Tag Archives: MACRA

5 steps to get your hospital’s MACRA strategy off and running

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http://www.beckershospitalreview.com/finance/5-steps-to-get-your-hospital-s-macra-strategy-off-and-running.html

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Anand Krishnaswamy, vice president of Kaufman Hall’s strategic and financial planning practice, makes the case that MACRA readiness should be a priority not only for physicians, but also for hospital boards and executives.

The first performance year of the Medicare Access and CHIP Reauthorization Act is now underway, which will determine Medicare Part B payments in 2019. Although 2017 is designed to be a transition year, providers who dive in now have the opportunity to maximize financial rewards and set themselves up for success down the line.

“The biggest underlying issue is the lack of awareness and engagement by health systems and physician groups,” Mr. Krishnaswamy tells Becker’s. Though many providers are distracted by the uncertainty on Capitol Hill, MACRA and value-based care are likely here to stay — and it’s time for hospitals to craft a strategy.

Mr. Krishnaswamy suggested providers take the following five steps to prepare for MACRA.

Value-based payment: Why practices need to get on board now

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http://www.fiercehealthcare.com/healthcare/practices-smart-to-get-board-now-value-based-payment

For an industry traditionally scrutinized for low executive pay, one has to wonder what our executives are actually making.

The smartest move physician practices can make right now is to move ahead with value-based payment arrangements, experts say.

The transition from fee-for-service to value-based care is inevitable and practices that embrace new payment methods will be ahead of the curve, according to Physicians Practice. If doctors are still unsure, here are a few of the reasons it makes sense for practices to move ahead with value-based care:

You’ll be better prepared for MACRA. The new payment systems implemented under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) are here to stay, and getting in on a payer’s value-based system will get you ahead on changes you need to make, such as tracking quality patient data, says Mott Blair, M.D., a family physician, whose practice has added a health coach and can identify high-risk patients and be pro-active to keep them healthy.

You won’t get left out in the cold. As local hospitals start setting up a system of providers, you want to be included in order to get referrals, particularly for specialty practices, Elizabeth Woodcock, president of the consulting firm Woodcock and Associates, told the publication.

You’ll get paid for more patient care. Under fee-for-service arrangements, practices don’t get reimbursed for some of the time they spend on patient care, such as returning patient calls or following up on missed appointments. With a value-based arrangement, you will be rewarded for these activities that lead to better patient care.

While there’s lots of questions about the future of healthcare, experts say the push to value-based care will likely continue under President Donald Trump’s administration. Dozens of leading healthcare organizations have called on Trump to continue the federal government’s push to value-based, patient-centered payment models that reward providers for improved quality and cost-effective care.

Can ACOs survive a repeal and replacement of the Affordable Care Act?

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http://www.fiercehealthcare.com/healthcare/future-acos-can-they-survive-a-repeal-and-replace-aca?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiWkRjeU1tTTFPVEUyTjJaaCIsInQiOiJBNGU4aWlDQkpcL3l6eURqQUMyR2w3aVFtNStxVzBraUpQcTVOamQ4SVNEVUNDeXFQQ1RDWG5qdmptMjI4VWpiVTdHUDltN0ZTMG5ObWlHOWl0cXRmVEpjQ0h2bFU1NXJKM2YzaHBrcnc2VlVJVkoyTHJrQjBndGI5b3BGWmdJV1oifQ%3D%3D

Doctor patient

Just as the fate of the Affordable Care Act is up in the air, so is the future of accountable care organizations, which were established under the healthcare reform law to improve care and reduce costs.

But one leading health policy expert predicted that even if Republican lawmakers come up with a plan to repeal and replace the healthcare reform law, ACOs will survive. They will just need to adapt to the new regulatory landscape.

“ACOs are here to stay,” wrote Paul Keckley, Ph.D., managing editor of The Keckley Report, in a post for Hospitals & Health Networks. “How they fit into a medical group or health system’s contracting and population health strategies will change as regulations like MACRA kick in and as employers, insurers, Medicare and Medicaid assess their value.”

More than 850 ACOs currently provide care to more than 28 million patients across the country. This year 570 ACOs will participate in Centers for Medicare & Medicaid Services models, including the Shared Savings Program  (MSSP), Next Generation ACO Model and The Comprehensive ESRD Care Model.

