Healthmonix Advisor

CMS estimates that between the 2013 and 2015 performance years, accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) saved $954 million. But according to a new analysis from Dobson DaVanzo & Associates, commissioned by the National Association of ACOs (NAACOS), they actually saved $1.84 billion—almost twice as much.

The analysis also found that MSSP delivered net savings of $541.7 million for 2013-2015 after accounting for shared savings bonuses; this is in contrast to the CMS benchmark calculation, which found that the organizations increased Medicare spending by $344.2 million.

You have been dealing with the bureaucracy behind quality reporting for years - silly questions with no relevance to your field or specialty, EMRs changing the way measures are recorded, CMS changing requirements during the reporting period. It’s hard enough to get your fingers around the changes as a manager or provider, but imagine the confusion on your staff’s side! Plus, they don’t have the incentive of financial responsibility or a reputation to uphold.

So, how do we get their buy-in?

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.

In a new proposal titled “Pathways to Success,” the Centers for Medicare & Medicaid Services (CMS) has laid out a modified set of participation options for ACOs (accountable care organizations) in the Medicare Shared Savings Program (MSSP). The proposed participation options would no longer include an “upside-only” risk model; instead, ACOs would be required to select one of two tracks, both of which ultimately include some downside risk.

I speak with a lot of different types of practices and healthcare organizations on a weekly basis, and so I get to learn about a lot of different challenges that organizations face in the shift towards value-based care and the adoption and implementation of Certified EHR Technology. Both are critical to maintaining a high level of quality of care and maximizing reimbursements from Medicare.

When I was in graduate school, I quickly gravitated to projects and classes that focused on the relatively new field of database design and database technology. I loved the deep analysis of data and exploring the question of how to leverage technology to support storage and access to data in order to find answers. It was challenging, it was new, and it was a field that I knew would have a huge impact. My thesis was about data organization and optimization, and I was lucky to be able to experiment with all sorts of database challenges and software as I ultimately built my own contribution to the science.

At the Optum Forum conference this year, once again I was brought back to the data. As a recent partner with Optum, Healthmonix provides MACRA (MIPS and ACO) reporting for Optum clients in addition to our existing client base. At the conference, I heard the cries of how fundamental the data really is as we move forward in the value-based care market. As much as we need to work with providers and payers to change patterns of practice, a critical component is the data that supports the change and that measures the impact.

This is because data is what drives precision medicine and AI initiatives. It drives understanding, affirms what we already know, points out new patterns that we haven’t realized, and shows us where our perceptions are correct and where they are not.

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?

It’s that time of year again: CMS has released final QPP performance feedback for 2017, including final scores and payment adjustment information. Here at Healthmonix, we believe in turning data into outcomes, taking control of performance, and driving revenue through value-based payments—which is why, now that you have access to your feedback, we’re outlining a few important next steps your practice can take to use that feedback in a meaningful way.