tag:blogger.com,1999:blog-27284113472747494892024-03-28T10:54:36.673-07:00DataGenRead DataGen’s blog to get the latest CMS news and insights. Exclusive healthcare data analytics blog content created to benefit DataGen users and non-users.Adminhttp://www.blogger.com/profile/02700653758262541729noreply@blogger.comBlogger127125tag:blogger.com,1999:blog-2728411347274749489.post-51107134940219856712024-03-15T11:07:00.000-07:002024-03-28T10:23:07.759-07:00BPCIA: 4 fast facts for a successful Model Year 7 kickoff <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbIYzvRManrzXbHDLHZOIMIjZE_382WKssNf1MID8A1GzI9N9XBnIOsXAze4wuAWdNAQpKHouE6KLLESPttdimY87LssIknejEZmASeSvjP6BhcX-Co0JclqVEjQCFx9yKzCFiCPWyypfao_C4tFYe9niWmZKtHcAViVfAGifqKKCWcIyqoUj4-RMsqUU/s640/BPCIA%20Blog_February%202024.jpeg" style="margin-left: 1em; margin-right: 1em;"><img alt="Doctor smiling, excited for BPCIA Model Year 7." border="0" data-original-height="403" data-original-width="640" height="405" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbIYzvRManrzXbHDLHZOIMIjZE_382WKssNf1MID8A1GzI9N9XBnIOsXAze4wuAWdNAQpKHouE6KLLESPttdimY87LssIknejEZmASeSvjP6BhcX-Co0JclqVEjQCFx9yKzCFiCPWyypfao_C4tFYe9niWmZKtHcAViVfAGifqKKCWcIyqoUj4-RMsqUU/w640-h405/BPCIA%20Blog_February%202024.jpeg" width="640" /></a></div><p>Participation in Model Year 7 launched on Jan. 1, 2024, with the first few months being a critical time for providers. New Bundled Payments for Care Improvement Advanced Model (BPCIA) participants got their footing, and continuing participants were able to change their clinical episode service line groups for the first time since 2020. </p><p>If you’re a provider participating in this model, read on for a BPCIA refresher and four fast facts for starting MY7 right. We’ll also cover core analytics activities to support your clinical and operational success. <br /><br /></p><h2 style="text-align: left;"> 4 Fast facts on BPCIA Model Year 7 </h2><h3 style="text-align: left;">1. Focus on clinical episodes and episode volume </h3><p>Before MY7 began, providers used historic baseline data provided by CMS to evaluate which CESLGs they would go at risk for, ensuring there would be sufficient episode volume. Large episode volume (100 episodes/year or more) reduces random variation and helps protect providers from financial risk associated with outlier Medicare episode spend. </p><p>During the model year, it is important that providers use their internal data systems to monitor which patients will trigger BPCIA episodes and account for specific exclusion criteria to the best of their ability. This is important for several reasons: </p><ul><li><p>Providers must provide these patients with CMS’s beneficiary notification letter to inform them of their inclusion in the BPCIA Model, their right to access medically necessary covered services and their right to choose any provider or supplier. </p></li><li><p>Providers will need to closely monitor and potentially engage with these patients across the care continuum in the 90 days post-discharge. </p></li></ul><ul><li><p>Providers will be accountable for several quality measures related to utilization and outcomes for these patients. <br /><br /></p></li></ul><h3 style="text-align: left;">2. Monitor utilization and expected care patterns </h3><p>Providers should carefully examine their episodes by patient risk profile and ask these three key questions, including: </p><ul><li><p>Does each episode have a well-designed care plan? </p></li><li><p>Have patients received the care plan? </p></li><li><p>Are patients able and willing to follow the care plan? </p></li></ul><p>Providers should evaluate which types of post-acute care are being utilized and if it is appropriate for the patient. They should also assess which providers a patient is receiving subsequent care from (and their CMS star rating), the length of stay and the occurrence of direct readmissions. </p><p>The type of post-acute care and length of stay have a direct impact on Medicare episode spend. In addition, some readmissions, especially those for ambulatory care sensitive conditions, may have been preventable and can indicate where improvements in care coordination must be made. <br /><br /></p><h3 style="text-align: left;">3. Re-confirm strategy strength and clinical buy-in </h3><p>Predictable utilization and care patterns can generate better outcomes throughout the year and beyond BPCIA. Achieving long-term <a data-cke-saved-href="https://datagen.info/solutions/delivery_of_carequality/value_based_care_consulting/" href="https://datagen.info/solutions/delivery_of_carequality/value_based_care_consulting/" target="_blank">practice transformation</a> is one of the many benefits of bundled payments and other APMs. </p><p>Keeping clinicians, staff and program champions engaged and informed of ongoing performance is critical to these efforts, especially when episode targets and intervention approaches change. While CESLGs are already locked in, <a data-cke-saved-href="https://news.datagen.info/2023/06/four-insights-that-improve-bpcia.html" href="https://news.datagen.info/2023/06/four-insights-that-improve-bpcia.html" target="_blank">key insights used for BPCIA episode selection</a> will remain valuable throughout the model year. <br /><br /></p><h3 style="text-align: left;">4. Track BPCIA initiatives and their impact </h3><p>The first few months of the new BPCIA model year are ideal for revisiting Key Performance Indicators. For practice transformation, providers need to know if their efforts are working for all patients equitably. If not, they must be able to pivot in ways that still meet BPCIA requirements. </p><p>KPIs that apply to multiple initiatives have high value, e.g., the <a data-cke-saved-href="https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/hospital-readmissions-reduction-program-hrrp" href="https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/hospital-readmissions-reduction-program-hrrp" target="_blank">CMS Hospital Readmissions Reduction Program</a>. They also address heart attack, heart failure, bypass surgery and joint replacement. Such intersections can break down practice silos, expand value-based care and help providers achieve the industry’s now <a data-cke-saved-href="https://www.ihi.org/improvement-areas/triple-aim-population-health" href="https://www.ihi.org/improvement-areas/triple-aim-population-health" target="_blank">Quintuple Aim</a>: improving population health, patient experience and healthcare costs while focusing on health equity and workforce satisfaction. </p><p><br /></p><h2 style="text-align: left;">Quick overview of BPCIA MY7 </h2><h3 style="text-align: left;">What is BPCIA MY7? </h3><p>BPCIA is a voluntary program that tests whether linking payment across episodes of care and care settings can lower costs and impact quality. BPCIA MY7 offers providers financial incentives if they deliver quality care below target prices. The model also helps them transform and standardize patient care. <br /><br /></p><h3 style="text-align: left;">How has BPCIA Changed? </h3><p>MY7 includes 207 participants, 99 of which are returning and 108 new. Of the 207, only 46 are Convenors, organizations that bear risk for participating providers. They’re also known as Downstream Episode Initiators. </p><p>Episode Initiators include acute care hospitals and physician group practices. MY7 includes 123 acute care hospitals and 124 physician group practice participants, per the CMS BPCIA model summary. </p><p>MY7 also includes 34 Clinical Episode Categories clustered into eight Clinical Episode Service Line Groups. These CESLGs, ranked in order of provider choice, are: </p><p>1. cardiac care; </p><p>2. medical and critical care; </p><p>3. orthopedics; </p><p>4. gastrointestinal care; </p><p>5. neurological care; </p><p>6. gastrointestinal surgery; </p><p>7. spinal procedures; and </p><p>8. cardiac procedures. </p><p>CMS published lists of all <a data-cke-saved-href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDEsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3LmNtcy5nb3YvZmlsZXMvZG9jdW1lbnQvYnBjaWEtbXk3LXBhcnRpY2lwYW50cy54bHN4IiwiYnVsbGV0aW5faWQiOiIyMDI0MDEyNC44OTA3MjA5MSJ9.pkFINZ8IKeCRAw-FiDIOhXVIV9NqkuD58yYRL6ct6Ns/s/777010186/br/235922951311-l" href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDEsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3LmNtcy5nb3YvZmlsZXMvZG9jdW1lbnQvYnBjaWEtbXk3LXBhcnRpY2lwYW50cy54bHN4IiwiYnVsbGV0aW5faWQiOiIyMDI0MDEyNC44OTA3MjA5MSJ9.pkFINZ8IKeCRAw-FiDIOhXVIV9NqkuD58yYRL6ct6Ns/s/777010186/br/235922951311-l" target="_blank">BPCIA participants</a> and <a data-cke-saved-href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDIsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3LmNtcy5nb3YvZmlsZXMvZG9jdW1lbnQvYnBjaWEtbXk3LWVwLWluaXQtY2xpbi1lcC1zdmMtbGluZS1zZWxlY3RzLnhsc3giLCJidWxsZXRpbl9pZCI6IjIwMjQwMTI0Ljg5MDcyMDkxIn0.vg4dFRwmV8l8woKw6yP-9qfB9q5sQabdzp3eEo7az8g/s/777010186/br/235922951311-l" href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDIsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3LmNtcy5nb3YvZmlsZXMvZG9jdW1lbnQvYnBjaWEtbXk3LWVwLWluaXQtY2xpbi1lcC1zdmMtbGluZS1zZWxlY3RzLnhsc3giLCJidWxsZXRpbl9pZCI6IjIwMjQwMTI0Ljg5MDcyMDkxIn0.vg4dFRwmV8l8woKw6yP-9qfB9q5sQabdzp3eEo7az8g/s/777010186/br/235922951311-l" target="_blank">Episode Initiators/CESLGs</a> on its BPCIA website. The higher-ranking groups suggest more providers believe they can control Medicare episode spend in these areas. </p><p><br /></p><h2 style="text-align: left;">A strong start can lead to better outcomes </h2><p>A successful kickoff to the BPCA model year can lead to better outcomes, cost control and patient experience. Whether you are a new or returning provider to MY7, DataGen can help you <a data-cke-saved-href="https://datagen.info/solutions/alternative_payment_models/bundled_payments_for_care_improvement_advanced/" href="https://datagen.info/solutions/alternative_payment_models/bundled_payments_for_care_improvement_advanced/" target="_blank">reach your goals and thrive in BPCIA</a>. <a data-cke-saved-href="https://datagen.info/contact/" href="https://datagen.info/contact/" target="_blank">Contact us today</a> for a free consultation. </p>Courtney Yulehttp://www.blogger.com/profile/15321700369247409594noreply@blogger.com0tag:blogger.com,1999:blog-2728411347274749489.post-39649317944489176832024-03-07T13:31:00.000-08:002024-03-07T13:32:08.557-08:00Avoid SPARCS Compliance Risks: 3 Deadlines to Know Now <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiynpdNcQc5o01OmDmjX0XWn1P7ZQBTrrksQ-21YhCL0-9PuDgc0z1qfeOVRzCa54Wgl_uL_j6WwYwyNuDL-XWosG5kUNv73OGx8SDqhqvqS5od0ZZSMej_Bflh4OU42zPrE8MA0m5SE7L1UddG6uvQInUJ9tPyMUCQyxrEARznuKYRfT5VtYwbSr-A2qQ/s640/DataGen_SPARCS%20Q3%20Data.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="Woman at computer looking up from notes." border="0" data-original-height="403" data-original-width="640" height="404" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiynpdNcQc5o01OmDmjX0XWn1P7ZQBTrrksQ-21YhCL0-9PuDgc0z1qfeOVRzCa54Wgl_uL_j6WwYwyNuDL-XWosG5kUNv73OGx8SDqhqvqS5od0ZZSMej_Bflh4OU42zPrE8MA0m5SE7L1UddG6uvQInUJ9tPyMUCQyxrEARznuKYRfT5VtYwbSr-A2qQ/w640-h404/DataGen_SPARCS%20Q3%20Data.jpeg" width="640" /></a></div><p>Third quarter Statewide Planning and Research Cooperative System deadlines are rapidly approaching! It’s more important than ever for hospitals to focus on meeting DOH requirements for SPARCS compliance. </p><p>In this blog, we'll help you understand what you need to focus on right now to ensure you meet New York state SPARCS data submission deadlines. Read on to learn which data will soon be delinquent, what’s at risk and which target dates hospitals must hit next. <br /><br /></p><h2 style="text-align: left;">March and April SPARCS compliance deadlines </h2><p>A hospital’s quarterly SPARCS submission isn’t “done” until it is submitted error-free. DOH publishes <a data-cke-saved-href="https://www.health.ny.gov/statistics/sparcs/reports/" href="https://www.health.ny.gov/statistics/sparcs/reports/" target="_blank">SPARCS Audit and SPARCS Compliance Reports</a> to help hospitals keep track. Weekly audit reports document the number of discharge claims a facility submits to the SPARCS data warehouse versus those accepted. Claims with errors are rejected. </p><p>The state monitors error resolution through monthly compliance reports. Hospitals with outstanding SPARCS errors receive three warnings before the state issues a Statement of Deficiency. A SOD can mean<b> hospital fines as high as $10,000 per patient type per facility</b>. <br /><br /></p><h2 style="text-align: left;">Q3 and Q4 SPARCS submission dates to know </h2><p><b>1. March 15 -</b> The date by which hospitals receive a third warning for noncompliant Q3 SPARCS data. This is a facility’s last chance to resolve data errors before the state issues a formal SOD. </p><p><b>2. March 31 - </b>The submission deadline for Q4 2023 SPARCS data. </p><p><b>3. April 15 - </b>This is a key date for Q3 and Q4 2023 SPARCS data. On April 15, hospitals will receive SODs if they have not resolved Q3 data errors after three warnings. This is also the first warning for missing the initial Q4 deadline for timely, accurate data submission. </p><p>The proximity of these dates demonstrates how quickly quarterly deadlines overlap and deficiencies compound, especially if hospitals do not correct their submissions through the “three-warnings” process. As hospitals stand at the crossroads of impending deadlines, compliance warnings and potential fines, adopting compliance tools, like DataGen's<a data-cke-saved-href="http://%20uds%20solution/" href="https://datagen.info/solutions/revenue_cycle_tools/sparcs_submissions_nys/" target="_blank"> UDS solution</a>, becomes not merely a convenience but a strategic imperative. </p><p>On top of this, there are more reasons to stay compliant. Changing state data requirements and special projects can add to ongoing SPARCS submission requirements. Two examples are DOH's <a data-cke-saved-href="https://news.datagen.info/2023/08/sparcs-updates-hospitals-on-injury.html" href="https://news.datagen.info/2023/08/sparcs-updates-hospitals-on-injury.html" target="_blank">injury, cause and place remediation project</a>, which expanded hospital data submissions, and the new Health Equity Impact Assessment requirements for select <a data-cke-saved-href="https://news.datagen.info/2024/02/sparcs-compliance-how-it-can-impact.html" href="https://news.datagen.info/2024/02/sparcs-compliance-how-it-can-impact.html" target="_blank">Certificate of Need applications</a>, which can be affected by SPARCS deficiencies. <br /><br /></p><h2 style="text-align: left;">Have time and compliance on your side </h2><p>If you're already compliant with 2023 Q3 and Q4 SPARCS deadlines, you’re well positioned to start your Q1 2024 SPARCS submissions, due June 2024. However, if you haven't submitted your 2023 Q3 and Q4 SPARCS data, now's the time to catch up on your requirements. That's where UDS can help. </p><p><a href="https://datagen.info/solutions/revenue_cycle_tools/sparcs_submissions_nys/" target="_blank">UDS automates SPARCS data entry</a>, correction, formatting and submission for a 100% on-time, error-free process. Contact us today to take the first step toward proactively avoiding deadlines and gaining workforce efficiencies. </p>Courtney Yulehttp://www.blogger.com/profile/15321700369247409594noreply@blogger.com0tag:blogger.com,1999:blog-2728411347274749489.post-76958301161981808682024-03-07T06:35:00.000-08:002024-03-07T06:36:18.985-08:00Navigating the Impact of Medicare Cuts on Hospital Providers<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4VVFnXaaGw7MfwH4mtam2MSgk7IeD5bRBFOF3XjxAMZElVyx_d_yu02CUEsbAw7rQ2Wz82FmTlFllb1Y5Q9owGn5bTVbiZE2W7NbdqR_f7TKTgDU604vsREJ5b5fW_sJk6VJyp8Ess_QaXIK8h2xDeXgtpTXFYiqfxCRohwJSWb_0m_1gTWeu-zygsmo/s640/KeySTATS%20Blog_February%202024.