Healthmonix Advisor

The tracks of the Medicare ACO model vary greatly, but have been steadily gaining in prevalence since their launch in 2011. Despite the steady increase in ACO participation, most groups are staying at the Track 1 level. In fact, in 2018, 460 of the 649 ACOs existed at the Track 1 level.

The new proposed rule for 2019 features a lot of changes to the Quality Payment Program, but CMS has also announced changes impacting Medicare reimbursement in general. One big change proposed would affect how much money a clinician receives for billing office or outpatient Evaluation and Management (E&M) visits for new and existing patients.

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.

The Centers for Medicare & Medicaid Services (CMS) released the 2019 Proposed Rule for the Medicare Physician Fee Schedule on July 12, 2018. The release of the 2019 proposed rule is advantageous in deciding what to conquer under the Quality Payment Program for both this year and in the future, which is why we published a series of posts summarizing the major proposed changes you should be aware of. But what if you have a suggestion that would improve the rule?

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.

Through my work with MIPSPRO, I’m given daily opportunities to watch people reporting from the outside looking in. As a result, I’ve uncovered a few truths in reporting that providers might not notice if they’ve only ever reported through their EHRs or Claims submission. Today I want to share some of those insights with you.

This past Sunday, I was fortunate enough to attend the Philadelphia Take Steps Walk. Sponsored by the Crohn’s and Colitis Foundation and organized by members of the local community, this event raised $388,000 to fight inflammatory bowel diseases (IBD). Hundred of patients, providers, and organizations met at Citizen’s Bank Park here in Philadelphia to enjoy an educational festival, celebrate loved ones fighting IBD, and walk through the stadium and field as a show of solidarity to anyone suffering from these diseases.

As the Merit-Based Incentive Payment System (MIPS) become more complex, clinicians will be looking for answers to their reporting questions. Consultants, billers, and technology vendors often face the brunt of those questions, but don’t feel best-suited to answer them. After spending most waking hours assisting with last-minute MIPS submissions last month, I wanted to disclose a few quick tips for you to share with anyone looking to report.

The Second National MACRA MIPS/APM Summit is the leading forum on MACRA, MIPS, APMs, and other Value Based Payment Models. With no fee increases across-the-board for physicians from 2020-2025, value-based payment is going to become key for any health system's viability. Healthmonix was pleased to attend this summit and see MACRA policy and perspective in the making, with thought leaders in the medical, research, and business fields convening to break down MACRA and it's implementation now, as well as look towards the future of what MACRA can and should be.

We put together a brief list of takeaways from this event.