and implementation looming, many providers are racing against the clock to adapt business practices to meet regulations and communicate the implications to consumers. And each organization’s financial health depends on transparency, as uncertainty about costs keeps many patients from seeking care.
Deb Gordon, seasoned healthcare executive and author of the book, “The Health Care Consumer’s Manifesto: How to Get the Most for Your Money,” and Pat Rocap, Director of Cost Management Services at Health Catalyst, examine the relationship between cost and pricing as the path to transparency for consumers. Deb and Pat provide expert analysis and practical advice to help you become a savvier provider and consumer when it comes to healthcare pricing and spending.
- The implications of federal price transparency regulations.
- The connection between healthcare costing and pricing.
- How to start your organization’s journey to understand costs and why it matters.
- Why price transparency is important to both patients and providers.
Medicare Access and Chip Reauthorization Act (MACRA) is the law that changes how Providers are to be reimbursed. One of the key characteristics is that it rewards Providers based on value and not volume.
PYA Principal Carol Carden and Senior Manager Angie Caldwell presented “Hot Topics in Physician Compensation” at the Kentucky Society of CPAs (KY CPA) Health Care Conference, May 18, 2016. The presentation explored the latest developments in physician compensation structure, as well as considerations related to stacking compensation elements, the role and impact of quality incentives, the latest in affiliation models, and population health initiatives.
Modern Physician-Hospital Affiliations in an Era of Increased Fraud and Abuse...PYA, P.C.
PYA Senior Manager Chris Beckham co-presented “Modern Physician-Hospital Affiliations in an Era of Increased Fraud and Abuse Scrutiny” with Ross Burris of Polsinelli at the American Health Lawyer Association’s (AHLA) Physicians and Hospitals Law Institute, February 8-10, 2016.
Big Data: Implications of Data Mining for Employed Physician Compliance Manag...PYA, P.C.
PYA Consulting Manager Kristen Lilly presented “Big Data: Implications of Data Mining for Employed Physician Compliance Management” during a webinar for the Georgia chapter of the Healthcare Financial Management Association (Georgia HFMA), March 31, 2016.
The presentation explored:
Public relations and litigation risk from the public dissemination of data by the government.
Internal use of broad spectrum analytics in employed physician compliance management.
Determination of risk tolerance and the customization of “outside the box” analytics.
Benchmarking, monitoring, and defining physician-focused risk area reviews.
Patient-Centered Medical Home: Navigating through Recognition and Rewardsathenahealth
Join athenahealth as we delve into Patient-Centered Medical Homes and the complications that come with navigating through the regulations to achieve level three recognition status.
Prepping for CCJR: Lessons Learned in Physician Alignment and Bundled PaymentsWellbe
With CMS’ recent announcement of its Comprehensive Care for Joint Replacement (CCJR) payment model and its plan to implement in seventy-five geographic areas, hospitals must be prepared to manage the entire episode of care from the time of surgery through ninety days after discharge. CCJR presents both opportunities and challenges for hospitals. In order to achieve success, organizations must manage their system of care delivery, ensure they are aligned with their physicians and post acute providers, and master the analytics necessary for driving high quality, low cost care.
MedAssets has worked with numerous providers to implement alignment models that bring hospitals and their physicians together, evaluate, identify, and implement changes to the care delivery system to improve quality and decrease cost across the continuum, and employ meaningful analytics for managing an episode of care.
Kevin Lieb, Senior Director for MedAssets’ Physician Alignment Solutions division, will share examples demonstrating how organizations have successfully implemented Episodes of Care. Mr. Lieb will also share examples from both hospital led and specialist led programs and provide lessons learned from these experiences.
This webinar will enable attendees to do the following:
• Identify alignment models within bundled payments and understand their applicability to your organization
• Understand the analytic capabilities necessary for success in a bundled payment environment
• Identify opportunities and strategies for cost reduction and quality improvement
About the Speaker:
Mr. Lieb has more than 20 years of healthcare-related experience focusing on quality improvement, market development and cost reduction initiatives for the hospital provider market. Mr. Lieb has worked for a number of well-known healthcare companies including GE Medical Systems, HCIA and LBA in Denver, Colorado. His responsibilities included healthcare consulting with a focus on process improvement and quality initiatives.