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="Hospital hallway with data on side door." border="0" data-original-height="403" data-original-width="640" height="404" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4VVFnXaaGw7MfwH4mtam2MSgk7IeD5bRBFOF3XjxAMZElVyx_d_yu02CUEsbAw7rQ2Wz82FmTlFllb1Y5Q9owGn5bTVbiZE2W7NbdqR_f7TKTgDU604vsREJ5b5fW_sJk6VJyp8Ess_QaXIK8h2xDeXgtpTXFYiqfxCRohwJSWb_0m_1gTWeu-zygsmo/w640-h404/KeySTATS%20Blog_February%202024.jpeg" width="640" /></a></div><p>Federal legislative and regulatory measures enacted since 2010 have fundamentally altered Medicare provider payments — and consequently, the operational landscape for hospitals across the United States. As part of an ongoing dialogue on health policy reform and fiscal strategy, it's crucial for hospital administrators and healthcare professionals to understand the breadth and depth of these payment adjustments. </p><p>That's why DataGen released the Enacted Medicare Cuts Analysis as part of our <a data-cke-saved-href="https://datagen.info/solutions/medicare_fee_for_service_policy_analytics/legislative_analyses/" href="https://datagen.info/solutions/medicare_fee_for_service_policy_analytics/legislative_analyses/" target="_blank">legislative analyses suite,</a> which is intended for advocacy purposes only. We looked at the extent to which hospitals have been impacted by existing Medicare provider payment cuts that Congress has enacted to achieve Medicare payment policy and/or long-term deficit reduction goals. The impacts shown in this analysis include the major cuts enacted since 2010. </p><p>In this blog, we'll cover the enacted legislative cuts, enacted regulatory cuts and quality programs analyzed in the Enacted Medicare Cuts Analysis. <br /><br /></p><h2 style="text-align: left;">The legislative landscape: A bird's-eye view </h2><p>DataGen analyzed the following legislative actions that have had a marked impact on Medicare reimbursement: </p><ul><li><p>The <a data-cke-saved-href="https://www.hhs.gov/healthcare/about-the-aca/index.html" href="https://www.hhs.gov/healthcare/about-the-aca/index.html" target="_blank">Affordable Care Act</a> of 2010 included adjustments to the Medicare market basket, Medicare Disproportionate Share Hospital funding and quality adjustments. Note: quality adjustments are broken out into their own category in this analysis. </p></li><li><p>The Budget Control Act of 2011 triggered a 2.0% across-the-board sequestration reduction to payment rates. </p></li><li><p>The American Taxpayer Relief Act of 2012 and subsequent legislation (Middle Class Tax Relief and Job Creation Act of 2012) authorized reductions related to inpatient coding adjustments and bad debt reimbursement, among other changes. </p></li><li><p>The Protecting Access to Medicare Act of 2014 authorized payment adjustments for services paid for under the clinical laboratory fee schedule. </p></li><li><p>The Bipartisan Budget Act of 2015 mandated reductions to Outpatient Prospective Payment System payments. These “site-neutral” reductions were for nonexcepted off-campus sites to a level equivalent to that paid under the Medicare Physician Fee Schedule. </p></li><li><p>The Patient-Driven Grouping Model changed Home Health Agency PPS payments. </p></li><li><p>The Medicare Access and CHIP Reauthorization Act of 2015 executed market basket adjustments, and recent reforms like the <a data-cke-saved-href="https://www.cms.gov/medicare/medicare-fee-for-service-payment/ambulancefeeschedule/downloads/bba-of-2018-website-summary.pdf" href="https://www.cms.gov/medicare/medicare-fee-for-service-payment/ambulancefeeschedule/downloads/bba-of-2018-website-summary.pdf" target="_blank">Bipartisan Budget Act of 2018</a> have continued to adjust payment policies further, including adding hospice to the Inpatient PPS short-stay post-acute care transfer policy. <br /><br /></p></li></ul><h2 style="text-align: left;">Regulatory cuts: Analyzing their impact </h2><p>Beyond the congressional chamber floor, regulatory coding adjustments implemented by CMS have also left an imprint on hospital finances. Adjustments to coding practices, market basket updates and payment methodologies for various care settings — from clinical labs to long-term care hospitals — have shifted the fiscal status quo. Specific changes include: <br /><br /></p><ul><li><p>a 2.0% reduction to the calendar year 2016 outpatient market basket update for rate inflation due to the packaging of laboratory payments; </p></li></ul><ul><li><p>payments for Wholesale Acquisition Cost-based drugs were reduced from WAC+6% to WAC+3%; and </p></li><li><p>OPPS payments for clinic services provided at excepted off-campus sites were reduced to a level equivalent to that paid under the MPFS. <br /><br /></p></li></ul><p>Newly introduced payment models, such as for skilled nursing facilities transitioning from Resource Utilization Groups to the Patient-Driven Payment Model, reflect a CMS-driven push toward precision in patient care economics. Some of the changes reflected in this analysis include: </p><ul><li><p>Long-Term Care Hospital site-neutral payment adjustment implemented in the federal fiscal year 2016 final rule; </p></li><li><p>payment impacts resulting from CMS’ policies tied to OPPS payments for 340B purchased drugs; and </p></li><li><p>change in SNF PPS payment methodology from the RUG-IV system to the Patient-Driven Payment Model. <br /><br /></p></li></ul><h2 style="text-align: left;">Quality programs: Quantifying performance </h2><p>Medicare’s value-based initiatives are predicated on the principle that high-quality, patient-focused care should be recognized and rewarded. The estimations of impacts from these programs — Value-Based Purchasing, Readmissions Reduction Program and the Hospital Acquired Conditions Program — reveal a healthcare system increasingly attuned to performance excellence. In this analysis, you’ll find estimated impacts from the VBP, RRP and HAC programs. <br /><br /></p><h2 style="text-align: left;">The road ahead: Advocacy and adaptation </h2><p>For hospital providers, understanding these intricate payment adjustments is more than a matter of fiscal prudence — it's a call for advocacy. DataGen's Enacted Medicare Cuts Analysis articulates these changes, providing hospital stewards with the data necessary to engage in informed policy discussions. It represents a multi-dimensional challenge encompassing Medicare payment policy and the broader goals of sustainable deficit reduction. </p><p>Through insights offered in this analysis, hospitals are better equipped to adapt and advocate. As the landscape continues to shift with each policy tweak, the role of this analysis remains steadfast: to offer a clarion call for healthcare provider engagement in the policymaking process that shapes patient care for years to come. </p><p>If you'd like to learn more about DataGen's Enacted Medicare Cuts Analysis, as part of our <a data-cke-saved-href="https://datagen.info/solutions/medicare_fee_for_service_policy_analytics/legislative_analyses/" href="https://datagen.info/solutions/medicare_fee_for_service_policy_analytics/legislative_analyses/" target="_blank">legislative analyses suite,</a> don't hesitate to <a data-cke-saved-href="https://datagen.info/contact/" href="https://datagen.info/contact/" target="_blank">contact us today</a>! We're more than willing to talk you through this analysis and explain how our product can help you with Medicare cut analyses. </p>Courtney Yulehttp://www.blogger.com/profile/15321700369247409594noreply@blogger.com0tag:blogger.com,1999:blog-2728411347274749489.post-47257642011108714732024-02-23T11:46:00.000-08:002024-02-23T12:02:42.931-08:00Unlock the Potential of Value-based Payment<p><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgf3dl1W1qyWdWw5DqgsY8MgGo2wLYYwEFWdDA3z8uhkrdVji5EV6zgvdVyP1rK34RAnPbQ9s9BceanaEDKr6d5Js08mU9XH0EmQZSf9kWjKiV-7kXR7a698twFSpjbQetF6x83x8e9ier3laCWe73ZOpy5gyeeFji2No8r5GLg51fvJtxwT-bQXlCWJac/s640/PAS%20Blog_February%202024.jpeg" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img alt="Female doctor smiling wearing a hijab." border="0" data-original-height="403" data-original-width="640" height="404" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgf3dl1W1qyWdWw5DqgsY8MgGo2wLYYwEFWdDA3z8uhkrdVji5EV6zgvdVyP1rK34RAnPbQ9s9BceanaEDKr6d5Js08mU9XH0EmQZSf9kWjKiV-7kXR7a698twFSpjbQetF6x83x8e9ier3laCWe73ZOpy5gyeeFji2No8r5GLg51fvJtxwT-bQXlCWJac/w640-h404/PAS%20Blog_February%202024.jpeg" width="640" /></a><br /></p><p>A common misconception in healthcare practices: Organizations can quickly reap the benefits of value-based payment transformation. To launch a successful <a data-cke-saved-href="https://www.cms.gov/medicare/quality/value-based-programs" href="https://www.cms.gov/medicare/quality/value-based-programs" target="_blank">value-based payment program</a>, practices must implement a variety of foundational pieces. It may take time, resources and data before a practice can successfully engage in VBP.</p><p>In this blog, we'll cover what goes into VBP and its potential benefits. We'll also dig deeper into practice advancement strategies and how they can help you achieve your practice goals.<br /></p><h2 style="text-align: left;"><strong>What goes into VBP?</strong></h2><p>Many practices want to implement VBP because of its payment structure and return on investment. Yet, they might not consider how to nurture a successful VBP program in their organization. It starts with a gap analysis regarding people, processes and technologies. It’s important to celebrate what is working well and intervene where improvement can be made.</p><p>Successful VBP starts with the practice team. There are many perceptions vs. realities that exist within organizational cultures to address, including:</p><ul><li>Do we clearly communicate our goals?</li><li>Does everyone in my system understand and take accountability for their role?</li><li>Are we addressing barriers to change that individuals are facing?</li><li>Do we break down silos between our clinical and clerical workflows?</li><li>Are the “whys” as important as the “whats” to enforce engagement?</li></ul><p>Leaders building toward VBP engagements must perform change <em>with</em> their teams, not <em>to</em> their teams. Participating in a value-based contract doesn’t guarantee immediate money flow. It requires a lot of work to build a culture to foster the outcomes of a value-based contract.</p><p>Second, teams must look at their workflows.</p><p>Outlining processes can be an eye-opening experience for the team when thinking about:</p><ul><li>Are there standards in place regarding frequency, ownership and reason for the duties we carry out daily?</li><li>Does the entire team perform roles consistently and thoroughly?</li><li>Do we build workflows with input from key utilizers/stakeholders?</li><li>Do we collect and document information in the correct fields, from start to close of a visit and in-between?</li><li>Do we have policies to provide structure and repeatable processes?</li></ul><p>Having consistent processes leads to meeting goals. The subject matter experts should play a major role in creating policies as their input is invaluable. Also, this is the time to create buy-in and discover deficiencies.<br /></p><p>Lastly, explore technologies and statistics. Many practices implement electronic medical records and don’t realize that there are unused functionalities at their disposal. Things to consider are:</p><ul><li>How do our reports pull information and are we documenting appropriately to ensure our reports represent our efforts and outcomes?</li><li>Are there templates and alerts that need to be implemented?</li><li>Do we need further training with our technologies?</li><li>Are we optimizing the tools and templates?</li><li>Have we analyzed, and more importantly, interpreted data to assess our baseline and tell our current story and where we would like it to go?</li></ul><p>Technologies can make or break a VBP program. It’s important to gain a broadened knowledge of available technologies to maximize optimization and achieve accurate and actionable results.<br /><br /></p><h2 style="text-align: left;"><strong>6 Benefits of value-based payment models</strong></h2><p>There are many benefits once you do start participating in VBP. VBP allows organizations to:</p><ol><li>incur payments for meeting certain benchmarks regarding patient experience and quality of care;</li><li>focus on care gaps and act more proactively;</li><li>tackle patient needs by developing partnerships with medical professionals, community resources and behavioral health specialists;</li><li>be fully aware of and understand their patient attribution and their total cost of care;</li><li>take interest in bringing their coding and documentation to the highest degree of specificity, best representing the risk stratification of their patients; and</li><li>think of new interventions based on meeting the patient where they are, from medical to social and behavioral health needs, combined with evidence-based guidelines to move the needle forward. This is the opposite of traditional fee-for-service payments, where you get paid for services rendered and volume of patients seen.<br /><br /></li></ol><h2 style="text-align: left;"><strong>What are Practice Advancement Strategy services?</strong></h2><p>Now that you know about VBP and the benefits of participation, what steps can you take to engage in a <a data-cke-saved-href="https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2021/06/the-why-what-where-and-how-of-value-based-contracts/" href="https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2021/06/the-why-what-where-and-how-of-value-based-contracts/" target="_blank">value-based contract</a>?</p><p>To participate in a value-based contract, you'll need to create a framework based on foundational pieces. Then, you'll take what you've created and propose it to an insurance company and sell your value mission. In theory, this sounds simple, but many practices are fearful of the entry point of a value contract. That's where Practice Advancement Strategies can help.<br /><br /></p><h3 style="text-align: left;"><strong>How PAS can help your practice</strong></h3><p>You can think of PAS as another tool in your toolkit. The programs on which DataGen provides guidance are all foundational pieces of successful VBP arrangements or engagements, specifically, <a data-cke-saved-href="https://datagen.info/solutions/delivery_of_carequality/value_based_care_consulting/" href="https://datagen.info/solutions/delivery_of_carequality/value_based_care_consulting/" target="_blank">value-based care consulting</a> and <a data-cke-saved-href="https://datagen.info/solutions/medical_practice_consulting/" href="https://datagen.info/solutions/medical_practice_consulting/" target="_blank">medical practice consulting</a> services.</p><p>For example, DataGen's team of experts will help decipher your practice data to find opportunities to build your framework. They’ll analyze data to craft your value proposition and help define your practice goals and the pathways to reach them. This way, your organization can best position itself for insurance companies from a data perspective.</p><p>If you’re participating or looking to participate in National Committee for Quality Assurance programs such as Patient-Centered Medical Home, Patient-Centered Specialty Practice or Health Equity/HealthEquity+, DataGen will help to achieve, sustain, crosswalk and build your success from that foundation. Our experts can help find areas that overlap to streamline participation in both VBP and NCQA.</p><p>"We get creative quickly and think about interventions when things are not looking the way they should," says DataGen's Mandi Diamond. "Or, if the data are not reflecting what’s happening, that's when we do a deeper dive and engage the technical vendors and say, 'We're documenting here but our reports are showing X. Where's the gap? What's happening?'"</p><p>Because there are multiple layers of a value-based arrangement, and increasing opportunities, DataGen is constantly absorbing information on the latest programs from NCQA, the <a data-cke-saved-href="https://www.cms.gov/about-cms/who-we-are/leadership/medicare-medicaid-innovation" href="https://www.cms.gov/about-cms/who-we-are/leadership/medicare-medicaid-innovation" target="_blank">Center for Medicare and Medicaid Innovation</a> and other sources to provide the best guidance. Our experts are also NCQA-certified in PCMH and seasoned in PCSP and HEA/HEA+ transformation.</p><p><br /></p><h3 style="text-align: left;"><strong>How does PAS support payment reform?</strong></h3><p>Practices that want to participate in VBP will find it more difficult without a culture shift. That’s why having an expert to walk you through these requirements and educate you on important aspects is essential.</p><p>"I know some people call that [shift in organization culture] the fluffy part, but it really is so important because if it doesn't start with the people in the practice, it's just going to hit a wall," explains Diamond. "It's a bigger picture. So really dispersing that knowledge and not only saying, well, what do we have to do, but why do we have to do this? That's how you get the buy-in from the team."</p><p>DataGen will analyze your contracts or goals and find ways to incorporate essential cultural change. This is particularly helpful if you're pursuing other programs like NCQA. Together, all these pieces will strengthen your practice and help you reach VBP and NCQA goals.<br /><br /></p><h2 style="text-align: left;"><strong>Level up your VBP care: DataGen can help</strong></h2><p>As we mentioned, there are a lot of benefits to participating in VBP. However, getting to a place where you can be a part of VBP takes considerable practice transformation. It also takes a lot of patience and understanding to achieve a solid foundation used in your value-based contract. That's where DataGen's <a data-cke-saved-href="https://datagen.info/solutions/delivery_of_carequality/value_based_care_consulting/" href="https://datagen.info/solutions/delivery_of_carequality/value_based_care_consulting/" target="_blank">value-based care consulting</a> can help.</p><p>Our experts will take the time to ensure you're on the right path toward delivering high-quality, patient-centered care. <a data-cke-saved-href="https://datagen.info/contact/" href="https://datagen.info/contact/" target="_blank">Contact us today</a> to gain powerful VBP insights. </p>Courtney Yulehttp://www.blogger.com/profile/15321700369247409594noreply@blogger.com0tag:blogger.com,1999:blog-2728411347274749489.post-38878448443561321252024-02-14T12:58:00.000-08:002024-02-14T13:00:24.396-08:00SPARCS compliance: How it can impact your Certificate of Need applications<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuDeE9NT2Dv-xNUjebL0gzfgzKnlxyIIxDDC-dX9l_HOwD9_CEMrXEZrJXtsEhbdrxqgR5I_3EcmIcqFw2taUQy07EYIE853wodNN4isS31aduzwOT_NaAI5Dck-vRu-m77zVkUu32AxDJrnpjknS9PaL-plvQKHK4vOesBHoZxZoYxhOuiRH5YPmTlvw/s640/UDS%20Blog_January%202024.jpeg" style="margin-left: 1em; margin-right: 1em;"><img alt="Woman smiling and turning away from her computer that has SPARCS compliance information on it." border="0" data-original-height="403" data-original-width="640" height="403" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuDeE9NT2Dv-xNUjebL0gzfgzKnlxyIIxDDC-dX9l_HOwD9_CEMrXEZrJXtsEhbdrxqgR5I_3EcmIcqFw2taUQy07EYIE853wodNN4isS31aduzwOT_NaAI5Dck-vRu-m77zVkUu32AxDJrnpjknS9PaL-plvQKHK4vOesBHoZxZoYxhOuiRH5YPmTlvw/w640-h403/UDS%20Blog_January%202024.jpeg" width="640" /></a></div><p>Did you know that incomplete SPARCS data can delay Certificate of Need applications — all because of failure to stay within New York state SPARCS compliance?</p><p>In this blog post, we’ll go over the importance of SPARCS compliance and its potential impact on your market growth.</p><h2 style="text-align: left;">What is the Certificate of Need process?</h2><p>New York's CON process “governs establishment, construction, renovation and major medical equipment acquisitions of health care facilities, such as hospitals, nursing homes, home care agencies, and diagnostic and treatment centers.”