Two recent studies showed evidence that ACOs do lead to quality improvements and cost reductions, but those benefits grow over time. The problem is that Tom Price, the new head of the Department of Health & Human Services, doesn’t support some value-based care initiatives, such as Medicare’s mandatory bundled payment initiatives for hip and knee replacements.

But Keckley predicted physician-led ACOs that follow practices to standardize care and incentives for clinicians linked to cost savings will survive. However, in order to survive the organizations must focus on primary care driven care coordination, he said. “From these primary care centric models, virtual ACOs that incorporate rural health and teleconnectivity, and clinical models that include social determinants of health in assessing risks and care coordination tactics will evolve,” he wrote.

He also predicted that CMS will change quality measures and simplify reporting requirements under MSSP ACOs. And if Congress does move to Medicaid block grants, he expects Medicaid ACOs will be a growth opportunity.

IBM Watson Health debuts cloud solutions for value-based care

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http://www.healthcaredive.com/news/ibm-watson-health-debuts-cloud-solutions-for-value-based-care/436527/

Dive Brief:

  • IBM Watson Health unveiled a new series of value-based cloud solutions aimed at helping providers, health plans and employers better manage their healthcare costs and quality.
  • The solutions — debuted at HIMSS17 in Orlando, FL—will integrate patient-level data from electronic health records and other sources to enhance understanding of different patient populations, risk factors and red flags at the individual, group and population level.
  • Watson Health also announced an agreement with Atrius Health to develop a cloud-based service to improve the doctor-patient experience.

Dive Insight:

The shift to value-based care and reimbursement models is forcing hospitals, payers and employers to rethink the way they manage risk in patient populations and come up with new approaches to improve quality while reducing costs. However, CMS’ new Quality Payment Program lacks needed IT infrastructure for collecting the data allowed by MACRA, which implemented the program, a recent HHS report concluded. But IBM is not the only company hoping to provide helpful solutions for value-based care. Earlier this month, Epic said it will incorporate care management content into its electronic health records (EHRs) and Health Catalyst deployed a new software tool that can be used to identify and align quality measure selection.

The value-based solutions set combines capabilities of Watson Care Manager, Truven Health Analytics, Phytel and Explorys. Initial applications, to be rolled out later this year, will focus on provider performance, patient engagement, bundled payments forecasting and management and custom analytics. Under the agreement with Atrius Health, Watson Cognitive Insights will combined the various influences on an individual’s health, including behavioral determinants, to improve primary care physicians’ effectiveness and efficiency and the quality and safety of ambulatory care. Among other things, the IBM solution could summarize key cognitive insights about a patient’s health status, assemble a de-identified cohort of similar patients and predict how those people might respond to various treatment options, according to the company.

During her keynote address at HIMSS17, IBM CEO Ginni Rometty talked of a new “golden age” in healthcare, thanks to cognitive computing, digitalhealth reports. Yet the industry must work to ease concerns about transparency, privacy of personal health information and artificial intelligence replacing highly skilled healthcare workers, she said. Rometty urged companies to invest in scalable — rather than piecemeal — solutions and to support an open platform, noting that will allow users to combine data being generated with their own insights.

What will become of MACRA, Obamacare, health IT? HIMSS boss weighs in (podcast)

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What will become of MACRA, Obamacare, health IT? HIMSS boss weighs in (podcast)

HIMSS Chicago 2015

The annual Healthcare Information and Management Systems Society (HIMSS) conference gets under way Monday in Orlando, Florida, with numerous preconference activities starting Sunday.

As more than 40,000 people descend on Central Florida for the grueling event, MedCity News talked to HIMSS CEO and President H. Stephen Lieber for what has become an annual ritual, at least for this reporter. As usual, it’s on tape.

HIMSS17 is the last HIMSS conference with Lieber in charge; he announced in December that he would retire at the end of 2017.

Lieber is preparing to depart at a time when health IT is at a crossroads.

Healthcare organizations in the U.S. have spent the better part of the last 10 years installing and now optimizing electronic health records, though they continue to lag when it comes to sharing data across systems. And they continue to gripe about EHR usability and Meaningful Use requirements.

Providers in recent years also have grappled with updates to HIPAA regulations and the conversion to ICD-10 coding. Now, they face some new regulations affecting health IT.