The Key to Transitioning from Fee-for-Service to Value-Based ReimbursementsHealth Catalyst
The shift from fee-for-service to value-based reimbursements has good and bad consequences for healthcare. While the shift will ultimately help health systems provide higher quality lower cost care, the transition may be financially disastrous for some. In addition, the shifting revenue mix from commercial payers to Medicare and Medicaid is creating its own set of challenges. There are, however, three keys to surviving the transition: 1) Effectively manage shared savings programs to maximize reimbursement. 2) Improve operating costs. 3) Increase patient volumes. With an analytics foundation, health systems will be able to meet and survive today’s healthcare challenges.
2015 Physician Fee Schedule Proposed Rule: Value-Based Payments are Here to StayPYA, P.C.
Beginning January 1, 2015, a provider’s payments from Medicare may be increased, decreased, or remain neutral depending on a provider’s scores on quality, efficiency, and outcome measures. More importantly, these scores will impact providers’ reputations with patients, payers, and other providers. For these reasons, providers need to understand and take action to address CMS’ latest initiatives.
Great Basin Primary Care Association: Overview of Patient Centered Medical Home - Standards and Preparation to obtain recognition. This presentation is targeted toward federally qualified health centers and safety net providers (primary care practices) in Nevada. Information current as of 02.25.13.
Understanding the rate at which a business can grow without requiring additional debt is a starting point for assessing the risk inherent in lending to growing businesses. Here we take a look at how to determine a business' sustainable growth rate.
The Next Generation ACO Model team hosted an open door forum on Tuesday, February 28, 2017. During this open door forum Model team members provided a deep dive presentation examining details of financial aspects relating to the model.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Value-Based Purchasing in healthcare is here to stay. Though the industry has come to terms with this reality, there are still more updates and changes than most of us can keep up with. In a world of accountable care, quality measures, shared savings, and bundled payments, everyone seems to have more questions than answers.
Bobbi Brown, Vice President, Financial Engagements outlines the latest announcements on Value-Based and how to prepare your organization for success in this new reality. Having previously worked in healthcare administration and finance for Kaiser, Sutter, and Intermountain, Bobbi is no stranger to translating complex legislative requirements for complex health systems.
Bobbi discusses the various programs offered by CMS, in particular:
What the programs are
How these programs are measured
What the current incentives are
Results of the programs to date
Organizational changes needed for the shift in programs
The many ways in which healthcare reform affects the healthcare industry are still playing out. Undoubtedly, a question for physicians and the hospitals that employ many of them is “how will physician compensation be affected?”
PYA Principal Carol Carden recently spoke at the 2013 AICPA Healthcare Industry Conference, where she addressed this question with her presentation, “Current Reform Initiatives and Their Impact on Physician Compensation.”
Why You Need to Understand Value-Based Reimbursement and How to Survive ItHealth Catalyst
There are clear signs the healthcare industry is in the midst of a shift to value-based reimbursement. The most noticeable signs are the recent and proposed 2015 rulings from CMS. There are four areas in value-based reimbursement that will be impacted by the end of 2015: the physician payment structure, bundled payments, Inpatient Prospective Payment Systems regulations, and commercial payers. To survive the shift to value-based reimbursement, it’s important for providers and payers to take three steps: provide access to rich data, share knowledge and learn from each other, develop strategies by doing assessments.
SlideShare now has a player specifically designed for infographics. Upload your infographics now and see them take off! Need advice on creating infographics? This presentation includes tips for producing stand-out infographics. Read more about the new SlideShare infographics player here: http://wp.me/p24NNG-2ay
This infographic was designed by Column Five: http://columnfivemedia.com/
No need to wonder how the best on SlideShare do it. The Masters of SlideShare provides storytelling, design, customization and promotion tips from 13 experts of the form. Learn what it takes to master this type of content marketing yourself.