</p><p>According to the <a data-cke-saved-href="https://www.health.ny.gov/facilities/cons/" href="https://www.health.ny.gov/facilities/cons/" target="_blank">New York State Department of Health</a>, its objectives are “to promote delivery of high quality health care and ensure that services are aligned with community need” by providing DOH “oversight in limiting investment in duplicate beds, services and medical equipment which, in turn, limits associated health care costs.”<br /></p><h2 style="text-align: left;">3 ways being out of SPARCS compliance can harm your growth</h2><p>If you don’t satisfy SPARCS requirements, your Article 28 facility could face substantial consequences, including being fined by DOH. DOH also reserves the right to delay your CON application’s approval.</p><p>Article 28 facilities that aren’t SPARCS compliant and have their CON approval delayed can experience the following consequences:</p><ol><li><strong>Inability to grow service lines:</strong> Healthcare leaders need to know their market position and adapt as the market shifts. Being unable to grow service lines in key areas at the right time could result in potential revenue loss.<br /><br /></li><li><strong>Inability to compete: If your CON application approval is delayed and</strong> competing organizations or emerging market disrupters enter a market first, your patients could seek service at another facility, resulting in a revenue loss for your organization.<br /><br /></li><li><strong>Inability to offer the right services for your market:</strong> You want to deliver the services your community needs right now. CON delays can keep you from adapting as your community’s health needs evolve. </li></ol><p>To prevent these consequences and ensure you’re providing the services your community needs, you need up-to-date SPARCS data.</p><h2>Achieve SPARCS compliance to expand your footprint</h2><p>When you want to expand your market, don't let incomplete data hold your organization back. Instead, use DataGen's SPARCS submission tool, <a data-cke-saved-href="https://datagen.info/solutions/revenue_cycle_tools/sparcs_submissions_nys/" href="https://datagen.info/solutions/revenue_cycle_tools/sparcs_submissions_nys/" target="_blank">UDS (UIS Data System™)</a>.</p><p>Trusted by more than 130 New York state hospitals and ambulatory surgery centers, this comprehensive tool can help you resolve your SPARCS data in a fraction of the time. Discover how it can get you back into compliance and prevent any SPARCS-related delays to your next CON application’s approval. Reach out to us today to <a data-cke-saved-href="https://datagen.info/contact/" href="https://datagen.info/contact/" target="_blank">start the conversation</a>.</p>Courtney Yulehttp://www.blogger.com/profile/15321700369247409594noreply@blogger.com0tag:blogger.com,1999:blog-2728411347274749489.post-56463746225380828452024-02-14T08:32:00.000-08:002024-02-14T08:35:20.885-08:00What to know before MCP model participation decisions<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKfe11NDUCuNdiCRsYvE_wK4HYHTIfUZ4joZec6OwuFllx9Vu0MfF3U26H665hyphenhyphentmaCs4jX1yTp93BZvl5jKsm1IAiXdEqXfa6KqaCrwkkBEknMpGYLOyMGL8dFG_qeqjIUUCkq3Is53-fj2u-Fd7V6nKjB-LDmMYwUoRlZ7gXMQkVB5r5Dl5998gdAkE/s640/MCP%20Blog_February%202024.jpeg" style="margin-left: 1em; margin-right: 1em;"><img alt="Primary care physicians smiling because they were accepted into the CMS Making Care Primary model." border="0" data-original-height="403" data-original-width="640" height="404" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKfe11NDUCuNdiCRsYvE_wK4HYHTIfUZ4joZec6OwuFllx9Vu0MfF3U26H665hyphenhyphentmaCs4jX1yTp93BZvl5jKsm1IAiXdEqXfa6KqaCrwkkBEknMpGYLOyMGL8dFG_qeqjIUUCkq3Is53-fj2u-Fd7V6nKjB-LDmMYwUoRlZ7gXMQkVB5r5Dl5998gdAkE/w640-h404/MCP%20Blog_February%202024.jpeg" width="640" /></a></div><p>CMS will select participants for the <a data-cke-saved-href="https://datagen.info/solutions/alternative_payment_models/making_care_primary/" href="https://datagen.info/solutions/alternative_payment_models/making_care_primary/" target="_blank">Making Care Primary model</a> soon. Once accepted, primary care practices will have to decide whether they’ll join the MCP model. This is no easy decision.</p><p>In this blog, we’ll cover what primary care practices should consider before joining MCP, focusing on readiness and model design. Learn what you need to know before officially joining MCP and beginning the onboarding process, from April to July 1, 2024.</p><h2 style="text-align: left;"><strong>MCP model track eligibility</strong></h2><p>When organizations applied to MCP in November, they selected from three tracks depending on their value-based care experience. Track 1 was designed for practices with little to no VBC experience. This was done to encourage small and rural practices to participate. However, participants starting in Track 1 will eventually move to Tracks 2 and 3 over the performance model years.</p><p>When CMS accepts practices, providers may be found ineligible for the track for which they applied. In these cases, they may be eligible for, and CMS may offer the organization entry into, another track. CMS will likely communicate this once it announces eligible participants.</p><p><em>Note: organizations that wanted to be considered for Track 1 and the up-front infrastructure payment must have originally applied to Track 1 in November 2023. CMS will not retroactively offer applicants entry into Track 1 that did not apply to that track.</em></p><h2 style="text-align: left;"><strong>MCP model readiness</strong></h2><p>Primary care practices should consider three things when assessing their readiness. After acceptance into the model, they'll need to:</p><ul><li>accept the MCP payment reforms;</li><li>meet health information technology requirements listed by the date specified for each requirement; and</li><li>meet the care delivery requirements of the track they're considering by the end of 2025.</li></ul><p>These don't necessarily have to be done in this order. However, these are important steps that you'll need to complete to join and stay in the model. We'll break these down further in the next section.</p><p>MCP applications are not legally binding contracts; selected applicants will be required to sign a participation agreement with CMS. The participation agreement will contain detail regarding model requirements. Some aspects of the model may be modified, as CMS continues to consider stakeholder feedback and operational issues.</p><p>Before signing the participation agreement, CMS will provide each applicant information that may support financial modeling, based on the applicant’s attributed population at the time of application.</p><h2 style="text-align: left;"><strong>MCP payment reforms</strong></h2><p>The <a data-cke-saved-href="https://www.cms.gov/priorities/innovation/innovation-models/making-care-primary" href="https://www.cms.gov/priorities/innovation/innovation-models/making-care-primary" target="_blank">MCP model </a>design’s biggest selling point is its payment structure. Developed with primary care practices with limited VBC experience in mind, the MCP model offers a progressive pathway to allow practices to gradually move through the payment changes over the model's 10.5-year span.</p><p>For now, it's important to know that the tracks gradually transition participants from the traditional fee-for-service payment system to a model with full capitation for specific primary care services, increasing the link between care delivery and payment advancement over time.</p><p>Under all tracks, participating organizations will receive enhanced service payments to reflect the patient populations’ clinical and social risk and will have the opportunity to receive performance incentive payments.</p><h2 style="text-align: left;"><strong>Health IT requirements</strong></h2><p>According to CMS' <a data-cke-saved-href="https://www.cms.gov/priorities/innovation/mcp/faqs" href="https://www.cms.gov/priorities/innovation/mcp/faqs" target="_blank"><em>Making Care Primary (MCP) Model Frequently Asked Questions</em></a>, "MCP Health IT requirements will be designed to meet model-specific standards to promote data and health information exchange (HIE), provide patients access to electronic health information and avoid information blocking." You can learn more about this in CMS’s Health IT requirements in their <a data-cke-saved-href="https://www.cms.gov/files/document/mcp-rfa.pdf" href="https://www.cms.gov/files/document/mcp-rfa.pdf" target="_blank"><em>Making Care Primary Request for Applications</em></a> document.</p><p>With these health IT systems in place, CMS thinks participants will benefit from data sharing between clinicians, suppliers and patients. CMS also believes it will support improved care coordination with specialists through the use of e-consults. </p><p>In Track 1, participants will start to lay the framework for these technology models, and start to adapt their current internal processes to get ready for implementation in Track 2.</p><h2 style="text-align: left;"><strong>Care delivery requirements</strong></h2><p>The MCP framework focuses on whole person care, striving to enhance practices primary care offerings and overall quality of care. Across its three distinct phases, these practices are presented with tailored chances to strengthen their operational base, introduce innovative tactics and refine both care processes and collaborative efforts.</p><p>Those enrolled in the model can tap into specialized educational sessions and conferences tailored to foster best practices in exchanging and promoting widespread knowledge sharing. Here’s how the specific practice transformation standards must be met within each phase:</p><ol><li><strong>Examination and preparation of infrastructure:</strong> In Track 1, the goal is to develop the foundation for implementing advanced primary care services. This stage will help the enrolled practice to build workflows, identify gaps, act on opportunities and assess their progress as they move forward.</li><li><strong>Implementing advanced primary care:</strong> In Track 2, practices build on what you’ve done in Track 1 through provider partnerships, implementation of care management and behavioral health screening. Practices put into this track to start will focus on getting ready for the last track of the model. Specifically, you'll build communication with social support, optimize technology and more.</li><li><strong>Optimizing care and partnerships:</strong> In Track 3, practices will take everything they've done up a notch by strengthening patient care and care integration. They'll also implement quality improvement activities, assess their impact on patient care and track their progress throughout the model.<br /></li></ol><h2 style="text-align: left;"><strong>Don't join the MCP model alone</strong></h2><p>The decision to adopt a CMS model is one that demands careful consideration and commitment. The MCP model is particularly well suited for those embarking on their journey into VBC, ensuring that they are not alone as they navigate these new waters.</p><p>By prioritizing patient care and outcomes, and with DataGen's specialized services — Making Care Primary and Value-based Care Consulting — providers can confidently participate in MCP, supported by expert guidance. If you have questions, don't hesitate to <a data-cke-saved-href="https://datagen.info/contact/" href="https://datagen.info/contact/" target="_blank">contact us today</a>.</p>Courtney Yulehttp://www.blogger.com/profile/15321700369247409594noreply@blogger.com0tag:blogger.com,1999:blog-2728411347274749489.post-28143767195928663152024-02-06T12:11:00.000-08:002024-03-26T12:08:02.682-07:00What is a Community Health Needs Assessment? 4 Tips to Start<p><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLIVmupV96pFzexK3d1BfceI1wQWWJQa2955QuTq1kz78cUxovV4_aRU1krymEBcUzxDrdjQRvvt3lfrSFI5BT-z5ZSqX-oWLm-jhuUOmH1qXeLZ8X532AGW8RSUGeL7HNJZtX39jqap3UClp2k0fsQfsOkDiAZt9ZF6uW1oa5naGZ7yBmLcJFaz24hcaE/s640/CHNA%20Blog_February%202024.jpeg" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img alt="Team writing on sticky notes trying to figure out what is a community health needs assessment." border="0" data-original-height="403" data-original-width="640" height="404" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLIVmupV96pFzexK3d1BfceI1wQWWJQa2955QuTq1kz78cUxovV4_aRU1krymEBcUzxDrdjQRvvt3lfrSFI5BT-z5ZSqX-oWLm-jhuUOmH1qXeLZ8X532AGW8RSUGeL7HNJZtX39jqap3UClp2k0fsQfsOkDiAZt9ZF6uW1oa5naGZ7yBmLcJFaz24hcaE/w640-h404/CHNA%20Blog_February%202024.jpeg" width="640" /></a></p><p>Hospitals typically conduct a <a data-cke-saved-href="https://datagen.info/solutions/community_and_market_planning/community_health_needs_assessment/" href="https://datagen.info/solutions/community_and_market_planning/community_health_needs_assessment/" target="_blank">Community Health Needs Assessment</a> to comply with state requirements or to maintain 501(c)3 status. However, emerging trends around health outcomes and health equity have sparked organizations to update and better align their CHNA processes toward highlighting community needs, equity, population health concerns, service access, affordability and quality.</p><p>In a research study, <a data-cke-saved-href="https://pubmed.ncbi.nlm.nih.gov/37203650/#:~:text=Social%20determinants%20of%20health%20(SDOH,these%20data%20elements%20to%20clinicians." href="https://pubmed.ncbi.nlm.nih.gov/37203650/#:~:text=Social%20determinants%20of%20health%20(SDOH,these%20data%20elements%20to%20clinicians." target="_blank">The National Library of Medicine</a> found that "Social determinants of health impact 80% of health outcomes from acute to chronic disorders, and attempts are underway to provide these data elements to clinicians."</p><p>Because of the short- and<a data-cke-saved-href="https://health.gov/healthypeople/priority-areas/social-determinants-health#:~:text=For%20example%2C%20people%20who%20don,have%20access%20to%20healthy%20foods." href="https://health.gov/healthypeople/priority-areas/social-determinants-health#:~:text=For%20example%2C%20people%20who%20don,have%20access%20to%20healthy%20foods." target="_blank"> long-term effects of SDOHs</a>, it's important that hospitals assess community needs. This way, they can find solutions to improve quality of life, identify underserved populations and establish connections with the community.</p><p>What can your organization do to revamp its CHNA process to focus on community needs, equity, care access, affordability and quality? In the next section, we'll cover how to rethink the planning and early steps of your CHNA so you have the tools on hand to capture better data and market research.</p><p><br /></p><h2 style="text-align: left;">Planning for your CHNA</h2><p>Planning for the CHNA is as important as conducting it. By developing your hospital game plan, you can:</p><ul><li>invest your limited financial and people resources wisely, making it more cost-effective;</li><li>focus on evidence-based interventions that improve health status;</li><li>choose the right partners; and</li><li>pressure-test confirmation bias through a data and analytics-first approach.</li></ul><p>In the first two months, hospitals should focus on the who, what and when of CHNA planning. Below, we outline four ways to start your CHNA.</p><p><br /></p><h2><strong>4 ways to start your CHNA</strong></h2><h3><strong>1. Begin broadly: Weeks 1 and 2</strong></h3><p>At the beginning of the <a data-cke-saved-href="https://news.datagen.info/2022/07/community-health-needs-assessment.html" href="https://news.datagen.info/2022/07/community-health-needs-assessment.html" target="_blank">CHNA process</a>, it's essential to collect general information on important resources. In the first two weeks, you should identify internal participants at all levels and roles. This can include everyone from frontline staff to executives, service line clinicians and data teams. Some may participate in the CHNA; others might be the ones who champion and lead it.</p><p>After you're done identifying key people in weeks one and two, begin defining key resources and milestones. You should plan to accomplish this in weeks two through four. Important things to consider in this timeframe include:</p><ul><li>realistic staff availability and timelines;</li><li>CHNA operational expenses; and</li><li>securing sufficient funds for the entire assessment process.</li></ul><p><br /></p><h3><strong>2. Review your last CHNA</strong></h3><p>In addition to defining key resources and milestones during weeks two through four, hospitals should review their prior CHNA. Specifically, look at:</p><ul><li>participant input and feedback;</li><li>qualitative research from focus groups;</li><li>how and when data were collected; and</li><li>and health improvement outcomes.</li></ul><p>Note that this information-gathering stage shouldn’t focus on the prior year’s CHNA target population. While hospital teams can’t help but digest this information when reviewing their last assessment, it’s important to suspend judgment during early planning, as new populations may now have greater unmet needs.</p><p>In other words, your new CHNA shouldn’t only focus on the reporting and working on the same factors and measures. Instead, this should be your chance to look at your data to find the greatest need. From there, you can focus efforts on the measures that need the most work.</p><p>This is the last phase of reworking your planning. In the next two sections, we'll go deeper into how to conduct your CHNA assessment, thinking about partners and data.</p><p><br /></p><h3><strong>3. Assemble diverse community partners</strong></h3><p>During weeks two through eight, you'll want to update the community partners that work closely with your CHNA's population.</p><p>For example, let's say more migrant families have moved into your community since your last CHNA report. In this case, you may want to add specific community partners who help them meet their needs, such as translators, displacement organizations, etc.