The Healthmonix Advisor

MIPS Scores Impact More Than Medicare Revenue, Commercial Payers Are Following Suit

Posted by Shannon Scott on August 8, 2019

Since 2017, the Centers for Medicaid and Medicare Services (CMS) Merit-Based Incentive Payment System (MIPS) has provided eligible clinicians a score of zero -100 annually based on the clinician’s efforts and data collection in four program categories: Quality, Improvement Activities, Promoting Interoperability, and Cost. A clinician’s final score for each year’s MIPS performance ultimately dictates a payment adjustment that is applied to his or her Medicare Part B reimbursement rate two years later. In practical terms, this means that a clinician’s 2017 performance impacts all of his or her Medicare claims that are filed in the 2019 calendar year.

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Topics: PRO Tips, MACRA & MIPS, Industry insights, VBC, ROI

MIPS Hacking for Psychologists: Turbo-boost your ROI With This One Simple Trick.

Posted by Mike Lewis on August 1, 2019

In last week’s blog I laid out the case for opting into MIPS, an option that allows clinicians and groups to still receive a MIPS payment adjustment if they exceed 1 or 2, but not all, elements of the low-volume threshold. Although this option can be beneficial for a wide range of clinician types depending on their situation, today I want to focus on psychologists in particular. Because in my experience, they provide some of the most striking examples of this “MIPS hack” in action.

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Topics: PRO Tips, MACRA & MIPS, Eligibility, Small Practice, VBC, ROI

MIPS Hacking: Why the MIPS Opt-In Policy Could Seriously Boost Your Bottom Line.

Posted by Mike Lewis on July 25, 2019

Beginning in 2019, otherwise-eligible clinicians, groups, and APM entities can elect to opt-in to MIPS if they exceed 1 or 2, but not all, elements of the low-volume threshold. That means that for the first time, these previously ineligible clinicians have the opportunity to participate in the QPP and earn a payment adjustment.

Now maybe you haven’t had the time to pay close attention to policy minutiae, and this is the first you’re hearing of the opt-in option. Or maybe you’ve heard of it, but haven’t looked seriously at what it could mean for you or your organization. After all, on the surface it just sounds like work that isn’t required--and could it really make enough of a difference to your bottom line to be worth it?

Well, we highly recommend you do the math to find out. Because depending on your situation, you might be very, very glad you did.

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Topics: PRO Tips, MACRA & MIPS, Eligibility, Small Practice, VBC, ROI

CMS To Launch New Payment Models For Value-Based Transformation

Posted by Christina Zink on April 26, 2019

On April 22, the U.S. Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) announced the CMS Primary Cares Initiative, a new set of payment models that are part of HHS Secretary Alex Azar’s value-based transformation initiative. The CMS Primary Cares Initiative will be administered through the CMS Innovation Center. CMS expects the new programs to shift at least one quarter of people in traditional Medicare out of fee-for-service.

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Topics: CMS, Policy, VBC

CMS Announces $1M Artificial Intelligence (AI) Health Outcomes Challenge

Posted by Christina Zink on March 28, 2019

The future is here!

This Wednesday, the CMS Innovation Center, in collaboration with the American Academy of Physicians and the Laura and John Arnold Foundation, announced the Artificial Intelligence (AI) Health Outcomes Challenge to predict unplanned hospital and skilled nursing facility admissions and adverse events.

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Topics: CMS, Health IT, VBC

Three Steps Organizations Can Take to Foster a Patient-Centric Experience

Posted by Christina Zink on December 21, 2018

Patients want to be treated with dignity and respect. And when they are, as the American College of Physicians (ACP) points out in a recent position paper on patient engagement, they are more likely to interpret their experience as a quality care encounter. Organizations can improve outcomes and adherence to care plans by helping patients and families feel central to their own care experience, and research even suggests that patient experience is a more important factor in patient loyalty than standard marketing efforts.

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Topics: PRO Tips, Hospitals & Health Systems, VBC

The Problem of Patient Matching: New Pew Report Details Recommendations

Posted by Christina Zink on October 11, 2018

In the pursuit of value based care, interoperability is key. But is it achievable in the current healthcare landscape? And if not, what would we have to do to bridge that gap?

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Topics: Interoperability, VBC

Value-Based Care: Stalled But Here To Stay

Posted by Christopher Jayne on August 3, 2018

 

If you keep up to date about healthcare payment model trends, you may have noticed a newly re-ignited concern about the future of value-based care. A recent Quest Diagnostics survey highlighted perceptions that physicians lack the tools to succeed under the payment model, and that payers and providers are not well aligned in this endeavor. The survey further showed that over two-thirds of health plan executives and physicians believed the U.S. has a fee-for-service healthcare system versus a value-based care system. Overall, the study concluded that physicians and health plan executives perceive that progress toward value-based care has stalled.

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Topics: Industry insights, VBC

Hospital at Home: High Quality Care Outside of the Hospital

Posted by Christopher Jayne on July 5, 2018

I was intrigued by a recent Becker’s article which outlines the results of Mount Sinai’s use of the “Hospital at Home” model for acute care. According to the article, patient experience showed improvement and readmission rates were noticeably lower. I had to know more, so I decided to do some research into exactly what this model of care looks like.

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Topics: Industry insights, VBC

Revenue Cycle Management: A Key To Success in MIPS, MACRA, and VBC

Posted by Christopher Jayne on March 22, 2018
As MACRA barrels into its second full year of implementation, we’re noticing mixed reactions to the reporting process. Some practices and organizations have thrown their best efforts into reporting and earning an incentive, while others are only interested in finding the easiest way to get compliant and avoid any penalty on their Medicare Part B reimbursements.
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Topics: PRO Tips, MACRA & MIPS, RCM, VBC