10 Ways to Win at SlideShare SEO & Presentation OptimizationOneupweb
Thank you, SlideShare, for teaching us that PowerPoint presentations don't have to be a total bore. But in order to tap SlideShare's 60 million global users, you must optimize. Here are 10 quick tips to make your next presentation highly engaging, shareable and well worth the effort.
For more content marketing tips: http://www.oneupweb.com/blog/
MACRA Proposed Rule: Issues & OpportunitiesPolsinelli PC
A proposed rule implementing the 2015 Medicare Access and CHIP Reauthorization Act (MACRA) outlines changes to the Medicare program to migrate from payment for volume to arrangements linked to quality and value. This webinar will review key provisions of the proposed rule and their impact on existing and future payment structures, including key issues, opportunities, and potential areas for comment and modification before the rule is finalized.
On our agenda:
-MACRA background and policy objectives expressed in proposed rule
-Changes to existing Medicare reimbursement programs
-Merit-Based Payment Incentive System (MIPS) program proposals
-Alternative Payment Models (AMP) proposals
-Implications, opportunities, and issues under the proposed rule
Due to popular demand, the Comprehensive Primary Care Plus (CPC+) team hosted a repeat of the webinar that was originally held on Wednesday, April 27, 2016. During this webinar Model team members provided an overview of the model specifically for interested payers.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Due to popular demand, the Comprehensive Primary Care Plus (CPC+) team hosted a repeat of the webinar that was originally held on Thursday, April 21, 2016. During this webinar Model team members provided an overview of the model specifically for health IT vendors.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Guidebook to Medicare Access and CHIP Reauthorization Act of 2015 dispels MACRA myths and puts you in the know with easy-to-follow guidance. Interpret MACRA changes with step-by-step advice to understand and master MACRA’s final rule.
The Center for Medicare & Medicaid Services hosted a webinar on Thursday, April 14, 2016. During this webinar staff provided an overview of the model. A repeat of the webinar was held on Tuesday, April 19.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Meaningful Use: Programs, Penalities, and PaymentsBen Quirk
Meaningful Use is not dead!
MIPS may be just around the corner, but MU is still very much in the picture. There is enough time, however, for your practice to optimize 2016 reporting and increase 2018 payments and avoid penalties.
This presentation takes you through the steps needed to successfully attest for 2016 and be prepared for upcoming changes.
The CMS Innovation Center hosted a special webinar featuring Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer, on Monday, November 10, 2014 from 10:30am – 11:30 am ET. Dr. Conway will provided an update about the work of the CMS Innovation Center and the models being tested to improve better care for patients, better health for our communities, and lower costs through improvement for our health care system. Opportunities for questions were provided.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
An unexplored yet most valuable system in US Healthcare setting. Get a basic understanding about the program and gain an understanding of how to get benefited out of it.
PYA Principal Martie Ross joined University of Kansas Medical Center’s Robert Moser, MD, and CIO Chris Hansen for the keynote presentation at the joint symposium by Heart of America Healthcare Information and Management Systems Society and Missouri Health Information Management Association, September 14, 2016, at Johnson County Community College in Overland Park, Kansas. They discussed insights related to the role of advanced analytics and technology in transforming and transitioning to new payment models.
NYU Langone Medical Center’s TJA BPCI Experience: Lessons in How to Maximize ...Wellbe
The Bundled Payments for Care Improvement (BPCI) Initiative began generating data in January of 2013. Dr. Iorio will outline the challenges and benefits of implementing BPCI for Total Joint Arthroplasty at an urban, tertiary, academic medical center with a hybrid compensation model. Early results from the implementation of a Medicare BPCI Model 2 primary TJA program demonstrate cost-savings with an improvement in quality of care metrics and continued cost savings through year 3 of our experience. Changes in patient optimization, care coordination, clinical care pathways, and evidence-based protocols are the key to improving the quality metrics and cost effectiveness within the implementation of the Bundled Payment for Care Initiative, thus bringing increased value to our TJA patients.
