Healthcare

In our blog last week on the October 14, 2016 MACRA Final Rule with Comment Period (Final Rule), we began a series on topics of interest from the Final Rule, particularly those representing departures from the Proposed Rule, to summarize the decision in the Final Rule.

MACRA repealed the much maligned Sustainable Growth Rate (SGR) formula and replaced it with the Quality Payment Program, made up of two avenues to reward delivery of high quality patient care: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs).

With the release on October 14, 2016 of the Final Rule with Comment Period (Final Rule) for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), titled Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models [CMS-5517-FC], the healthcare industry received some much-awaited clarity around the May 9 Proposed Rule.

When Congress passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), “risk” moved front and center as a feature of provider reimbursement models. These days, we’re using terms such as “at risk” and “risk-based” more and more, but what do they really mean? And why should healthcare providers be more concerned with risk now than they have been in years past?

Shared savings arrangements began as a key component of the Medicare delivery system reform initiatives included in the Affordable Care Act, the intent being threefold: to generate better care for individuals, to generate better health for the population, and to lower growth expenditures. To participate in a Medicare shared savings arrangement, eligible providers and suppliers are required to form an accountable care organization (ACO).

This commentary originally appeared September 20 on the HORNE Cyber Blog.

A breach of a healthcare provider can have a serious impact, both in terms of financial loss and patient confidence. HIPAA violations can involve fines of up to $50,000 per patient record, and in many cases, attackers are able to access all of a provider’s patient records.

Did your hospital’s outpatient department begin operations, expand its service lines or relocate after November 2, 2015?

Is the following statement true or false? The new revenue recognition standards will have only a minimal effect on my accounting practices and policies.

Return on investment. It’s something every business calculates—from marketing efforts to large equipment purchases to capital improvements. We want to know if our investments in the business are paying off.

In a move that was widely applauded by medical groups such as the Medical Group Management Association, the American Medical Association, and the American Academy of Family Physicians, CMS announced that it is making the start of MACRA implementation more flexible next year. Although the performance evaluation period may be delayed, the start of payment changes will not be delayed.

The introduction of the dual track Quality Payment Program within the MACRA proposed rule has many healthcare systems considering their options. My most recent blog focused on the MIPS track of QPP, so today I will focus on an overview of Advanced Alternative Payment Models. 

There’s no denying it—healthcare data has gone digital. The days of paper health records are fast disappearing, and if the Centers for Medicare & Medicaid Services have their way, we won’t be going back. CMS has built meaningful use of electronic health records into its plans for a number of years, and the healthcare industry is responding.

Think back to your last car, truck or SUV purchase. What did you want to know before spending so much money?

More than likely, you wanted to know the price range of the type of car you were considering. You might have wanted to know what features were standard on different makes and models. You might even have identified one or two features that you couldn’t live without, and that helped you narrow your choice. You aIso might have wanted to know where to find the best financing. If you’re tech savvy, you probably found much of the information you needed online—even in a single app or website. In recent years, our collective consumer needs have changed the way we buy cars. In fact, consumer preferences have changed the way we buy most things—even healthcare.

There is growing recognition that the social determinants of health—where we live, work, and play; the food we eat; the opportunities we have to exercise; our ability to live in safety—drive health outcomes. Of course, there is a large role for health care to play in delivering health care services, but it is indisputable that the foundation of a healthy life lies within the community. To manage true population health—that is, the health of a community—hospitals and healthcare systems must partner with a broad spectrum of stakeholders who share ownership for improving health in our communities.