Tag: hospitals

Morning musings from a CEO

CMS launches ‘Pick Your Pace’ options for physicians as part of Quality Payment Program

Sep 11, 2016 by Raghu Vir 0 Comments , ,

money-tighteningAs part of CMS’ move to link physician payments to patient outcomes, the Quality Payment Program put in place by CMS is set to begin on January 1, 2017. CMS has shared plans for the timing of reporting for the first year of the program. It allows Quality Payment Program to allow physicians to pick their pace of participation for the first performance period that begins January 1, 2017. During 2017, eligible physicians and other clinicians will have multiple options for participation. Choosing one of these options would ensure you do not receive a negative payment adjustment in 2019.

First Option: Test the Quality Payment Program

With this option, as long as you submit some data to the Quality Payment Program, including data from after January 1, 2017, you will avoid a negative payment adjustment. This first option is designed to ensure that your system is working and that you are prepared for broader participation in 2018 and 2019 as you learn more.

Second Option: Participate for part of the calendar year

You may choose to submit Quality Payment Program information for a reduced number of days. This means your first performance period could begin later than January 1, 2017 and your practice could still qualify for a small positive payment adjustment. For example, if you submit information for part of the calendar year for quality measures, how your practice uses technology, and what improvement activities your practice is undertaking, you could qualify for a small positive payment adjustment. You could select from the list of quality measures and improvement activities available under the Quality Payment Program.

Third Option: Participate for the full calendar year

For practices that are ready to go on January 1, 2017, you may choose to submit Quality Payment Program information for a full calendar year. This means your first performance period would begin on January 1, 2017. For example, if you submit information for the entire year on quality measures, how your practice uses technology, and what improvement activities your practice is undertaking, you could qualify for a modest positive payment adjustment. We’ve seen physician practices of all sizes successfully submit a full year’s quality data, and expect many will be ready to do so.

Fourth Option: Participate in an Advanced Alternative Payment Model in 2017

Instead of reporting quality data and other information, the law allows you to participate in the Quality Payment Program by joining an Advanced Alternative Payment Model, such as Medicare Shared Savings Track 2 or 3 in 2017. If you receive enough of your Medicare payments or see enough of your Medicare patients through the Advanced Alternative Payment Model in 2017, then you would qualify for a 5 percent incentive payment in 2019.

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Morning musings from a CEO

Hospitals are not ready for bundled payments

Apr 8, 2016 by Raghu Vir 0 Comments , ,

Effective April 1 many hospitals will be paid a bundled fee for Knee and Hip replacement surgeries. This is a part of the overall strategy by CMS to move providers away from Fee for Service to Value Based Payment model. CMS’ goal is to make such payments reach 30% of all reimbursements for this year. It is a lofty goal but we all know that is the direction all providers have to transition to.

Bundled payments create a host of challenges for hospitals. CMS still pays everyone involved in the care process on the fee for service model but at the end of episode of care (90 days) CMS either pays the hospital for efficiency or penalizes them by asking hospitals to pay back the excess money that CMS paid over and above the hospital’s standard rate. There is no doubt that to make healthcare providers more responsible for outcomes rather than just for providing services, value based payments is a great idea. But many hospitals in the country are nowhere near ready for such a payment model.

At the current time hospitals do not have technologies in place that they can use to monitor and measure a patient’s care across hospitals and providers. An acute care facility and a post-acute care facility may or may not talk to each other. The doctors in one acute care hospital do not communicate with the doctors in another post-acute care hospital. The post-acute care hospital may or may not have an EHR system. Even if they have one, the two EHRs may not be talking to each other. Same is the case with primary care physician offices, surgeons offices, outside rehab facilities. So how can a hospital keep track of the care being provided to a patient for 90 days after the surgery? Most of the hospitals today do not have an idea of how each of their own service costs them in their hospital. How are they supposed keep track of costs across the care settings?

Hospitals now not only need to communicate closely with each other but also get involved in each other’s operations. All discharges and discharge medications have to be reviewed by the doctors from the acute care facility with the doctors from the post-acute care facility. Not only that, they have to continuously monitor the care and progress of the patient outside of their facility. They need to start implementing systems that will enable 360 degree communication and interface with all the providers involved in each episode of care. They need to start doing this now because it is hard to stop a train.