Maximizing Value in a Bundled Environment – Keys to Success:
• Evidence based, cost effectiveness analysis
• Standardized protocol adoption
• Transparent data
• Perioperative Patient Optimization
• Care management
• Physician-hospital alignment with Gain sharing
• Enhanced pain relief and rehabilitation protocols
• Blood management and rational VTED prophylaxis
About the Speaker:
Richard Iorio, MD, is the William and Susan Jaffe Professor of Orthopaedic Surgery at New York University Langone Medical Center Hospital for Joint Diseases and Chief of Adult Reconstruction at NYU Langone HJD. He co-founded Labrador Healthcare Consulting Services, Responsive Risk Solutions, and the Value Based Healthcare Consortium in 2015. He is a member of the Board of Directors for LIMA, the Lifetime Initiative for the Management of Arthritis. Dr. Iorio is a national expert in physician and hospital quality and safety and a leader in the implementation of alternate payment paradigms in orthopaedic surgery.
Performance and Reimbursement under MIPS for OrthopedicsWellbe
The 2015 MACRA legislation fundamentally changed the way in which providers are paid for their services. It also provides some relief from the “all or nothing” approach used by Meaningful Use.
This session, a review of the Final Rule published on Oct 14, 2016, conveys a practical approach to maximizing reimbursement under MIPS while reducing burden on clinical staff.
After this session, attendees will have a firm grasp of:
– the major components of the Quality Payment Program
– operational strategies for measure selection
– orthopedic-specific quality measures
About the Speaker:
karenclarkKaren R. Clark is chief information officer for OrthoTennessee, where she has worked since 1998. In that role, she serves on national committees for the Healthcare Information Management Systems Society (HIMSS.) A HIMSS Fellow and Certified Professional in Healthcare Information and Management Systems, her current HIMSS committee is the HIT User Experience, which focuses on clinician experience with health information technology.
She has spoken at the AAOE, AAOS and OrthoForum conferences on both information security and the 2015 MACRA legislation, specifically on the Merit Based Incentive Payment System (MIPS.). She is a member of the College of Healthcare Information Management Executives (CHIME) as well as the CIO/CMIO Council with the American Medical Group Association.
After graduating from American University with a degree in marketing in 1979, she joined Brooks Brothers in New York, where she was a buyer. She earned her MBA in finance from Fordham University in 1984. She moved to Knoxville in 1988 and joined Watson’s as director of planning and distribution when her husband, Brooks, was recruited from Sports Illustrated to Whittle Communications. They have two adult daughters, Isabel, and Olivia.
Speaker presentation from U.S. News Healthcare of Tomorrow leadership summit, Nov. 17-19, 2019 in Washington, DC. Find out more about this forum at www.usnewshot.com.
Quality Payment Program (MACRA) Proposed RuleMick Brown
The Quality Payment Program, established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), began in 2017, known as the transition year. The Program’s main goals are to:
Improve health outcomes.
Spend wisely.
Minimize burden of participation.
Be fair and transparent.
The Quality Payment Program has 2 tracks: (1) The Merit-based Incentive Payment System (MIPS) and (2) Advanced Alternative Payment Models (Advanced APMs).
Because the Quality Payment Program brings significant changes to how clinicians are paid within Medicare, the Centers for Medicare & Medicaid Services (CMS) is continuing to go slow and use stakeholder feedback to find ways to streamline and reduce clinician burden. CMS has engaged more than 100 stakeholder organizations and over 47,000 people since January 1, 2017 to raise awareness, solicit feedback, and help clinicians prepare to participate. Based on stakeholder feedback, CMS established transition year policies from the clinician perspective, such as:
Giving clinicians the option to choose how they’ll participate (also known as Pick Your Pace).
Having a low-volume threshold that exempts many clinicians with a low volume of Medicare
Part B payments or patients.
Allowing flexibilities for clinicians who are considered hospital-based or have limited face-to-
face encounters with patients (referred to as non-patient facing clinicians).
