COVID-19Merit-Based Incentive Payment System (MIPS)Quality Payment ProgramValue-Based Health Care
August 5, 2020

“Push-Pull” for Providers in Medicare’s Proposed 2021 Rule for Physician Fees and Quality Reporting

The newly published 2021 CMS Physician Fee Schedule and Quality Payment Program (QPP) Proposed Rule reflects our harsh reality: Operate under the constraints of the COVID-19 pandemic, while moving toward uniformity and Risk. That tension is palpable in the Proposed Rule’s "push-pull" of CMS trying to continue to advance a Value agenda while stuck in the mud of the pandemic. Rather than launching the next step of integrating CMS quality improvement activities, the Proposed Rule stays the current course for MIPS Quality Reporting to avoid additional stress on providers during the COVID-19 pandemic. But the Proposed Rule also continues to…
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Episodes of CareFuture of Health CareRiskValue-Based Health Care
July 20, 2020

Episodes Are More Than Payment Models: They’re Key to Improving Care

For many health systems and groups, episodes are esoteric. Providers often think of them only in context of risk-based payment models like bundled payments and capitation. Navigating Value-Based Health Care contracts, providers analyze and model performance under Fee-for-Service and episode-based payments to decide their course of action. Or, if already in Value-Based reimbursement, they use them as targets for costs to pinpoint physicians who exceed the targets. These strategies are shortsighted and limited. Even at best, they do nothing to address what is actually driving cost of care. By using payer-constructed episode specifications, such strategies potentially obscure valuable clinical and…
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Future of Health CarePopulation HealthRacial Inequities in Health CareValue-Based Health Care
July 1, 2020

How to Start Redressing Racial Bias and Reducing Health Care Inequities

In recent weeks there have been many cries for the health care system to finally address racial inequities. Now is the moment to harness that energy toward a process of substantive change. Value-Based Health Care is not achievable without addressing racial inequities that drive costs and poor outcomes: patient disengagement, higher risk factors, greater admissions, and emergency room usage. Fully acknowledging the issues is the first step. Creating better methods to evaluate how race affects decisions and to innovate change is the next. Racial inequities in health care in the U.S. are well documented, including: Higher maternal mortality, with Black…
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COVID-19Merit-Based Incentive Payment System (MIPS)RiskValue-Based Health Care
June 26, 2020

The Fallacy of “Relief”: The Dangers of MIPS Extreme and Uncontrollable Circumstances Applications

Under the banner of “relief,” CMS has announced that clinicians will have the opportunity to file an Extreme and Uncontrollable Circumstances  application to qualify for re-weighting in some or all components of the Merit-Based Incentive Payment System (MIPS). This possibility may sound intriguing, but don’t be fooled—those who take this route are overlooking the longer-term consequences of maintaining and expanding MIPS efforts. MIPS Is Not Going Away The day before releasing 2020 MIPS flexibility guidance, CMS announced the creation of the Office of Burden and Health Informatics, which has grown out of the Patients Over Paperwork initiative. In this notice…
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Consumers & PatientsCOVID-19Future of Health CarePopulation Health
June 11, 2020

Is Telehealth Bridging or Widening the Health Care Gap? We Need to Find Out.

ROJI Health Intelligence CEO Theresa Hush frames the questions we need to ask about the future of telehealth in this 3:37 minute video. Telehealth has become the go-to solution for health care during the COVID-19 pandemic, enabling providers and consumers to remain in contact for routine and non-emergency visits while brick-and-mortar spaces have been closed. Now that health care is reopening, however, telehealth remains a preferred communications medium, and many providers plan to expand it much more going forward. So, it’s time to ask: Are the services we are offering through telehealth really delivering the best health care possible? And,…
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COVID-19Future of Health CareRacial Inequities in Health Care
June 3, 2020

A Pandemic Recovery for Health Care Means Addressing Racial Inequities

Health systems, eager to bring patients back, are using new methods to reach out—mass emails to reassure patients of clean and safe facilities, targeted phone calls to reschedule cancelled appointments and procedures, broadcast television announcements and social media ads that strive to convince patients not to defer care any longer. Providers hope they can recover by encouraging their patients to return. But the pandemic has changed the landscape in health care, in ways that health systems didn't expect. Significantly, it has laid bare the fact that Black Americans are dying in far larger numbers from COVID-19, driven by more severe…
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COVID-19Future of Health CarePopulation HealthSpecialty Services
May 14, 2020

Size is Now a Problem That Large Hospitals and Health Systems Must Solve

For two decades, consolidation in health care has been a strong industry trend. Championed by hospitals and hospital-organized systems, care is now less independent and more centralized, especially in urban settings. Widespread acquisitions of physician practices and towers of specialty services, diagnostics, and treatment seem to have forever changed the health care landscape. But in the era of COVID-19, that configuration of big health care is proving to be a problem. Large systems started turning off the spigot of specialty and non-essential services almost immediately once the community spread of COVID-19 became apparent. As these organizations now try to entice…
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ACO ReportingCOVID-19RiskValue-Based Health Care
May 6, 2020

The Interim ACO Rule Explained: A Pause, Not a Reprieve

As the coronavirus pandemic continues to upend health care in the U.S., pressure has mounted on CMS to adjust its efforts to drive providers to adopt risk. In response, at the end of last week CMS announced a carve-out of COVID-19 patient expenses from certain reporting requirements. In this round, ACOs were on the receiving end, being largely excused from remaining 2019 reporting and 2020 enrollment obligations. True to our predictions, this will slow, but not reverse CMS’s ultimate agenda to push providers to manage under risk. Those who interpret the Interim Rule as a reprieve will do so at…
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COVID-19Future of Health CarePopulation Health
April 29, 2020

Restarting “Regular” Health Care Will Be Hard: How Providers Can Prepare Now

As states across the country begin to loosen restrictions for the coronavirus pandemic and return to a modified version of normal life, how will our health care system get back to providing regular care? In particular, how can providers pivot from the scale and aftereffects of COVID-19, and bring their patients back? In hot spot areas, that task will also require healing their own organizations. COVID-19 has upended traditional care delivery and revised priorities for patient care. It has changed status of providers and foisted enormous stress on front line staff, to the point of serious trauma and even suicide.…
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ACOsCOVID-19Future of Health CareValue-Based Health Care
April 15, 2020

Stretched to the Limit by COVID-19, Will Providers Get Relief from Medicare Value-Based Programs?

This article originally appeared in the April 2020 edition of Accountable Care News . COVID-19 continues its inexorable, exponential spread here in the U.S. Hospitals in New York City, now accounting for more than 7 percent of confirmed cases worldwide, have less than a quarter of the critical equipment and supplies needed to serve an overwhelming surge of patients. Our health care providers are facing impossible choices, even considering universal Do Not Resuscitate orders for patients with COVID-19. Less than one month ago, CMS was closing applications from providers willing to be part of a major movement to adopt financial…
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