</p><p>To reflect and account for these changes, your CHNA should include input and representation from:</p><ul><li>community members at large;</li><li>healthcare, education and philanthropic institutions;</li><li>the community, ranging from the underserved to public health experts;</li><li>the local health department; and</li><li>community-based organizations.</li></ul><p>In some cases, hospitals can only have a limited number of collaborators. This makes choosing the right ones even more crucial. A small pool of community partners won’t be as representative and diverse as a larger one. However, by getting the best organizations together, you'll gain the best experience, data and insights into the community.<br /><br /></p><h3 style="text-align: left;"><strong> 4. Discover the data</strong></h3><p>Identifying needed data sources allows you to piece your CHNA together and address any gaps. Hospitals should collect and analyze CHNA data from:</p><ul><li>prior assessments and internal sources;</li><li>publicly available secondary sources;</li><li>proprietary third parties; and</li><li>validated SDOH sources.</li></ul><p>These sources generate quantitative and qualitative data for comprehensive collection and analysis. Both tell the community’s story with accuracy.</p><p>Most importantly, last year’s data should be considered outdated. A lot can change about a hospital’s patients and markets in a year. By looking at how you'll obtain your data, you can check biases early on while making sure you don't have any data gaps.</p><p><em>Remember: This step is to identify sources, not data collection and analysis. Just as hospitals wait to identify a CHNA vision, they must wait before drawing early conclusions.<br /><br /></em></p><h2><strong>Essential next steps to meet community health needs</strong></h2><p>The CHNA helps a hospital understand its community. It also identifies and targets unmet community health needs. This process doesn't happen overnight, but by following the steps above, you can set the stage for success and improve your CHNA process. You can also<a data-cke-saved-href="https://news.datagen.info/2023/09/how-to-conduct-community-health-needs.html" href="https://news.datagen.info/2023/09/how-to-conduct-community-health-needs.html" target="_blank"> simplify the CHNA process with these three key steps</a>.</p><p>If you're feeling overwhelmed, DataGen can assist. <a data-cke-saved-href="https://datagen.info/solutions/community_and_market_planning/community_health_needs_assessment/" href="https://datagen.info/solutions/community_and_market_planning/community_health_needs_assessment/" target="_blank">Our experts can help you throughout every CHNA stage</a> with toolkits, templates and analytics expertise. <a data-cke-saved-href="https://datagen.info/solutions/community_and_market_planning/community_health_needs_assessment/free_consultation/" href="https://datagen.info/solutions/community_and_market_planning/community_health_needs_assessment/free_consultation/" target="_blank">Contact DataGen</a> today for best-in-class CHNA preparation. </p>Courtney Yulehttp://www.blogger.com/profile/15321700369247409594noreply@blogger.com0tag:blogger.com,1999:blog-2728411347274749489.post-11346406910033227062024-02-01T07:52:00.000-08:002024-03-26T12:41:37.579-07:005 Key Health Equity Impact Assessment Components<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhe6WwYAwmXCeGN3ec94VE6K5o4iXUF5KgAThS4GR5wFdgiAZKLPdmucfjIZi6gqUMUKXwMT6IXBdgbbsRGVOF33VAmUSw4QLFwxsk712NaU2P_HPKviSGusYLjefRisTcJl6aZ0VZXO8R7TogC0VpnTNMUEB3F1-nl_LbegBK-5ANFNlxqco46MQH3M5g/s640/CON%20HEIA%20Blog_January%202024.jpeg" style="margin-left: 1em; margin-right: 1em;"><img alt="People together in a park smiling and talking about health equity." border="0" data-original-height="403" data-original-width="640" height="404" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhe6WwYAwmXCeGN3ec94VE6K5o4iXUF5KgAThS4GR5wFdgiAZKLPdmucfjIZi6gqUMUKXwMT6IXBdgbbsRGVOF33VAmUSw4QLFwxsk712NaU2P_HPKviSGusYLjefRisTcJl6aZ0VZXO8R7TogC0VpnTNMUEB3F1-nl_LbegBK-5ANFNlxqco46MQH3M5g/w640-h404/CON%20HEIA%20Blog_January%202024.jpeg" width="640" /></a></div><p>New York enacted legislation last year requiring healthcare providers to contract with a third-party, referred to as an independent entity, to define if and how some proposed projects will impact health equity. Hospitals, ambulatory surgery centers and other facilities must now, for many projects, provide a <a data-cke-saved-href="https://datagen.info/solutions/community_and_market_planning/health_equity_impact_assessment/" href="https://datagen.info/solutions/community_and_market_planning/health_equity_impact_assessment/" target="_blank">Health Equity Impact Assessment </a>conducted by an independent entity as part of their Certificate of Need application.</p><p>To help your organization complete these new requirements, we've highlighted five essential HEIA components. Read on for a distilled HEIA summary. Plus, learn how experienced assessment partners can facilitate successful expansion, amplify the community’s voice and improve health equity. </p><h2><strong>Health Equity Impact Assessment requirements</strong></h2><p>Effective June 22, 2023, hospitals, ASCs and other Article 28 facilities in New York state must submit HEIA documentation with their CON applications. For projects requiring an HEIA, providers’ contracted independent entities must use the DOH’s <a data-cke-saved-href="https://www.health.ny.gov/facilities/cons/health_equity/docs/heia_template.docx" href="https://www.health.ny.gov/facilities/cons/health_equity/docs/heia_template.docx" target="_blank">HEIA template</a> to describe:</p><ul><li>the project’s scope and impact;</li><li>how the organization will mitigate health inequities for medically underserved populations; and</li><li>how the organization will monitor and disseminate information about their projects.</li></ul><p>One of the purposes of the HEIA is to identify health inequalities and disparities. From there, organizations can address public health issues in their CON applications, further advancing health equity and improving health.</p><p>The state’s goal is to better shape healthcare delivery to advance equity and achieve the highest level of health across the state, specifically:</p><ul><li>achieving health equity across underserved populations;</li><li>removing potential discriminatory practices/barriers; and</li><li>positively affecting the health of communities that need it most.</li></ul><p>Use these <a data-cke-saved-href="https://news.datagen.info/2023/10/5-fast-facts-on-new-yorks-health-equity.html" href="https://news.datagen.info/2023/10/5-fast-facts-on-new-yorks-health-equity.html" target="_blank">HEIA five fast facts</a> to get the full overview of the guidelines.</p><h2><strong>Your step-by-step HEIA guide</strong></h2><h3><strong>1. Scoping</strong></h3><p>Independent entities must use state-defined <a data-cke-saved-href="https://www.health.ny.gov/facilities/cons/health_equity/docs/heia_data_tables.xlsx" href="https://www.health.ny.gov/facilities/cons/health_equity/docs/heia_data_tables.xlsx" target="_blank">HEIA Data Tables</a> to identify populations impacted by the provider’s CON. These data must:</p><ul><li>capture the impacted service area;</li><li>include the impacted demographics, e.g., employment, education, transportation; and</li><li>identify medically underserved populations.</li></ul><p>Data on medically underserved populations include age; income; race, gender and sexual orientation; disabilities and other medical vulnerabilities; and other socioeconomic factors, such as immigration and insurance coverage status. These data can be difficult to collect and maintain. The regulation requires the independent entity to obtain and interpret these data to prevent the likelihood of introducing bias into the assessment.</p><p>Additionally, within the HEIA, an independent entity must identify how a CON project will impact every medically underserved population identified. It should also explain how the population used services before and will use services after the project.</p><h3><strong>2. Potential impacts</strong></h3><p><a data-cke-saved-href="https://regs.health.ny.gov/volume-c-title-10/content/section-40026-health-equity-impact-assessments" href="https://regs.health.ny.gov/volume-c-title-10/content/section-40026-health-equity-impact-assessments" target="_blank">Section 400.26</a>, Title 10 New York Codes, Rules and Regulations, requires CON applicants to identify whether and how a facility’s proposed project will impact healthcare access and service delivery, particularly for medically underserved groups.</p><p>On behalf of hospitals, ASCs and other Article 28 facilities, independent entities must identify how the project will affect access to care. They also must identify overall equity and disparities across all underserved populations. Examples include impacts on indigent care, transportation and mobility.</p><p>DOH also requests answers to the following questions:</p><ul><li>Were stakeholders engaged?</li><li>If so, which ones and did these include local health departments?</li><li>How was the community informed of the HEIA and its impacts?</li></ul><p>This helps describe community engagement around the project. In each case, the HEIA must describe the independent entity’s role in the process.</p><h3><strong>3. Mitigation</strong></h3><p>CON applicants must use evidence-based approaches to mitigate project impacts and amplify positive outcomes. HEIA requirements here span engagement and communication with non-English speakers, those with impairments and all medically underserved groups that the project will impact. If feedback identifies better mitigation strategies, state law requires that the HEIA include them.</p><h3><strong>4. Monitoring</strong></h3><p>A provider’s CON impact mitigation strategies must be put into practice. In their HEIAs, facilities must document how they will monitor their project’s impacts on affected populations. DOH requires providers to identify new and existing strategies to minimize negative effects based on HEIA findings. Monitoring and mitigation steps are two more areas where the independent entity can provide invaluable objective input.</p><h3><strong>5. Dissemination</strong></h3><p>According to the state, the <a data-cke-saved-href="https://www.health.ny.gov/community/health_equity/impact_assessment_faqs.htm" href="https://www.health.ny.gov/community/health_equity/impact_assessment_faqs.htm">public posting of documents</a> goes as follows:</p><p style="margin-left: .5in;">“When an HEIA is filed with a CON application, the applicant must provide a full version of the application and a version with proposed redactions. The applicant is required to post the redacted CON application and the HEIA on its website within one week of acknowledgement by the NYSDOH, and until a decision on the application is rendered by the Public Health and Health Planning Council or the Commissioner of NYSDOH. The Department will also publicly post the redacted CON application and the HEIA on the NYSE-CON system within one week of the filing.”</p><p>Key takeaways: Providers must post their redacted CON application and HEIA publicly within one week of acknowledgment by DOH. DOH will also post the redacted documents publicly within one week of the filing.</p><h2><strong>Turn to a partner you already trust</strong></h2><p>DataGen is an <a data-cke-saved-href="https://datagen.info/solutions/community_and_market_planning/health_equity_impact_assessment/" href="https://datagen.info/solutions/community_and_market_planning/health_equity_impact_assessment/" target="_blank">HEIA analytics</a> subcontractor of <a data-cke-saved-href="https://www.chartis.com/campaigns/health-equity-impact-assessment-new-york-LI" href="https://www.chartis.com/campaigns/health-equity-impact-assessment-new-york-LI" target="_blank">Chartis</a>, an experienced independent entity. DataGen already provides analytics-first support to hospitals and health systems across New York and the U.S. Contact us today for a <a data-cke-saved-href="https://datagen.info/solutions/community_and_market_planning/health_equity_impact_assessment/#contact" href="https://datagen.info/solutions/community_and_market_planning/health_equity_impact_assessment/#contact" target="_blank">free HEIA consultation</a> and learn how we can support your health equity efforts every step of the way.</p>Courtney Yulehttp://www.blogger.com/profile/15321700369247409594noreply@blogger.com0tag:blogger.com,1999:blog-2728411347274749489.post-82469309926880413342024-01-24T09:41:00.000-08:002024-03-26T11:41:56.924-07:00What is the purpose of a Community Health Assessment?<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhaGc2-9zBT-t-0UySzKLjU_xG1BuluoxOO1YIBjmX4ZvSRViRtwVwwQ60S6evGFHKH4tDh0urZAqGAuFk0j_bj5NfZ0gYrIf8NmAWatn5mkaIeD6yURB7HR-j7SFFryTNEYhLYQlt8ccpimdbtHewXm8ATvGxfq4yLJyOCWy6oqT63Mh9nIo2QtnzfP2I/s640/CHA%20Blog%203_January%202024.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="Group of people smiling and clapping after finishing a meeting on the purpose of a Community Health Assessment." border="0" data-original-height="403" data-original-width="640" height="404" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhaGc2-9zBT-t-0UySzKLjU_xG1BuluoxOO1YIBjmX4ZvSRViRtwVwwQ60S6evGFHKH4tDh0urZAqGAuFk0j_bj5NfZ0gYrIf8NmAWatn5mkaIeD6yURB7HR-j7SFFryTNEYhLYQlt8ccpimdbtHewXm8ATvGxfq4yLJyOCWy6oqT63Mh9nIo2QtnzfP2I/w640-h404/CHA%20Blog%203_January%202024.jpeg" width="640" /></a></div><p>The purpose of a Community Health Assessment goes beyond achieving state requirements or receiving accreditation. If you're a local health department, you may be interested in finding ways to push your CHA data further to more easily identify ways to improve health equity and community outcomes. Focusing only on submission can be counter-productive to the community outcomes you want to achieve.</p><p>In this blog, we'll give you an overview of the importance of conducting a CHA. Plus, we'll provide you with key information you can use to reset your workflow and rethink your processes.</p><h2 style="text-align: left;"><strong>Why you need to complete a Community Health Assessment</strong></h2><p>Certain states require a CHA because it provides a systematic review of a community's health status and essential data and information regarding the health of the community.</p><p>Specifically, the<a data-cke-saved-href="https://www.health.ny.gov/statistics/chac/docs/chaguide.pdf" href="https://www.health.ny.gov/statistics/chac/docs/chaguide.pdf" target="_blank"> New York state Department of Health</a> writes, "Community health assessment is a fundamental tool of public health practice. Its aim is to describe the health of the community, by presenting information on health status, community health needs, resources, and epidemiologic and other studies of current local health problems."</p><p>States like New York require the CHA to be submitted as a part of a Community Health Improvement Plan. This allows New York to ensure that local health departments have taken the appropriate time to capture their communities’ health needs. It also enables them to see how health improvement will be measured in their CHIP.</p><p>By completing a CHA, you’ll gain valuable expertise on how to address health needs and implement strategy. This can help organizations like hospitals complete their Community Health Needs Assessment requirements every three years. Another reason to complete a CHA could be for Public Health Accreditation Board accreditation. <a data-cke-saved-href="https://phaboard.org/accreditation-recognition/" href="https://phaboard.org/accreditation-recognition/" target="_blank">PHAB accreditation and recognition</a> help organizations demonstrate their willingness to improve quality and performance. Benefits include:</p><ul><li>better serving communities;</li><li>strengthening health departments;</li><li>improving public health response; and</li><li>developing a culture of quality and performance improvement.</li></ul><h2 style="text-align: left;"><strong>What is the purpose of completing a CHA?</strong></h2><p>By focusing only on CHA/CHIP submission or PHAB accreditation, you can miss out on the CHA's main purposes:</p><ul><li>understanding community health needs;</li><li>identifying resources;</li><li>developing strategies; and</li><li>forming partnerships.</li></ul><p>It's important to think about CHAs as more than a requirement. Its purpose is to get health departments involved with their communities, allowing them to promote and achieve health equity. In the next section, we'll identify some ways to better align your work with the purpose of the CHA. Also, be sure to check out this blog to <a data-cke-saved-href="https://news.datagen.info/2023/09/the-hardest-community-health-assessment.html" href="https://news.datagen.info/2023/09/the-hardest-community-health-assessment.html" target="_blank">learn the hardest CHA step and how to overcome it.</a><br /></p><h2 style="text-align: left;"><strong>Helpful tips to refresh your CHA process</strong></h2><h3 style="text-align: left;"><strong>1. Have clear responsibilities</strong></h3><p>A CHA requires a lot of information. If you don't know who captures what data, you may not know who is responsible for what task. Everyone knows who the CEO is — but only a few may know the person pulling data in a health department's archives.</p><p>This can result in missed deadlines and confusion over who to contact at community-based organizations. Take time to learn who is involved in the process from start to finish.</p><h3 style="text-align: left;"><strong>2. Create a data identification structure</strong></h3><p>A data identification structure is essential. It tells you what you're capturing, how you're finding it and if it's publicly and/or locally reported. This can be helpful since the CHA is cycled every two years. Once you're done with one, you start the process for the next one.</p><h3 style="text-align: left;"><strong>3. Rethink external participation</strong></h3><p>When complete the CHA and Community Health Improvement Planning, you’ll need to have your board sign a statement to adopt the CHA/CHIP. The board is required to adopt the CHA/CHIP before it can be submitted. Therefore, it’s essential that you give yourself and your board enough time to review your CHA/CHIP. This can prevent any possible delays in approval and submission.