As the Quality Payment Program moves into the second year, CMS wants to ensure that there is meaningful measurement and the opportunity for improved patient outcomes while minimizing burden, improving coordination of care for patients, and supporting a pathway to participation in Advanced APMs.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
2. Background
2
MACRA permanently eliminates the
SGR (and annual rate cuts)
Consolidates Medicare PQRS, MU,
VBM reporting programs
Establishes a path to predominant
Value-Based payment methodologies
Passed in Senate 92-8; Passed
in House 392-37
3. Fears
3
Medicare projects 70% of rural practices
with 2-9 docs will be penalized via MIPS
50% of non-pediatric physicians have
never heard of MACRA
MIPS program is budget neutral;
penalized providers will pay rewards
for other providers
It is widely reported MACRA will force
further consolidation
4. MIPS: National Financial Impact
4
• MIPS is Budget Neutral
• Government expects $833 million will be redistributed
• Additional $500 million in bonuses for top performers
7. QPP: MIPS? APM? Both….
7
Merit Incentive Based Payment
System (MIPS)
Default Program (≈90% of Medicare
Providers): A portion of Medicare
Revenue at the TIN/Individual Provider
Level is at risk based on the following
performance categories:
Alternative Payment Models (APMs)
Generic term for providers who receive
significant revenue through 2-sided risk-
based contracts.
Currently Proposed Options:
• Medicare Shared Savings Program
(MSSP) Tracks 2 & 3
• Next Generation ACO
• Oncology Care Model Two-sided Risk
Arrangement (Available 2018)
• Comprehensive End-Stage Renal Disease
Care (CEC) Model
8. Ultimate Goal: APM’s
8
• Requires:
• “More than nominal” Risk
• Quality measurement
• Very advanced Value-
Based Design
(Technology, Analytics,
Workflow, Contracts, etc.)
• Provides:
• Prospective 5% Lump-
Sum annual bonus in
2019-2024
• Exemption from MIPS
requirements
2019
–
2020
2021–
2022
25% N/A
50%
N/A 25%
50%
OROption 1 Option 2
Required for All
Providers
2023
and
on
75%
N/A 25%
75%
Required Percentage of Revenue
Under Risk-Based Payment Models
Option 1
Medicare Only
Option 2
Medicare +
Commercial
Contracts
9. Current Focus: MIPS
9
• MIPS is the Default Program;
AKA New Medicare FS
• CMS anticipates 90% of all
physicians will be paid via MIPS
in 1st year of the Quality Payment
Program (QPP)
• Adjusts Medicare payments
based on performance on a
single budget-neutral payment
beginning in 2019 (2-year Look-
Back)
• Applies to physicians, NPs,
clinical nurse specialists,
physician assistants, and
certified RN anesthetists
10. MIPS: Composite Performance Scores
10
4 Categories = 100%
1. Quality = 50%
2. Advancing Care Information = 25%
3. Clinical Practice Information Activities = 15%
4. Cost = 10%
13. MIPS Category: Quality (50% Yr 1 MIPS Score)
13
From 9 PQRS Measures to 6 total Measures
During Open Comment period, many pushed towards specialty and
practice-specific measures
Final Rule to show many changes
Focus today on ability to incorporate 6 measures into workflow
14. MIPS Category: ACI (25% Yr 1 MIPS Score)
14
Key Takeaways:
High, historical MU compliance does not guarantee a high ACI score.
Unlike Historical MU, ACI Scoring is a CONTINUOUS scale, Not All-Or-Nothing
• Replaces Meaningful Use
• Potential to Participate as a group (If Final Rule allows)
• Advanced Practice Providers – exempt (Midlevels, NPs, PAs, etc.)
