Fee for Service (FFS) reimbursement is going the way of the dinosaurs, but many providers are ignoring the signals. Here are two clear indicators: Medicare’s adoption of episodic cost models and the planned movement to financial risk models for both Medicare and Medicaid. Indeed, most Medicaid plans have now transitioned the majority of beneficiaries into […]
The 2018 Quality Payment Program Final Rule: What You Need to Know
Halloween may be over, but CMS has given us one more scare—a 1,653-page Final Rule for Year 2 of the Quality Payment Program. The Proposed Rule represents the next phase of the transition into a full-fledged Quality Payment Program. For eligible providers, more is required to avoid penalties, but CMS has defined the process to […]
Providers Should Believe in Health Care Cost Control Now—If They Want to Stay in Business
Despite MACRA and other Value-Based Health Care efforts, many health care providers believe that controlling health care costs is impossible to do. They cite lack of comprehensive data about their patients and where they obtain services, and lack of control of patients’ decisions. But the real issue that providers have with cost control is much […]
What the Dog Show Taught Me: Performance Improvement Is Not Just Science, But Art
Last week I attended the Bearded Collie Club of America National with my two highly energetic and driven dogs, along with about two hundred other competitors. A calm vacation it was not. My dog athletes enjoyed multiple days of performance competition, capped off by show competition. For people who believe dogs are pets and don’t […]
If Federal Policy Can’t Improve Health Care, What’s Next? 5 Trends to Track
Health care has been extraordinarily resistant to change. Escalating costs have been at issue since the early 1980s—think about it!—but continue to rise unabated. Ask anyone participating in the system, be they physicians or other health care providers, payers or patients, and you will be inundated with complaints about health care economics, outcomes or processes. […]
Physician-Patient Interaction: Where We Should Begin to Measure and Improve Medicine
Data is not always the path to identifying good medicine. Quality and cost measures should not be perceived as “scores,” because the health care process is neither simplistic nor deterministic; it involves as much art and perception as science—and never is this more the case than in the first step of that process, making a […]
Physicians Aren’t Engaged in Performance Because Measure Results Aren’t Real
According to management guru Peter Drucker, “If you can’t measure it, you can’t fix it.” Quality measurement and reporting have been rooted in similar reasoning. The idea is that we find out what’s wrong, and then we launch programs to improve it. That’s the linear route mapped out by Medicare starting with Meaningful Use, PQRS […]
Can Academic Medical Centers Be a Force for Health Care Reform?
Can Academic Medical Centers (AMCs) survive Value-Based Health Care and its metamorphosis to financial risk? That’s the question many industry watchers have been asking for several years, as margins have slimmed and some university-based programs have sold off their facilities and physician groups to private interests. But a number of economic and policy impacts are […]
CMS Eliminates Episode Groups in MIPS Cost Tracking for 2018—But Providers Should Not
It’s no surprise that Cost is one of the most significant targets of Medicare Value-Based Health Care initiatives, as well as those in the private sector. So it was a real surprise last month to learn that CMS would delay weighing Cost as a component of MACRA MIPS total scoring. Equally significant is the CMS […]
How to Evolve MACRA MIPS Quality Reporting for Better Physician and Patient Value
Critics are pushing back against Medicare quality reporting, deeming it burdensome and time-consuming to meet confusing quality measures. One survey asserts that barely a majority feel knowledgeable about MACRA or prepared to achieve long-term success. Indeed, CMS is pulling back on program requirements, with the stated desire of making it easier for physicians. So, here’s […]