</p><p>Also, if you’re looking for true community data, don’t overlook the power of facilitating focus groups. Focus groups will give you helpful qualitative data that you can use to reinforce your data findings. They may also shed light on trends or other assumptions. This can be good when trying to avoid biases.</p><h3 style="text-align: left;"><strong>4. Use external resources</strong></h3><p>The National Association of County and City Health Officials has helpful resources for completing your CHA/CHIP. They're a well-known entity PHAB trusts to help create and compile CHA reports. One of their most-used resources is the <a data-cke-saved-href="https://www.naccho.org/programs/public-health-infrastructure/performance-improvement/community-health-assessment/mapp" href="https://www.naccho.org/programs/public-health-infrastructure/performance-improvement/community-health-assessment/mapp" target="_blank">Mobilizing for Action through Planning and Partnerships</a> toolkit. <a data-cke-saved-href="https://toolbox.naccho.org/pages/tool-view.html?id=6012" href="https://toolbox.naccho.org/pages/tool-view.html?id=6012" target="_blank">MAPP 2.0</a> provides step-by-step guidance for CHA's three-phrase process.</p><p>DataGen uses this in our <a data-cke-saved-href="https://datagen.info/solutions/community_and_market_planning/community_health_assessment/" href="https://datagen.info/solutions/community_and_market_planning/community_health_assessment/" target="_blank">CHA Advantage</a> product to ensure clients follow all MAPP guidelines to receive PHAB accreditation.</p><h3 style="text-align: left;"><strong>5. Let the data drive your focus</strong></h3><p>If your organization has completed a CHA several times, let data drive your focus. Avoid making assumptions and use the data to drive what you want to improve or capture. Also, think about ways you can expand your data to capture insights you haven't looked at yet.<br /></p><h2 style="text-align: left;"><strong>How new data can level up your CHA</strong></h2><p>DataGen <a data-cke-saved-href="https://datagen.info/solutions/community_and_market_planning/community_health_assessment/" href="https://datagen.info/solutions/community_and_market_planning/community_health_assessment/" target="_blank">CHA Advantage</a> acts like your personal quantitative and qualitative data archive. With over 200 curated metrics from 20 different domains of data points (public and private), you can dig deeper at the county, ZIP code and census-tract levels. We save you time with pre-packaged quantitative data that's not publicly available. You also gain:</p><ul><li>a ready-to-use survey tool to more easily capture qualitative and quantitative data;</li><li>26 helpful documents, guides, lists, templates and worksheets;</li><li>full report template we can help populate; and</li><li>personalized one-on-one support that gets you to the finish line, i.e., CHA submission.</li></ul><p><a data-cke-saved-href="https://datagen.info/contact/" href="https://datagen.info/contact/" target="_blank">Contact us today</a> to learn how to reduce months of work into weeks. Also, <a data-cke-saved-href="https://news.datagen.info/2024/01/community-health-assessment-re.html" href="https://news.datagen.info/2024/01/community-health-assessment-re.html" target="_blank">use our CHA five-month action plan to enhance your results</a>.</p>Courtney Yulehttp://www.blogger.com/profile/15321700369247409594noreply@blogger.com0tag:blogger.com,1999:blog-2728411347274749489.post-17573688643196226572024-01-19T07:01:00.000-08:002024-03-26T13:10:42.567-07:002024 healthcare strategic planning: 3 new data tips<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghrP3qoAt5Naj1N1wOwpNOi2CJhgUbt_Kwn2qIo_l1EO5_lJuiAZHR0J8GEFkzTM4XyrWixe3AWAGtH8ATJBn_-yPgH3DPvVzTEixiOCpMwdzssY3L-n_UMPuVIWFzOqzn2SoitfuF78UV2VvpVZ93KYda6NUvfeweGquJ6LlqzgYTrDR_ElSLqDSKBHU/s640/CHA%20Blog_January%202024.jpeg" style="margin-left: 1em; margin-right: 1em;"><img alt="healthcare strategic planning" border="0" data-original-height="403" data-original-width="640" height="404" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghrP3qoAt5Naj1N1wOwpNOi2CJhgUbt_Kwn2qIo_l1EO5_lJuiAZHR0J8GEFkzTM4XyrWixe3AWAGtH8ATJBn_-yPgH3DPvVzTEixiOCpMwdzssY3L-n_UMPuVIWFzOqzn2SoitfuF78UV2VvpVZ93KYda6NUvfeweGquJ6LlqzgYTrDR_ElSLqDSKBHU/w640-h404/CHA%20Blog_January%202024.jpeg" width="640" /></a></div><p>Hospitals and health systems understand the importance of diligent healthcare strategic planning. It enables them to monitor their markets while evaluating potential challenges and opportunities. However, without the right healthcare data at their fingertips, these initiatives can be more time-consuming and less efficient.</p><p>How are players in the healthcare industry using data in 2024 and beyond to drive their strategic planning efforts? Let's look at some pain points hospitals and health systems are facing.</p><p>First, hospitals and health systems must contend with recurring data challenges related to interoperability, accuracy and privacy. Secondly, to keep up with a changing consumer landscape, providers must adjust workflows and projects based on new industry data. We've detailed each challenge below and provided three strategies to combat them.<br /></p><h2><strong>What data to use in your strategic planning</strong></h2><h3><strong>1. Claims data</strong></h3><p>When it comes to strategic planning in healthcare in 2024, providers must widen their view. Many providers are recovering financially and don’t have the capital to invest in long-term projects. On top of that, new cost transparency rules will strain already tight finances.</p><p>Hospitals and health systems must balance their three- to one-year plan and find ways to capture return on investment immediately. One method is to use claims data for more effective strategic planning.</p><h3>How claims data gives you an edge</h3><p>First, data can bridge the gap between short- and long-term strategic goals and objectives. Claims data are especially useful because these data help drive dollars into facilities faster. This is imperative as healthcare industry challenges grow.</p><p>According to the study, <a data-cke-saved-href="According%20to%20the%20study,%20The%20Use%20of%20Claims%20Data%20in%20Healthcare%20Research,%20%22Claims%20data%20may%20also%20be%20good%20for%20establishing%20the%20cost%20for%20certain%20diagnoses.%20The%20purpose%20of%20a%20claim%20is%20to%20collect%20payment,%20so%20it%20is%20convenient%20for%20researchers%20to%20consult%20fee%20schedules%20and%20reimbursement%20data%20and%20perform%20cost-effectiveness%20analyses.%22" href="https://openpublichealthjournal.com/contents/volumes/V2/TOPHJ-2-11/TOPHJ-2-11.pdf#:~:text=Claims%20data%20may%20also%20be,%5Be.g.%2C%20see%2017%5D." target="_blank"><em>The Use of Claims Data in Healthcare Research</em></a>, "Claims data may also be good for establishing the cost for certain diagnoses. The purpose of a claim is to collect payment, so it is convenient for researchers to consult fee schedules and reimbursement data and perform cost-effectiveness analyses."</p><p>You'll want to investigate your claims data to further build on the efficiency and effectiveness of your care. Some other benefits of looking at your claims data are finding ways to:</p><ul><li>improve the quality of care;</li><li>improve patient experience;</li><li>better allocate resources;</li><li>support your healthcare organization's long-term goals.</li></ul><h3><strong>2. Service line data</strong><br /></h3><p>All healthcare is local: patients’ needs impact the entire community and the market must respond. But today’s “local” is larger and growing. The impact of disrupters, such as big tech, retail, payers and next-gen medical groups, can't be ignored. A disrupter can leverage data in ways that most traditional healthcare stakeholders still can’t and understand a market from miles away.</p><p>For example, UnitedHealth Group, parent to the nation’s largest private payer, <a data-cke-saved-href="https://www.medscape.com/viewarticle/10-us-physicians-work-or-under-unitedhealth-problem-2023a1000vhg?form=fpf" href="https://www.medscape.com/viewarticle/10-us-physicians-work-or-under-unitedhealth-problem-2023a1000vhg?form=fpf" target="_blank">controls nearly 10%</a> of all U.S. physicians by affiliation or employment.</p><p>Even small health systems with strong post-acute services, integrated physicians and market concentration are not immune. In fact, such systems are more likely to be acquired. So, what can health systems do to remain viable and provide high-quality care that beats disrupters?</p><h3>Why you should use service line data</h3><p>Strategic planning should involve understanding your service line's strengths and weaknesses. From there, you'll gain a better sense of your market position and be able to use your data to the fullest. With a better grasp of your data, you can use additional <a data-cke-saved-href="https://news.datagen.info/2023/10/key-strategies-to-combat-market.html" href="https://news.datagen.info/2023/10/key-strategies-to-combat-market.html" target="_blank">key strategies to combat market disrupters in healthcare</a>.</p><p>Not all of these strategies are alike. First steps can include answering<a data-cke-saved-href="https://news.datagen.info/2023/06/the-3-must-ask-questions-to-grow-your.html" href="https://news.datagen.info/2023/06/the-3-must-ask-questions-to-grow-your.html" target="_blank"> three must-ask questions</a> or researching tools that can provide these insights.</p><p>Sg2’s MarketEdge <a data-cke-saved-href="https://datagen.info/solutions/community_and_market_planning/market_and_referral_pattern_analyses_nys/" href="https://datagen.info/solutions/community_and_market_planning/market_and_referral_pattern_analyses_nys/" target="_blank">market and referral pattern analyses</a> can help you achieve this. They'll help you better understand your health system’s market position based on:</p><ul><li>historic use;</li><li>demographic data; and</li><li>other user-defined specifications, such as geographies and hospitals.</li></ul><h3><strong>3. Hard intel data</strong></h3><p>As more companies collect and analyze different data types, "drinking from the data firehose" will be even harder. Collecting more data is a challenge as resources shrink. Plus, with bigger players entering the market, the nature of the data hospitals and health systems can access has changed.</p><p>For example, more than <a data-cke-saved-href="https://www.healthcaredive.com/news/covid-pandemic-healthcare-burnout-providers-quit-jobs/634946/" href="https://www.healthcaredive.com/news/covid-pandemic-healthcare-burnout-providers-quit-jobs/634946/" target="_blank">over 200,000 healthcare workers quit their jobs in 2021</a>, according to the HealthcareDive. This year, RevCycleIntelligence reported that <a data-cke-saved-href="https://revcycleintelligence.com/news/1-in-3-healthcare-workers-plan-to-leave-their-position-survey-finds" href="https://revcycleintelligence.com/news/1-in-3-healthcare-workers-plan-to-leave-their-position-survey-finds" target="_blank">another third</a> say they plan to quit before 2025, stating, "Healthcare workers are experiencing anxiety, depression and exhaustion, prompting them to leave their jobs."</p><p>That leaves less people in the organization to distill what’s most critical with higher data volumes. Resource constraints sharpen an ongoing risk, data bias, at a time when providers need a bigger competitive edge.</p><h3>How hard intel data gives you an edge</h3><p>With so many healthcare workers leaving, you'll need to either adjust your strategic planning process to incorporate these factors or adjust your strengths, weaknesses, opportunities and threats.</p><p>You'll also want to start looking into “hard intelligence” data. In the past, providers relied on anecdotal data. But to stay competitive, you need hard intel from diverse sources. Examples of hard intel data include claims, demographics and social drivers of health. All these data sources will help you achieve a more comprehensive strategic plan.<br /></p><h2><strong>Develop a strategic plan with powerful data</strong></h2><p>Strategic plans in healthcare organizations are as only strong as the data collected. More data doesn’t always improve your market leverage, especially if you don't know how to optimize it. Plus, with shrinking staff and resources, adjusting your strategic plan (or pulling data) might not be a top priority.</p><p>Let DataGen be your data hub for strategic planning. Through our partnership with Sg2 MarketEdge, we'll work as an extension of your staff, providing you with key data points that drive ROI, growth and high-quality care. <a data-cke-saved-href="https://datagen.info/contact/" href="https://datagen.info/contact/" target="_blank">Reach out to us today</a> and see for yourself how we can <a data-cke-saved-href="https://datagen.info/solutions/community_and_market_planning/market_and_referral_pattern_analyses_nys/" href="https://datagen.info/solutions/community_and_market_planning/market_and_referral_pattern_analyses_nys/" target="_blank">optimize your lines, financials and footprints</a>.</p>Courtney Yulehttp://www.blogger.com/profile/15321700369247409594noreply@blogger.com0tag:blogger.com,1999:blog-2728411347274749489.post-54886170314555272952024-01-16T10:52:00.000-08:002024-03-26T11:46:09.896-07:00Community Health Assessment re-evaluation: Your 5-month action plan<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIGNZPJnRse1T58lN6FkTSJTqCWmSHJswVz6Sad5BcLn4WUkNzDcXaX9U2AFASCNXTPXc0w3Sou-LRt6Udaoy6Ma-yHdPYtk4ofwNHyYB8Sr2XobIRyaBIt3HUfq5KvPyiOZLi0g8TvBYWUBS2aP9kzuNX5MZYocMM3P0lumFOMn-3TP8yIH2sD_inTWI/s640/CHA%20Blog%202_January%202024.jpeg" style="margin-left: 1em; margin-right: 1em;"><img alt="Group of colleagues re-evaluating their Community Health Assessment" border="0" data-original-height="403" data-original-width="640" height="404" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIGNZPJnRse1T58lN6FkTSJTqCWmSHJswVz6Sad5BcLn4WUkNzDcXaX9U2AFASCNXTPXc0w3Sou-LRt6Udaoy6Ma-yHdPYtk4ofwNHyYB8Sr2XobIRyaBIt3HUfq5KvPyiOZLi0g8TvBYWUBS2aP9kzuNX5MZYocMM3P0lumFOMn-3TP8yIH2sD_inTWI/w640-h404/CHA%20Blog%202_January%202024.jpeg" width="640" /></a></div><p>As a local health department, your Community Health Assessment helps you discover your community’s story so you can better identify and achieve key improvements. If you feel you can achieve more from your CHA, then it’s time to re-examine your approach.</p><p>It’s not as difficult as it seems, and there is a roadmap: <a data-cke-saved-href="https://toolbox.naccho.org/pages/tool-view.html?id=6012" href="https://toolbox.naccho.org/pages/tool-view.html?id=6012" target="_blank">MAPP 2.0</a>. The Mobilizing for Action through Planning and Partnership tool was developed by the <a href="https://www.naccho.org/" target="_blank">National Association of County and City Health Officials</a> in collaboration with the Centers for Disease Control and Prevention. Using MAPP 2.0, DataGen created a five-month action plan that you can use over the span of five months for a better CHA — no matter where you start from or what your results have been.</p><h2>How to re-examine your CHA approach</h2><h3>Month 1: Organize for success and partnership development<br /></h3><p style="margin-left: 0.25in;">Identifying the right internal and external community partners is the single most important step for a successful CHA. These are the individuals, at every level, who will champion, lead and execute your CHA projects.<br /></p><p style="margin-left: 0.25in;">Be sure to identify representative leads and liaisons across your health department and community. In addition to staff, re-examine your resources, e.g., funds, data sources and past CHA learnings, and assess these against your budget and operational expenses.<br /></p><p style="margin-left: 0.25in;"><em>Tip: People before the process</em>. <em>Assemble your internal team during the first two weeks, before you identify your resources and create a top-line budget.</em><br /></p><h3>Month 2: Plan, mobilize and align<br /></h3><p style="margin-left: 0.25in;">Planning is one of the most inspiring parts of the CHA process. You want to improve your community but may not truly know who needs the most help and how you can provide it. When you conduct the CHA, anchor your early vision with these project mobilization steps:<br /></p><ul><li>identify data from prior assessments and internal and secondary sources;</li><li>define and describe your community;</li><li>tailor your CHA;</li><li>create survey, communication and collaboration plans; and</li><li>integrate your internal and community teams.</li></ul><p style="margin-left: 0.25in;">The last step is vital to align vision across all partners. But remember, even an agreed-upon vision at this stage must be pressure tested. You’ll use months 3 and 4 to do that.<br /></p><p style="margin-left: 0.25in;"><em>Tip: Expand your data discovery</em>. <em>Health equity should be the foundation of every CHA, but you may need additional social drivers of health data to achieve it. Start with what you have and consider data from well-resourced third parties.</em><br /></p><h3>Months 3-4: Assess the community and its story equitably<br /></h3><h4 style="text-align: left;">Part 1: How to review your survey and analyze results</h4><p style="margin-left: 0.25in;">After you tailor the CHA in month 2, you will need to distribute it and collect and analyze the community health assessment survey.<br /></p><ul><li>confirming that your assessment population is a sufficient size and representative;</li><li>leveraging all possible internal and external resources for survey distribution and completion; and</li><li>analyzing the survey results.