Notably, the 2016 Medicare Access and CHIP Reauthorization Act (MACRA) is coming into force for ambulatory care. The rise of accountable care is “certainly having an impact already in terms of how care is not only delivered,” as well as how payers calculate reimbursements, Lieber noted.

They also face the uncertainty that comes with a change in administration in Washington.

Still, some things do remain relatively constant in health IT.

“The ongoing challenge in dealing with security, there is going to be an even greater focus this year as we try to bring more attention, more focus on what it takes to make sure that we’re handling data in a secure way,” Lieber said.

Clinical analytics has become a normal course of business in the field as well, though it has changed from merely clinical decision support and retrospective analytics to predictive analytics and machine learning. “As the field evolves, we’re evolving the programming with it.” Lieber noted.

Policy seems to be where a lot of intrigue is right now. It’s easy to make assumptions about what the new Trump administration might do, but assumptions are just that.

More than a third of health systems unprepared for MACRA: 8 findings

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http://www.beckershospitalreview.com/finance/more-than-a-third-of-health-systems-unprepared-for-macra-8-findings.html

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While most healthcare providers expect to participate in the Medicare Access and CHIP Reauthorization Act, only 35 percent have a strategy for doing so, according to a study published by Health Catalyst and Peer60.

For the study, researchers surveyed 187 healthcare professionals, including 37 CEOs and 94 other C-suite executives. Survey respondents came from organizations ranging from some of the nation’s largest urban academic medical centers and integrated delivery networks to small, rural critical access facilities.

Here are eight survey findings.

Top 2017 challenges healthcare executives face

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http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/top-2017-challenges-healthcare-executives-face?cfcache=true&ampGUID=A13E56ED-9529-4BD1-98E9-318F5373C18F&rememberme=1&ts=15022017

Working as a managed care executive in today’s healthcare environment is a demanding role. According to Managed Healthcare Executive’s 2016 State of the Industry Survey, challenges abound. Government requirements and mandates, such as implementing value-based reimbursement, are difficult to meet. Meanwhile, employing new technologies, such as electronic health records and data analytics, is no easy task. Pharmaceutical costs continue to rise dramatically, burdening the entire system.

The survey findings, based on 160 responses, show the biggest challenges that executives at health systems, health plans, pharmacy benefit organizations, and more anticipate next year. Here’s a closer look at the survey results, and what industry experts say organizations can do to overcome them.

Healthcare Triage News: Many with Employer Insurance Still Need CHIP to Insure Their Kids

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Healthcare Triage News: Many with Employer Insurance Still Need CHIP to Insure Their Kids

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As employer-sponsored insurance becomes more expensive for children, public programs are picking up the slack. This is Healthcare Triage News.

More families with employer-sponsored insurance are needing public assistance

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http://www.academyhealth.org/blog/2017-01/more-families-employer-sponsored-insurance-are-needing-public-assistance

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As employer-sponsored insurance becomes more expensive for children, public programs are picking up the slack.

The Medicaid Expansion, which was responsible for a large part of the reduction in uninsurance in the United States over the last few years, was mostly aimed at adults. This is because Medicaid has traditionally covered nearly all children in poverty for some time. The CHIP program has bolstered that coverage, so that uninsurance in children fell steadily in the 1990’s and well into the 21st century.

The passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) assured that CHIP coverage would continue for some time. But even before that, trouble was brewing with respect to the coverage of children. These troubles were not in the Medicaid  program, though. Issues were arising in the employer-sponsored insurance market.

As I’ve written about in many posts here before, the cost of employer-sponsored insurance has been rising quite steadily for some time. Further, the out-of-pocket costs for such insurance have also been increasing. Deductibles, co-pays, and co-insurance – not to mention premiums – can put the cost of insurance out of reach for many employees even when it is “offered” as a benefit from their job. The costs of insurance have outpaced both income and wages for more than a decade, meaning that more and more must come out of employee’s pockets if they want to maintain coverage for themselves and their children.

 

2016 Health Care Year in Review

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http://www.commonwealthfund.org/publications/blog/2016/dec/2016-health-care-year-in-review

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This was a tumultuous year in health care and elsewhere. Wherever we looked, the improbable and unbelievable became true and believable: from Brexit to a President-elect Trump to alleged foreign sabotage of our political institutions. Historians will dissect the remnants of these events for decades. For us, for now, let’s focus on health care, which is plenty.