• Split Into Base Score & Performance Score
• Proposed Rule = Complicated Scoring (130 total points, only 100
needed to earn full score in ACI category)
15. ACI Base Score (50 Points)
15
6 Objective and Measure Categories
1. Protect Patient Health Information - Y/N (Required)
2. Patient Electronic Access - N/D
3. Coordination of Care & Patient Education - N/D
4. Electronic Prescribing - N/D
5. Health Information Exchange – N/D
6. Public Health/Registry Reporting – Y/N
*N/D = Numerator/Denominator
16. ACI Performance Score (80 Points)
16
3 Objective and Measure Categories
1. Patient Electronic Access - N/D
2. Coordination of Care & Patient Education – N/D
3. Health Information Exchange – N/D
** Immunization Registry – Mandatory
** Bonus Point – Pub Health reporting beyond immunizations
* N/D = Numerator/Denominator
17. MIPS Category: Clinical Practice
Improvement Activities (15% of MIPS Score)
17
* Max Score = 60
* PCMH Participation Guarantees 100%
CPIA Score
* Largely Undefined Currently
* Secretary shall give consideration to
practices <15 Eps, rural practices, and Eps
in underserved areas
90 Proposed activities – 9 Categories
1. Expanded Practice Access
A. After hours hotline
B. Same-day appointments
2. Beneficiary Engagement
A. Care Plans
B. Self-assessment training
C. shared decision-making, etc.)
3. Achieving Health Equity
4. Population Health Management
1. Qualified clinical data registry
2. Monitoring conditions
5. Patient Safety & Assessment
1. Use of Surgical Checklists
2. Assessments related to maintaining Certifications
6. Emergency Preparedness & Response
7. Care Coordination
8. Participation in Advanced APM or Medical HomeModel
9. Integrated Behavioral Health
18. MIPS Category: Cost (10% 1st Yr MIPS Score)
18
1. Replaces cost component / resource use of VBMP.
2. Scored on Medicare claims = NO REPORTING.
3. 40 specific episode measures – among specialists.
4. Must see at least 20 patients in respective category.
5. Each cost measure max out at 10 points.
20. Key Questions & Suggestions
20
Key Questions
1. Do you use CEHRT (Certified EHR Technology)?
2. Do you feel comfortable with your reporting process? (Proposed Full-year
reporting)
3. Do you know the measures your EHR is capable of reporting? (These metrics will
become public under MACRA) http://oncchpl.force.com/ehrcert
Key Suggestions
1. Stay familiar with CMS’ Core Measures as CMS & AHIP agree to harmonize
metrics
2. Improving your PQRS reporting process will pay dividends
3. 2017 Reporting Year will be 50 % PQRS & 25% ACI (Formerly Meaningful Use)
4. Download QRUR
5. Prepare to adjust workflows
6. Focus resources on specific PQRS measures. Identify workflow adjustments
7. Assess EHR/technological capability to comply
21. Strategic Plan
21
1. Short-run: Focus on Coding, PQRS Workflow, Care-Coordination
(CCM 99490), Chronic Care management, CPC+*, analytics
2. Long-Term: Learn via MIPS; Prepare APM contracts by expanding
to MA plans, then commercial FFV arrangements
3. Educate staff on initiatives
A. Many metrics involve strong communication & non-physician
reporting processes
B. Cultural change management in pursuit of Triple Aim
4. Establishing a CIN provides the architecture to strategically step
towards value-based payments to shift from MIPS to APMs & receive
further incentive-rewards
* CPC+ (Comprehensive Primary Care Plus) Regions are to be announced August 1, 2016
23. Acronyms Reference Guide
23
• ACO – Accountable Care
Organization
• APM – Advanced Alternative
Payment Model
• CMS – Centers for Medicare &
Medicaid Services
• CPC+ – Comprehensive
Primary Care Plus
• EHR – Electronic Health
Record
• EP – Eligible Professional
• HHS – U.S. Department of
Health & Human Services
• MACRA – The Medicare Access
and CHIP Reauthorization Act of
2015
• MIPS – Merit-Based Incentive
Payment System
• MSSP – Medicare Shared
Savings Program
• PQRS – Physician Quality
Reporting System
• QPP – Quality Payment Program
• QRUR – Quality and Resource
Use Report
• VBPM – Value-Based Payment
Modifier
24. Summary: Merit Health QPP Plan
24
1. More education for members
2. Continue CIN objectives
3. Analytics implementation
4. More clinical workgroups
5. Analytics support
6. Partnership