</li></ul><p style="margin-left: 0.25in;">Analysis should include two levels: macro-level data (community health status and context) from all sources and micro-level data (individual health status) from the CHA. Your initial analysis will help you identify <em>potential</em> community-based interventions. Here, the word potential is key since you’ll want to look at your data with fresh eyes.<br /></p><p style="margin-left: 0.25in;">Many times, organizations that have already conducted CHAs might try to make the data fit the community-based interventions that they’ve identified in the past. Whether this is your first CHA or not, you’ll want to account for any potential bias you’re bringing to your data.<br /></p><p style="margin-left: 0.25in;"><em>Tip: First impressions are just that</em>. <em>Embed a beginner’s mindset in your re-examined CHA process. This will set your health department up for success as you revisit your findings during the final assessment phase. </em><br /></p><h4 style="text-align: left;">Part 2: Other types of data</h4><p>Your CHA survey results are only one component in a larger process. To successfully identify and target community health problems, you’ll also need to collect other types of data which can be <a href="https://news.datagen.info/2023/09/the-hardest-community-health-assessment.html" target="_blank">one of the hardest CHA steps</a>.</p><p>By that, you’ll need to investigate data that is either publicly available or proprietary. Examples of this include data that shows things like:</p><ul><li>SDOH-social determinants of health;</li><li>demographic;</li><li>behavior;</li><li>outcome; and</li><li>utilization information.</li></ul><p>These are a big part of the CHA process and a major offering with DataGen’s <a data-cke-saved-href="https://datagen.info/solutions/community_and_market_planning/community_health_assessment/" href="https://datagen.info/solutions/community_and_market_planning/community_health_assessment/" target="_blank">CHA Advantage</a> product.<br /></p><h4 style="text-align: left;">Part 3: Qualitative data</h4><p>On top of collecting other types of data, you’ll need to also go out into the community, build relationships and collect qualitative data.</p><p>This is a key step many organizations overlook because they’re constricted on time. It can also be overwhelming to go out into the community and create the relationships you planned on building in months one and two. Regardless of the time and stress this may cause, qualitative data helps you produce a richer, deeper understanding of the neighborhoods you serve. Plus, depending on what state you reside in, it could be a requirement for your application, e.g., New York state.</p><p>Another reason why you’ll want to make community partnerships is that it can help you detect inconsistencies or biases in your CHA data. For example, if you’ve been doing your CHA for many years without talking to community leaders, the data assumptions you’ve been pulling may be incorrect. Why?</p><p>A lot changes over a year, let alone years. Without a broader scope of what’s going on in your community, you may miss emerging trends, raising community concerns and population stressors — all of which could be represented in your data but not necessarily identified. This could lead to health initiatives that aren’t effective (and, possibly outdated).</p><p>By acknowledging the benefits of working directly with community leaders, you’ll strengthen relationships and better use resources that create meaningful changes that you can demonstrate.<br /></p><h3>Month 5: Identify key needs to formulate goals and strategies<br /></h3><p style="margin-left: 0.25in;">The CHA’s goal is to identify the most significant community health needs and their causes. Your team will identify and discuss key takeaways — internally first, then with your community and partners — to collect feedback and refine your intervention goals and strategies. Re-examining the CHA at this stage involves prioritization, consensus and an evidence-based approach to intervention.<br /></p><p style="margin-left: 0.25in;"><em>Tip: Goals versus resources</em>. <em>Assess your final plan against your resource inventory. Can you achieve what you want with the people, processes and funds you have in place? Have any of those variables changed since month 1?</em><br /></p><h2>Need help? Contact us for a stress-free CHA</h2><p>By re-examining your CHA approach, you can more efficiently revisit and refine its main components: organization, partnership, visioning and assessment. This will enable you to improve your results while making a better, more targeted impact in your community.<br /></p><p>If you’re still looking for assistance when it comes to your CHA, DataGen can help. Our <a data-cke-saved-href="https://datagen.info/solutions/community_and_market_planning/community_health_assessment/" href="https://datagen.info/solutions/community_and_market_planning/community_health_assessment/" target="_blank">CHA Advantage suite</a> streamlines your assessment from start to finish, providing you with invaluable data and analytics all in one place. Schedule your <a data-cke-saved-href="https://datagen.info/solutions/community_and_market_planning/community_health_assessment/free_consultation/" href="https://datagen.info/solutions/community_and_market_planning/community_health_assessment/free_consultation/" target="_blank">free consultation</a> today and see how we can level up your CHA.</p>Courtney Yulehttp://www.blogger.com/profile/15321700369247409594noreply@blogger.com0tag:blogger.com,1999:blog-2728411347274749489.post-75674399629217450882024-01-02T14:06:00.000-08:002024-03-27T07:17:05.412-07:00 What does healthcare improvement look like in 2024 and beyond?<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTXO9UWR_l9QI1kCwXCr3oA_qSiBk31rwsta7neeIpajGVfeSKVuaBmrVlrW53jN3MwMWDpPB1-484d8sw2QmWv7guBeUPPn0golHjHZaU-Y6hJW3wDIFZq4h0ndHRn2ImAH0dfrQu7jzuCu3weI6OCaFHhjMe8P2jRKddyE0TWh9sZtQ_P4s7kUT4mQM/s640/CSI%20Blog_December%202023.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="Team smiling and trying to create healthcare improvement" border="0" data-original-height="403" data-original-width="640" height="404" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTXO9UWR_l9QI1kCwXCr3oA_qSiBk31rwsta7neeIpajGVfeSKVuaBmrVlrW53jN3MwMWDpPB1-484d8sw2QmWv7guBeUPPn0golHjHZaU-Y6hJW3wDIFZq4h0ndHRn2ImAH0dfrQu7jzuCu3weI6OCaFHhjMe8P2jRKddyE0TWh9sZtQ_P4s7kUT4mQM/w640-h404/CSI%20Blog_December%202023.jpeg" width="640" /></a></div><p>The healthcare industry has faced many new challenges in recent years. How does this seemingly ever-changing landscape impact healthcare improvement in 2024 and beyond?</p><p>Based on the Institute for Healthcare Improvement 2023 Forum, quality improvement, safety and culture, equity and a functional delivery system remain top priorities across sectors. This was reflected in the forum <a data-cke-saved-href="https://na.eventscloud.com/website/60742/agenda/" href="https://na.eventscloud.com/website/60742/agenda/" target="_blank">agenda</a>, which included 10 tracks and a scientific symposium with three primary focus areas:<br /></p><ol><li><strong>Quality:</strong> Addressing value, cost and quality; diagnostic excellence and improvement science</li><li><strong>Culture and safety:</strong> Building capability, leadership, workforce well-being and patient and workforce safety</li><li><strong>Patient focus:</strong> Equity, person-centered care and population health</li></ol><p>Since DataGen participated, we’ll give you some exclusive insight into what was discussed so you can better understand what’s driving healthcare in the new year.<br /></p><h2 style="text-align: left;"><strong>The future of healthcare improvement: 4 major insights</strong></h2><h3>1. Quality requires a systems approach</h3><p>There is a constant challenge in healthcare: how to operationalize strategy to achieve quality improvement. One answer is a <a data-cke-saved-href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502599/" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502599/" target="_blank">systems approach</a>, which involves sharing evidence-based best practices in a persistent, coordinated way across stakeholder groups. The importance of a systems approach — particularly for care redesign — will be critical to address persistent problems and create sustainable solutions. <br /></p><p>While value-based care has been a part of healthcare for more than a decade, stakeholders continue to debate the link between quality and value and how to improve it. Sessions at the IHI Forum stressed an expanded definition of value that includes:<br /></p><ul><li>maximizing workforce capacity and professional development;</li><li>expanding interdisciplinary collaboration; and</li><li>improving the patient experience.</li></ul><p>These intersection points will be necessary for value-based care to lower healthcare costs and improve outcomes and efficiency.<br /></p><h3>2. Safety intersects with quality, culture and patient-centeredness</h3><p>Multiple IHI Forum sessions stressed the importance of the <a data-cke-saved-href="https://www.ihi.org/initiatives/national-steering-committee-patient-safety/national-action-plan-advance-patient-safety" href="https://www.ihi.org/initiatives/national-steering-committee-patient-safety/national-action-plan-advance-patient-safety" target="_blank">National Action Plan to Advance Patient Safety</a>, which provides<strong> “clear direction for making significant advances toward safer care and reduced harm across the continuum of care</strong>.” Created by the IHI and nearly 30 public and private stakeholder groups, the NAP includes four key areas:<br /></p><ul><li>culture, leadership and governance;</li><li>patient and family engagement;</li><li>workforce safety; and</li><li>learning system.</li></ul><p>The IHI notes these areas as essential and interdependent to achieve total systems safety.<br /></p><h3>3. Workforce well-being cannot ignore the fundamentals</h3><p>To improve quality and safety, providers must improve culture. Technology, data and artificial intelligence dominate healthcare headlines. But one thing is clear: these tools can support, but never replace, the fundamentals of workplace culture. This includes communication, collaboration and education ― and the values that underlie them: trust, kindness and an abiding commitment to patients and their families.<br /></p><h3>4. Equity is finding its business case<br /></h3><p>One of the IHI Forum sessions stated what has become obvious: "Addressing clinical outcomes through the lens of race and ethnicity is not engrained in how we have historically viewed quality of care."<br /></p><p>But how do providers change this?<br /></p><p>Multiple IHI sessions stressed the importance of a define-measure-improve framework that emphasizes not only clinical outcomes but also patient experience. Providers can use electronic health record data stratified by key process indicators to:<br /></p><ul><li>create and prioritize business use cases;</li><li>improve processes in care delivery that contribute to disparities; and</li><li>analyze outcomes, drivers and findings to improve outcomes.</li></ul><p>As with workplace culture, equity efforts must marry operations and culture, and ask not only "What is our business case?" but "What is our ethical and moral imperative?"</p><h2>The healthcare of the future</h2><p>Beyond these broader themes, the IHI Forum agenda stressed three delivery system areas that will continue to be the focus of quality and safety improvement: primary care, maternal health and diagnostics. Also key to healthcare's future is what it can continue to learn from other sectors, such as technology and manufacturing.<br /></p><p>DataGen's <a data-cke-saved-href="https://datagen.info/solutions/delivery_of_carequality/culture_of_safety_insights/" href="https://datagen.info/solutions/delivery_of_carequality/culture_of_safety_insights/" target="_blank">Culture of Safety Insights</a> supports the healthcare frameworks of the future. <a data-cke-saved-href="https://datagen.info/contact/" href="https://datagen.info/contact/">Contact us today</a> to learn more or <a data-cke-saved-href="https://datagen.info/contact/" href="https://datagen.info/contact/" target="_blank">request a free demo</a>.</p>Courtney Yulehttp://www.blogger.com/profile/15321700369247409594noreply@blogger.com0tag:blogger.com,1999:blog-2728411347274749489.post-90004162672444301642023-12-01T08:51:00.000-08:002024-03-27T07:05:34.044-07:00CMS finalizes 2024 OPPS final rule: 4 must-know updates<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTG1Ffap02i1b_x1u6W2yX3ZAs5reqID_bGrjc3peOuJmeo6_doK1Ur85qFNgB2-2J4gYvl3hSWxQDXMV1fASsQ_BovcsCxaHWF9iPCp05pRckuq8B6Qgde39qdfCJHMNXYTWtdo9mUTVRMAdy2igdni2QIjCdfiVxtqQ_aTMvacDaUgIGNfi3bZnLwDg/s640/OPPS%20Blog_December%202023.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="2024 OPPS final rule" border="0" data-original-height="403" data-original-width="640" height="404" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTG1Ffap02i1b_x1u6W2yX3ZAs5reqID_bGrjc3peOuJmeo6_doK1Ur85qFNgB2-2J4gYvl3hSWxQDXMV1fASsQ_BovcsCxaHWF9iPCp05pRckuq8B6Qgde39qdfCJHMNXYTWtdo9mUTVRMAdy2igdni2QIjCdfiVxtqQ_aTMvacDaUgIGNfi3bZnLwDg/w640-h404/OPPS%20Blog_December%202023.jpeg" width="640" /></a></div><p>On Nov. 2, CMS finalized the calendar year <a data-cke-saved-href="https://www.federalregister.gov/d/2023-24293" href="https://www.federalregister.gov/d/2023-24293" target="_blank">2024 Medicare Outpatient Prospective Payment System final rule</a>. The 2024 OPPS final rule includes policies that will:</p><ul><li>add 10 services to the Inpatient Only list;</li><li>establish an intensive outpatient program;</li><li>expand the partial hospitalization program rate structure;</li><li>update payment rates and policies for ambulatory surgical centers;</li><li>update the requirements for the Hospital Outpatient Quality Reporting Program;</li><li>outline quality program requirements for Rural Emergency Hospitals; and</li><li>standardize the reporting of standard chart data using a CMS template.</li></ul><p>Read on to learn essential OPPS final rule information, important details and dates. We’ll also reveal how you can register for DataGen’s upcoming <a href="https://hanys-org.zoom.us/meeting/register/tZwsfuivpzkiHdQkNEBTtoWbHWx7qvr4WeEJ#/registration" target="_blank">client exclusive OPPS rule analysis webinar</a>.<br /></p><h2>4 key CMS 2024 OPPS final rule components</h2><h3>1. Expanded and updated rates</h3><p>CMS estimates a 2.1% rate increase for CY 2024, which represents a $6 billion increase in outpatient payments compared to the <a data-cke-saved-href="https://www.cms.gov/newsroom/fact-sheets/cy-2023-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center-2" href="https://www.cms.gov/newsroom/fact-sheets/cy-2023-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center-2" target="_blank">CY 2023 OPPS final rule</a>.<br /></p><p>2024 OPPS final rule changes include new and expanded reimbursement for mental health services and ambulatory surgery centers.<br /></p><h3>2. New services and programs</h3><p>As lines between inpatient and outpatient care blur, CMS continues to define care that Medicare will only reimburse in an inpatient setting. For CY 2024, CMS added 10 new services and procedures to the Inpatient Only list, including vertebral body tethering; select cardiac diagnostics (ultrasounds) and treatments (valve implants or replacements); and select cranial procedures (neurotransmitter implants, craniectomy and craniotomy).<br /></p><p>To expand covered mental health treatment options, the OPPS rule includes intensive outpatient program services in CY 2024. An IOP is less intensive than a partial hospitalization program, and multiple providers can deliver services in addition to hospitals: community mental health centers, federally qualified health centers and rural health clinics.<br /></p><h3>3. Quality program changes and additions</h3><p>The CY 2024 OPPS final rule includes CMS’ annual updates to its <a data-cke-saved-href="https://www.cms.gov/medicare/quality/initiatives/hospital-quality-initiative/hospital-outpatient-quality-reporting-program" href="https://www.cms.gov/medicare/quality/initiatives/hospital-quality-initiative/hospital-outpatient-quality-reporting-program" target="_blank">Hospital Outpatient Quality Reporting Program</a>. CMS designed the Hospital OQR to help improve the quality and safety of Medicare outpatient services, assisting its larger effort to support value-based care.<br /></p><h4 style="text-align: left;">Program changes</h4><p>COVID-19 vaccinations, cataract surgery outcomes and colonoscopies will start at age 45 for average-risk patients.<br /></p><h4 style="text-align: left;">New additions</h4><p>Two new Hospital OQR program measures address patient-reported outcomes after elective outpatient care. This includes total hip and/or knee arthroplasty and CT radiation dosage and image quality.<br /></p><p>Quality reporting expansion includes the creation of the Rural Emergency Hospital Quality Reporting program, a new reimbursable provider type as of Jan. 1, 2023. The first REHQR measures will include:<br /></p><ul><li>Abdomen Computed Tomography – Use of Contrast Material;</li><li>Median Time from ED Arrival to ED Departure for Discharged ED Patients;</li><li>Facility Seven-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy; and</li><li>Risk-Standardized Hospital Visits within Seven Days After Hospital Outpatient Surgery.</li></ul><p>Measure outcomes will appear on <a data-cke-saved-href="https://www.cms.gov/medicare/quality/physician-compare-initiative" href="https://www.cms.gov/medicare/quality/physician-compare-initiative" target="_blank"><em>Care Compare</em></a>.<br /></p><h3>4. Price transparency standards<br /></h3><p>As part of the 2024 OPPS final rule, CMS will standardize several hospital price transparency requirements to improve monitoring and enforcement. It will also reduce hospitals’ compliance burden. CMS has updated the required standard charge information and data elements that hospitals must submit and provided a new template. Its <a data-cke-saved-href="https://www.cms.gov/newsroom/fact-sheets/hospital-price-transparency-fact-sheet" href="https://www.cms.gov/newsroom/fact-sheets/hospital-price-transparency-fact-sheet" target="_blank">Hospital Price Transparency Fact Sheet</a> details these changes further.