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 […]
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 […]
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, […]
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 […]
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 […]
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 […]
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 [PDF download]. 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 […]
Value-Based Care Defined: Know the Vocabulary of Health Care Reform
Today, as we confront a viral threat that is challenging our health system, its capacity, and how care is financed, it seems appropriate to review some fundamentals. Health care reform has been speeding down a particular track, changing how health care is covered, paid, delivered, and organized. These reforms may seem to be about health […]
ACO Path to Viability: Direct Contracting May Be the Opportunity
What if your best route to viability was the high-risk path you feared the most, because that failure might destroy you? That’s the question Accountable Care Organizations (ACOs) have been asking this week—whether to participate in Medicare’s new Direct Contracting (DC) initiative. With a shift in payments from Fee for Service (paid per-provider service), to […]
Could AI Push Sales of Personal Health Data? How to Protect Consumers While Advancing Science
We are just beginning to see the power of Artificial Intelligence (AI) in medicine and management of conditions. AI is being used to enhance and speed diagnostic capabilities in conjunction with wearable devices as well as to identify health care cost issues and high risk patients. Companies, health care providers, and researchers hoping to move […]