<br /></p><h2>Upcoming 2024 OPPS final rule dates</h2><p>Watch for these upcoming dates related to the CY 2024 OPPS final rule:<br /></p><ul><li><strong>Dec. 5, 2023:</strong> <a href="https://hanys-org.zoom.us/meeting/register/tZwsfuivpzkiHdQkNEBTtoWbHWx7qvr4WeEJ#/registration" target="_blank">Join DataGen’s OPPS rule analysis webinar</a> for national clients and hospitals, 3 - 4 p.m. EST. </li><li><strong>Jan. 1, 2024: </strong>This is the comment due date for new service level status indicator assignments. Take advantage of a final OPPS rule comment opportunity at <a data-cke-saved-href="https://www.regulations.gov/document/CMS-2023-0120-3747" href="https://www.regulations.gov/document/CMS-2023-0120-3747" target="_blank">Regulations.gov</a> (rule number <a data-cke-saved-href="https://www.cms.gov/medicare/payment/prospective-payment-systems/ambulatory-surgical-center-asc/asc-regulations-and/cms-1786-fc" href="https://www.cms.gov/medicare/payment/prospective-payment-systems/ambulatory-surgical-center-asc/asc-regulations-and/cms-1786-fc" target="_blank">CMS-1786–FC</a>).</li></ul><h2>Need help calculating the final rule’s impact?</h2><p>Want a better grasp on how your facility’s revenue and margins will be impacted? DataGen analyzes major rule components with a special focus on those that impact reimbursement. Our insights help providers educate key stakeholders and plan changes to payment and workflow, easily allowing you to compare the differences between CMS’ 2023 and 2024 OPPS final rules (and so much more!).<br /></p><p>Streamline your impact analysis and <a data-cke-saved-href="https://datagen.info/contact/" href="https://datagen.info/contact/" target="_blank">contact us</a> today for a consultation.</p>Courtney Yulehttp://www.blogger.com/profile/15321700369247409594noreply@blogger.com0tag:blogger.com,1999:blog-2728411347274749489.post-22713524202527475662023-11-28T06:28:00.000-08:002024-02-05T08:11:01.716-08:00Where have all the Enhancing Oncology Model practices gone? 3 key observations<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHjtVrerXdhSGp8DYs76y2FkZmagSoD9Of5l-_Sk7zExmE9BThnzLecljlFvPyaIWqroHCrtEof2a2qDyLeJ37IihfLwcAhsCHlmBNl6JlIs55nJfAkFmPl2x7w9mvQsKbF7Qwb2tbjWMSNs63ozEv0_f6tnNpWuHTML_uBw66But-TjMuQCl3M_BorC0/s640/EOM%20Blog_November%202023.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="enhanced oncology model" border="0" data-original-height="403" data-original-width="640" height="404" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHjtVrerXdhSGp8DYs76y2FkZmagSoD9Of5l-_Sk7zExmE9BThnzLecljlFvPyaIWqroHCrtEof2a2qDyLeJ37IihfLwcAhsCHlmBNl6JlIs55nJfAkFmPl2x7w9mvQsKbF7Qwb2tbjWMSNs63ozEv0_f6tnNpWuHTML_uBw66But-TjMuQCl3M_BorC0/w640-h404/EOM%20Blog_November%202023.jpeg" width="640" /></a></div><p>Six years after its launch, CMS’ Oncology Care Model ended on June 30, 2022. Oncology practices that participated and stayed through the entirety of the program had clinical buy-in for the delivery of value-based care for cancer patients. However, despite CMS’ desire for a replacement model to continue OCM’s practice transformation, its Enhancing Oncology Model didn’t attract critical mass.</p><p>At this point, you may be asking yourself, “What happened to all the practices that participated in OCM? Why didn’t they choose to continue?” In this blog, DataGen will answer those questions with three observations about EOM.<br /></p><h2>Observation #1: Failure to meaningfully incorporate clinical adjustments</h2><p>CMS failed to incorporate clinical adjustments into EOM’s target price methodology in a meaningful way, beyond what was demonstrated in the final performance periods of <a data-cke-saved-href="https://www.cms.gov/priorities/innovation/innovation-models/oncology-care" href="https://www.cms.gov/priorities/innovation/innovation-models/oncology-care" target="_blank">OCM</a>. Instead of factoring clinical data elements into the underlying cancer-specific regression models, <a data-cke-saved-href="https://www.cms.gov/priorities/innovation/innovation-models/enhancing-oncology-model" href="https://www.cms.gov/priorities/innovation/innovation-models/enhancing-oncology-model" target="_blank">EOM</a> continues to incorporate a benchmark-neutral clinical risk adjustment approach.<br /></p><p>Under EOM, the clinical data elements that CMS risk-adjusts for include:</p><ul><li>ever-metastatic status for breast cancer, lung cancer, and small intestine/colorectal cancer episodes (which was applied in OCM); and</li><li>HER2 status for breast cancer episodes only (which was new for EOM). </li></ul><p>Other factors like cancer stage and current clinical status can be ascertained, but they are not yet being adjusted in the methodology, even though CMS requires practices to report this registry information, and <a data-cke-saved-href="https://ascopubs.org/doi/10.1200/OP.22.00211" href="https://ascopubs.org/doi/10.1200/OP.22.00211" target="_blank">peer-reviewed research</a> has demonstrated their impact on predicting Medicare episode spend. <br /></p><h2>Observation #2: New challenges for potential EOM participants</h2><p>Within EOM, CMS took steps to incorporate health equity considerations. Some actions taken include the collection of patient demographic information and adjustment of monthly enhanced oncology services payments by a beneficiary’s dual status.<br /></p><p>The value of monthly enhanced oncology services payments in EOM is much lower than in OCM:</p><ul><li>EOM: $70 per beneficiary per month + $30 PBPM for dual beneficiaries</li><li>OCM: $160 PBPM.</li></ul><p>This created a new challenge for potential model participants, as they used the funding from monthly enhanced oncology services payments to make the required participant care redesign activity components of the program possible. <br /></p><h2>Observation #3: Not enough time to review baseline model data</h2><p>Time and trust came into play. Practices that applied to participate did not have adequate time to review <a data-cke-saved-href="https://hanys-org.zoom.us/rec/component-page?hasValidToken=false&clusterId=us06&action=play&filePlayId=&componentName=recording-register&meetingId=W5qgK7qIn8mBGmAzaUMBVBzOHXon168x17ICZ1J_sRhN_txR2H5mP113RxgHVw37.1EK9lAEg_iAbeYgO&originRequestUrl=https%3A%2F%2Fhanys-org.zoom.us%2Frec%2Fshare%2Fa7GPafHZpEjqi9AXpBx8-u6QcBoOx2XP2uS-ODdPAgDYGC_Zoup0ayiAScVXwTaH._pv95tQLklf9bDYY" href="https://hanys-org.zoom.us/rec/component-page?hasValidToken=false&clusterId=us06&action=play&filePlayId=&componentName=recording-register&meetingId=W5qgK7qIn8mBGmAzaUMBVBzOHXon168x17ICZ1J_sRhN_txR2H5mP113RxgHVw37.1EK9lAEg_iAbeYgO&originRequestUrl=https%3A%2F%2Fhanys-org.zoom.us%2Frec%2Fshare%2Fa7GPafHZpEjqi9AXpBx8-u6QcBoOx2XP2uS-ODdPAgDYGC_Zoup0ayiAScVXwTaH._pv95tQLklf9bDYY" target="_blank">baseline data</a> before the new EOM went live. EOM requires that practices take two-sided risk from the start of the model and offers two different risk arrangements to choose from, including narrow “neutral zone” corridors that impact financial performance. Any organization with experience in OCM knew how much financial uncertainty there was in oncology episodes, especially due to the continued inclusion of Part D drugs. <br /></p><h2>Final conclusions on EOM</h2><p>Although positive changes were made to the model design when CMS rolled out EOM, many practices still mistrusted the program after the methodological challenges that plagued OCM. Unfortunately, fewer practices are in EOM: 44 practices began their participation in EOM, compared to 196 practices at the start of OCM. <br /></p><p>EOM certainly won’t be the end of value-based care for cancer treatment. Many practices that considered participating in the model but chose not to go forward still expressed their continued focus on enhancing care for their cancer patient population within their accountable care organizations, through other payer relationships or outside of a formal alternative payment model — because they consider it to be the right thing to do for their patients. <br /></p><p>The practices that elected to participate in EOM now have the challenge of implementing the care redesign strategies set forth in the model. They also need to critically evaluate their performance and opportunities for improvement. <br /></p><p>Have more questions about EOM? <a data-cke-saved-href="https://datagen.info/contact/" href="https://datagen.info/contact/" target="_blank">Contact DataGen today</a> to learn how we can help EOM participants or those interested in oncology episodes of care.</p>Courtney Yulehttp://www.blogger.com/profile/15321700369247409594noreply@blogger.com0tag:blogger.com,1999:blog-2728411347274749489.post-63777637676023055272023-11-16T03:00:00.000-08:002024-03-27T07:29:29.168-07:003 SPARCS data submission deadlines to know before 2024 <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjK5nix9KrjWYyHh2IiMpFcMzTIS-u1VBDcFhIGL2ZGqFGLpZt6YyalV9o5NsLjKtKvicQtp2fESLYohBO00YUWEa_mbhfFVpl_wPCQ7niDhBhwnwaKwpmXEg2JpsICULJdP6OfNN7xBfm0nUau9fCg_-83YlSZZITSbbugVaMZywed-iVcSvFwH_YrF_o/s640/UDS%20Blog_November%202023.jpeg" style="margin-left: 1em; margin-right: 1em;"><img alt="SPARCS data submission" border="0" data-original-height="403" data-original-width="640" height="404" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjK5nix9KrjWYyHh2IiMpFcMzTIS-u1VBDcFhIGL2ZGqFGLpZt6YyalV9o5NsLjKtKvicQtp2fESLYohBO00YUWEa_mbhfFVpl_wPCQ7niDhBhwnwaKwpmXEg2JpsICULJdP6OfNN7xBfm0nUau9fCg_-83YlSZZITSbbugVaMZywed-iVcSvFwH_YrF_o/w640-h404/UDS%20Blog_November%202023.jpeg" width="640" /></a></div><p>Tackling Statewide Planning and Research Cooperative System data is a large lift for New York state Article 28 hospitals and ambulatory surgery centers. This can be even more challenging when the state updates or adds SPARCS requirements and adjusts timeframes.</p><p>In this blog, we’ll outline three SPARCS submission deadlines you need to know. Plus, we’ll cover how the Department of Health addresses statements of deficiency and what it could mean if your facility receives one.<br /></p><h2>2023 SPARCS data submission compliance deadlines</h2><p>As New York hospitals and ambulatory surgery centers know well, DOH requires <a data-cke-saved-href="https://www.health.ny.gov/statistics/sparcs/" href="https://www.health.ny.gov/statistics/sparcs/" target="_blank">SPARCS</a> data submission for its comprehensive all-payer data reporting system. Facilities must submit 100% of required clinical, billing, admission, discharge and transfer data with 100% accuracy, on a quarterly basis and by a set date.<br /></p><h3>1. Quarter 1 2023 data</h3><p>Facilities that haven’t submitted their first quarter 2023 SPARCS data began receiving statements of deficiency last month. (See the “What is a statement of deficiency?” section below for details on the DOH compliance notification cycle.) The Q1 data were due by June 30, with DOH sending monthly reminder emails in July, August and September.<br /></p><h3>2. Quarter 2 2023 data</h3><p>If hospitals have deficiencies for both Q1 and Q2 2023, their noncompliance alerts are now overlapping. DOH sent the first Q2 2023 monthly reminders in October, with second warnings already arriving or on their way. DOH will follow with third warnings in December and SOD for noncompliance by Jan. 15, 2024.<br /></p><h3>3. Cause/Place remediation data</h3><p>In addition to Q2 2023 SODs, January 2024 is also the deadline for the <a data-cke-saved-href="https://www.health.ny.gov/statistics/sparcs/submission/" href="https://www.health.ny.gov/statistics/sparcs/submission/" target="_blank">SPARCS injury, cause and place remediation project</a>. Announced in April, the project supports a grant-funded study underway at DOH. It requires New York state hospitals to provide <a data-cke-saved-href="https://news.datagen.info/2023/05/sparcs-releases-updated-injury-cause.html" href="https://news.datagen.info/2023/05/sparcs-releases-updated-injury-cause.html" target="_blank">injury, cause and place diagnosis codes</a> that hospitals did not include in their inpatient and emergency department claims from 2016 to 2023.<br /></p><p>In response to hospitals’ concerns about workforce and financial burdens, the state extended the submission deadline from Oct. 31, 2023, to Jan. 31, 2024. This also gives the state more time to process the data for the DOH study. DataGen has distilled the state’s submission instructions to <a data-cke-saved-href="https://news.datagen.info/2023/08/sparcs-updates-hospitals-on-injury.html" href="https://news.datagen.info/2023/08/sparcs-updates-hospitals-on-injury.html" target="_blank">three steps</a>.<br /></p><h2>What is a statement of deficiency?</h2><p>Most hospitals and ASCs make every attempt to be SPARCS compliant, but the state changes requirements often. When facilities submit late or inaccurate data, DOH:<br /></p><ul><li>issues three monthly warnings;</li><li>sends a statement of deficiency if noncompliance continues; and</li><li>requires a plan of correction for continued deficiency.</li></ul><p>DOH issues SPARCS data submission deficiency statements on a quarterly basis and at the end of every calendar year. If facilities remain noncompliant, DOH can impose financial penalties — up to $10,000 per patient type per facility.<br /></p><p>While the state is slow to penalize, hospitals and ASCs do face downstream implications. When a facility submits a Certificate of Need application and has SPARCS data submission deficiencies, that process will be delayed. Facility expansion comes at a time of need and speed. It is the wrong time to grapple with a data compliance backlog, as it could put your competitors ahead or change costs.<br /></p><h2>Even if you’re behind, compliance with 100% accuracy is possible</h2><p>SPARCS deadlines are unavoidable, but that doesn’t mean you have to tackle them alone. Read our resource, <a data-cke-saved-href="https://news.datagen.info/2023/10/how-to-overcome-sparcs-data-changes-3.html" href="https://news.datagen.info/2023/10/how-to-overcome-sparcs-data-changes-3.html" target="_blank"><em>How to overcome SPARCS data changes: 3 most common challenges</em></a>, to find new ways to manage SPARCS data changes. Then, check out <a data-cke-saved-href="https://datagen.info/solutions/revenue_cycle_performance/sparcs_submissions_nys/" href="https://datagen.info/solutions/revenue_cycle_performance/sparcs_submissions_nys/">DataGen’s UDS</a> solution to learn how you can take formatting, syncing and error sweeping out of the equation.<br /></p><p>Ready to add an extra analyst on your team, ensuring 100% submission accuracy no matter how often requirements change? To make compliance easier, <a data-cke-saved-href="https://datagen.info/solutions/revenue_cycle_performance/sparcs_submissions_nys/#contact" href="https://datagen.info/solutions/revenue_cycle_performance/sparcs_submissions_nys/#contact" target="_blank">contact us today</a> or <a data-cke-saved-href="https://datagen.info/contact/" href="https://datagen.info/contact/" target="_blank">request a demo</a>.</p>Courtney Yulehttp://www.blogger.com/profile/15321700369247409594noreply@blogger.com0tag:blogger.com,1999:blog-2728411347274749489.post-20417698015874896652023-11-07T03:00:00.006-08:002024-03-27T07:02:01.745-07:00Making Care Primary: Do you need value-based care experience to apply?<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEir1HYkeGtPTbC0w3-QvM1EdePQI5Wml8gClN1EQC2FZHyeMqOERtkR7w3KGIzSh9dd3OqEMRqXPw-3ESjuoZS5B8pCW8qCkxx8-RVH0bEHaNhZVRHlZ3QokKN4-OBXwnPEINgDli7R-9xmu3hL1BzO2xPqFiccSTJTKOyuCQXvGcj5PefxXtsUizFb_bQ/s640/MCP%20Blog_November%202023.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="making care primary" border="0" data-original-height="403" data-original-width="640" height="404" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEir1HYkeGtPTbC0w3-QvM1EdePQI5Wml8gClN1EQC2FZHyeMqOERtkR7w3KGIzSh9dd3OqEMRqXPw-3ESjuoZS5B8pCW8qCkxx8-RVH0bEHaNhZVRHlZ3QokKN4-OBXwnPEINgDli7R-9xmu3hL1BzO2xPqFiccSTJTKOyuCQXvGcj5PefxXtsUizFb_bQ/w640-h404/MCP%20Blog_November%202023.jpeg" width="640" /></a></div><p>Are you a primary care practice that’s considering joining the <a data-cke-saved-href="https://datagen.info/solutions/advanced_payment_models/making_care_primary/" href="https://datagen.info/solutions/advanced_payment_models/making_care_primary/" target="_blank">Making Care Primary</a> model? If so, you may have concerns about the experience needed to participate in a value-based care model. In this blog post, we’ll explore whether VBC experience is a requirement to apply for MCP and what benefits you can expect from the program, regardless of your experience level.</p><h2>Is value-based care experience required for MCP?</h2><p>Primary care providers don’t need VBC experience to apply for MCP. However, since MCP is a <a data-cke-saved-href="https://www.cms.gov/newsroom/press-releases/cms-announces-multi-state-initiative-strengthen-primary-care" href="https://www.cms.gov/newsroom/press-releases/cms-announces-multi-state-initiative-strengthen-primary-care" target="_blank">multi-state initiative</a>, you do need to be located in one of the following states:</p><ul><li>Colorado;</li><li>Massachusetts;</li><li>Minnesota;</li><li>New Jersey;</li><li>New Mexico;</li><li>New York;</li><li>North Carolina; or</li><li>Washington.</li></ul><p>Note, in New York only upstate counties are included under the model. See Appendix D in the <a data-cke-saved-href="https://www.cms.gov/files/document/mcp-rfa.pdf" href="https://www.cms.gov/files/document/mcp-rfa.pdf" target="_blank">Making Care Primary Request for Applications</a> for more information. </p><h2>Is there an advantage for practices with little to no VBC experience?</h2><p>One of the key benefits of the model is that primary care providers who have no experience with VBC can come in at Track 1 (out of 3). This track is designed to help facilitate the operational setup of the program. Track 1 supports organizations as they build infrastructure and become capable of delivering accountable care. </p><p>The Center for Medicare and Medicaid Innovation’s new <a data-cke-saved-href="https://news.datagen.info/2023/10/4-provider-benefits-under-making-care.html" href="https://news.datagen.info/2023/10/4-provider-benefits-under-making-care.html" target="_blank">MCP model means a lot for eligible providers</a> with no previous VBC experience. It’s a major advantage for providers who are small, independent or rural or who support underserved populations and may not have the resources to invest in VBC themselves. Additionally, coming in at Track 1 means that you have the lowest level of potential financial risk for the first two and a half years of the model. During this time, practices will build the foundation needed to redesign their care delivery system and will expand upon that as the model progresses. </p><h2>MCP participation benefits providers should consider</h2><p>In Track 1, providers can take advantage of an upfront infrastructure payment option. This is a time-limited, $72,500 payment that can be used to increase staffing, address patients’ social determinants of health needs or invest in health information technology. </p><p>It’s worth noting that most alternative payment models don’t provide this type of start-up financial support. Historically, providers have had to make the needed practice transformation investments on their own. However, <a data-cke-saved-href="https://www.cms.gov/" href="https://www.cms.gov/" target="_blank">CMS</a> is making it available to those who otherwise may not have the opportunity to explore VBC.</p><p>The three-track design of the MCP model means that providers who enter at Track 1 won’t enter Track 3 until the middle of the 10.5-year model. This allows for gradual changes in the required care delivery activities, payment methodology and performance criteria to take place.</p><p>Practices will also be able to leverage exclusive learning opportunities and events throughout the duration of the model to encourage the sharing of best practices and information dissemination.</p><p>Ultimately, participation in MCP will empower practices to deliver highly coordinated, patient-centered advanced primary care to their patients. </p><h2>Need help determining if MCP is right for you? Contact us.</h2><p>VBC experience is not a requirement to apply for the MCP program. In fact, the program is designed to offer accessibility to providers of all sizes and experience levels. If you’re considering applying, <a data-cke-saved-href="https://datagen.info/contact/" href="https://datagen.info/contact/" target="_blank">schedule a time to speak with DataGen</a> to discuss how MCP can elevate your care.</p><p>Our experts can help give you the robust data and guidance needed to apply and sustain your MCP participation — plus, we’ll even take you through a <a data-cke-saved-href="https://datagen.info/contact/" href="https://datagen.info/contact/" target="_blank">live demonstration</a> of our performance monitoring analysis platform. In the meantime, read our blog, <a data-cke-saved-href="https://news.datagen.info/2023/08/making-care-primary-model-5-crucial.html" href="https://news.datagen.info/2023/08/making-care-primary-model-5-crucial.html" target="_blank"><em>Making Care Primary Model: 5 crucial things to know</em></a>, to learn everything you need to know about MCP. </p>Courtney Yulehttp://www.blogger.com/profile/15321700369247409594noreply@blogger.com0tag:blogger.com,1999:blog-2728411347274749489.post-36016111939599927622023-10-30T03:00:00.003-07:002024-03-26T12:44:36.643-07:005 fast facts on New York’s health equity impact assessment<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEim7ZacoGhCfXuL9X0LrVDCi1mt_Lu9bYRQwyQB66b-1PHcWajSMuE6DvV_t0wSeO0-6YD3EYXp1YhoGfX8PfLLvHXbPtUzIl5Dv_JwOIKODIto78kRTd6vVE0GNzIWvdX90Q47G_ZDQVn_XVdQ6HoIP6i0QqgUn-YWFAjf2czy5r_44puD-yaFPtyzua0/s640/CON%20HEIA%20Blog_October%202023.jpeg" style="margin-left: 1em; margin-right: 1em;"><img alt="health equity impact assessment" border="0" data-original-height="403" data-original-width="640" height="404" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEim7ZacoGhCfXuL9X0LrVDCi1mt_Lu9bYRQwyQB66b-1PHcWajSMuE6DvV_t0wSeO0-6YD3EYXp1YhoGfX8PfLLvHXbPtUzIl5Dv_JwOIKODIto78kRTd6vVE0GNzIWvdX90Q47G_ZDQVn_XVdQ6HoIP6i0QqgUn-YWFAjf2czy5r_44puD-yaFPtyzua0/w640-h404/CON%20HEIA%20Blog_October%202023.jpeg" width="640" /></a></div><p>As of June 22, 2023, New York state hospitals and ambulatory surgery centers are among the New York Article 28 facilities that must file <a data-cke-saved-href="https://datagen.info/solutions/community_and_market_planning/health_equity_impact_assessment/" href="https://datagen.info/solutions/community_and_market_planning/health_equity_impact_assessment/" target="_blank">Health Equity Impact Assessment</a> documentation when submitting a Certificate of Need application.</p><p>The goal of this change is to “provide information on whether a proposed project impacts the delivery of or access to services for the service area, particularly medically underserved groups,” according to the <a data-cke-saved-href="https://www.health.ny.gov/community/health_equity/impact_assessment.htm" href="https://www.health.ny.gov/community/health_equity/impact_assessment.htm" target="_blank">New York State Department of Health</a>.<br /></p><p>To help you better understand the CON HEIA requirement and its impact, we put together five fast facts to get you up to speed and ready to tackle the new requirement.<br /></p><h2>Multiple facilities are subject to the new requirement</h2><p>Under the new requirement, the following New York state Article 28 facilities must complete an HEIA requirement criteria form to determine whether they are subject to the new equity assessment:</p><ul><li>hospitals;</li><li>ambulatory surgery centers;</li><li>nursing homes;</li><li>select diagnostic and treatment centers; and</li><li>midwifery birthing centers.</li></ul><h2>1. HEIA guidelines apply to five scenarios</h2><p>The HEIA requirement applies to <a data-cke-saved-href="https://www.health.ny.gov/facilities/cons/" href="https://www.health.ny.gov/facilities/cons/" target="_blank">CON applications</a> involving new construction or equipment, a new facility operator, a new facility owner as the result of merger or consolidation, a facility acquisition and an updated operating certificate.<br /></p><h2>2. Four guidelines govern the HEIA requirement</h2><p>The proposed project impact changes can impact patient access to care, particularly in underserved areas and among populations that are already disadvantaged. Access, in turn, impacts health equity. HEIA requirement criteria address whether a facility’s CON project will:<br /></p><ul><li>eliminate services or care;</li><li>reduce by 10% or greater the number of certified beds, certified services or operating hours;</li><li>expand or add to the number of certified beds, certified services or operating hours by 10% or more; and/or</li><li>change the location of service or care.</li></ul><h2>3. HEIA CON submissions must include six documents</h2><p>If a facility answers yes to just one of the above scenarios, it must submit the following HEIA documents with its CON application:<br /></p><ul><li><a data-cke-saved-href="https://www.health.ny.gov/facilities/cons/health_equity/docs/heia_requirement_criteria.pdf" href="https://www.health.ny.gov/facilities/cons/health_equity/docs/heia_requirement_criteria.pdf" target="_blank">HEIA requirement criteria form</a>: Determines if an HEIA is required;</li><li><a data-cke-saved-href="https://www.health.ny.gov/facilities/cons/health_equity/docs/heia_conflict_of_interest.pdf" href="https://www.health.ny.gov/facilities/cons/health_equity/docs/heia_conflict_of_interest.pdf" target="_blank">HEIA conflict-of-interest form</a>: Affirms that there is no COI with the entity that performs the equity assessment;</li><li><a data-cke-saved-href="https://www.health.ny.gov/facilities/cons/health_equity/docs/heia_template.docx" href="https://www.health.ny.gov/facilities/cons/health_equity/docs/heia_template.docx" target="_blank">HEIA template</a>: Describes the project scope, impact, and mitigation and monitoring plans; and</li><li><a data-cke-saved-href="https://www.health.ny.gov/facilities/cons/health_equity/docs/heia_data_tables.xlsx" href="https://www.health.ny.gov/facilities/cons/health_equity/docs/heia_data_tables.xlsx" target="_blank">HEIA data tables</a>: Define demographics that facilities must report on impacted populations, e.g., sex, age, race, and insurance and disability status.</li><li>a full, redacted version of its CON application, which will be shared publicly; and</li><li>an assessment contract.</li></ul><h2>4. Facilities must contract with an independent third party to conduct the HEIA</h2><p>An independent entity must conduct the HEIA. A qualified entity, per the HEIA conflict-of-interest form, has “demonstrated expertise and experience in the study of health equity, anti-racism, and community and stakeholder engagement” and “preferred expertise and experience in the study of health care access or delivery of health care services.”<br /></p><p>The entity must be able to produce an HEIA assessment that includes whether and how “a facility’s proposed project will impact access to and delivery of health care services, particularly for members of medically underserved groups.”<br /></p><h2>5. It takes time to adjust to new compliance requirements</h2><p>New processes like completing a CON HEIA have a learning curve. It’s normal that New York state Article 28 facilities will need some time to adjust. Despite this, they don’t have to do it alone. There is external help available to better understand and meet these new requirements.</p><p>DataGen can help you get more information on CON HEIA requirements, the assessment and the data analysis process. <a data-cke-saved-href="https://datagen.info/contact/" href="https://datagen.info/contact/" target="_blank">Schedule a time to speak with us today</a> and learn the ways we can support you through this process.</p>Courtney Yulehttp://www.blogger.com/profile/15321700369247409594noreply@blogger.com0tag:blogger.com,1999:blog-2728411347274749489.post-8797895514867169172023-10-26T03:00:00.001-07:002024-03-26T13:39:32.952-07:004 Provider benefits under the Making Care Primary model<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1MGDP6dED5WcxxI_XRn0snwtlTDY8XMEppVBwfF692EuF-y9KAmgkKzlXX_4Sa6hhwXhmu0w1xG-nXL3e-Y-jYszz_p1XyEs9JVUc5dIkPjAvw7njqntOVkiV08TnbiordB3TiWoiHj1nSWuEMeaYfhV1kXdNvlz6nqXdTl99nRYhGFMXTve8LEdgDto/s640/MCP%20Blog_October%202023.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="making care primary" border="0" data-original-height="403" data-original-width="640" height="404" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1MGDP6dED5WcxxI_XRn0snwtlTDY8XMEppVBwfF692EuF-y9KAmgkKzlXX_4Sa6hhwXhmu0w1xG-nXL3e-Y-jYszz_p1XyEs9JVUc5dIkPjAvw7njqntOVkiV08TnbiordB3TiWoiHj1nSWuEMeaYfhV1kXdNvlz6nqXdTl99nRYhGFMXTve8LEdgDto/w640-h404/MCP%20Blog_October%202023.jpeg" width="640" /></a></div><p>The <a data-cke-saved-href="https://datagen.info/solutions/advanced_payment_models/making_care_primary/" href="https://datagen.info/solutions/advanced_payment_models/making_care_primary/" target="_blank">Making Care Primary</a> model presents a unique new opportunity for practices to deliver advanced primary care over 10.5 years. As a primary care provider, you may be wondering whether you should take on the risk and how you’ll manage the program requirements, especially if you’ve never participated in a value-based care model before.</p><p>In this blog, we’ll cover four noteworthy model benefits you may not have considered. These model design elements aim to reduce historic participation barriers and provide an on-ramp for primary care practices to transition to value-based care. </p><h2>Benefit #1: New structure that encourages participation</h2><p>Unlike other alternative payment models, MCP aims to reduce financial exposure and some of the upfront infrastructure challenges for primary care practices with no or limited value-based care experience.</p><p>CMS created these flexibilities to encourage more primary care clinicians to participate, especially small, independent, rural and safety net organizations. In this model, value-based care experience informs the track in which a practice will enter the program, the payment mechanisms that will be applied, and the specific care delivery initiatives that the practice will undertake.</p><h2>Benefit #2: Gradual three-track transition</h2><p>The <a data-cke-saved-href="https://innovation.cms.gov/innovation-models/making-care-primary" href="https://innovation.cms.gov/innovation-models/making-care-primary" target="_blank">MCP model</a> includes three participation tracks. Track 1 is designed for organizations that are new to value-based care. This means they have not previously participated in performance-based Medicare initiatives like Comprehensive Primary Care Plus or the Next Generation Accountable Care Organization.</p><p>Organizations that have value-based care experience have the option to start in Track 2 or 3. Participants will spend two years in each track before progressing to the next track with an extra six-month period in the track that they enter.</p><p>The track progression gradually shifts participants from the traditional Medicare fee-for-service payment system to a model with prospective primary care payments. This slow transition allows practices with less experience to take on less risk at the start of the model.</p><h2>Benefit #3: Model payment options based on track</h2><p>There are six underlying payment mechanisms in the MCP model. Some are present across all tracks and others are only options in specific tracks. Inexperienced practices that start MCP under Track 1 can take advantage of an upfront infrastructure payment option. This provides start-up funds for health information technology investments, increased staffing or social determinants of health strategies.</p><p>Participants in Track 2 will be eligible to bill for e-consults. In Track 3, specialty care partners can bill for ambulatory co-management, further promoting better communication and coordination among providers managing a patient’s care.</p><p>Under all tracks, participating organizations will receive enhanced service payments to reflect the patient populations’ clinical and social risk and will have the opportunity to receive performance incentive payments. Together, these elements will help practices build their capacity to transform the care delivery system.</p><h2>Benefit #4: Practice transformation</h2><p>The MCP model’s ultimate goal is to make primary care more available, sustainable, patient-centered and coordinated. This is a major component of the MCP model’s care delivery approach.</p><p>In each track, practices will undertake initiatives to address care integration for behavioral health and specialty care, care management and community connection. In addition, the Capability Maturity Model Integration has interwoven model components designed to improve health equity to achieve high-quality care for all Medicare beneficiaries.</p><h2>Want to participate but not sure where to start?</h2><p>There is still time to put together your application before the end of November 2023. If you’re stuck determining whether you have the resources and knowledge to apply, DataGen can assist.</p><p>Our countless years of expertise with multiple APMs position us to be a great resource for you. We’ll help you understand the MCP model’s payment methodology and build a strategy around your data. This way you can monitor and address future performance.</p><p>In addition to our data expertise, we can provide you with advanced consulting services that allow you to implement and operationalize care delivery requirements.</p><h2>Get more information: Next steps toward participation</h2><p>Want more information? Obtain a comprehensive overview of the MCP model and its deadlines in our blog post, <a data-cke-saved-href="https://news.datagen.info/2023/08/making-care-primary-model-5-crucial.html" href="https://news.datagen.info/2023/08/making-care-primary-model-5-crucial.html" target="_blank"><em>Making Care Primary Model: 5 crucial things to know</em></a>. Then, <a data-cke-saved-href="https://datagen.info/contact/" href="https://datagen.info/contact/" target="_blank">contact us today</a> to learn more about how we can help prepare your MCP application and assist beyond acceptance, or <a data-cke-saved-href="https://datagen.info/contact/" href="https://datagen.info/contact/" target="_blank">request a demo</a> to see our analytic and consulting services firsthand.</p>Courtney Yulehttp://www.blogger.com/profile/15321700369247409594noreply@blogger.com0tag:blogger.com,1999:blog-2728411347274749489.post-5499611857472504232023-10-16T03:00:00.004-07:002024-03-26T13:07:28.835-07:00Key strategies to combat market disrupters in healthcare<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDraebHlLV-OeIU2vtM4U71Sf3VauD9Df6ymSvIwiv52mfixYUABUXikTO53ghvCoKKF6b-XcAJJP2wb1jA6N-DWm-kWGRlAuqvdLL6TRoDlkeQeAnp7lJdylGQK5OxaLa8Nsgt7pzPB0Rh6Rsu9R-fthdqErYXaqN8pR2Kz98r1tuaHn6PKGuS3ZxnCg/s640/UDS%20Blog_October%202023%20(1).jpeg" style="margin-left: 1em; margin-right: 1em;"><img alt="market disrupters in healthcare" border="0" data-original-height="403" data-original-width="640" height="404" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDraebHlLV-OeIU2vtM4U71Sf3VauD9Df6ymSvIwiv52mfixYUABUXikTO53ghvCoKKF6b-XcAJJP2wb1jA6N-DWm-kWGRlAuqvdLL6TRoDlkeQeAnp7lJdylGQK5OxaLa8Nsgt7pzPB0Rh6Rsu9R-fthdqErYXaqN8pR2Kz98r1tuaHn6PKGuS3ZxnCg/w640-h404/UDS%20Blog_October%202023%20(1).jpeg" width="640" /></a></div><p>In the last three years, market disrupters in healthcare have increased their activity and deepened their presence. Although they bring about change, not all market disrupters are negative. Using the strategies discussed in <em><a data-cke-saved-href="https://datagen.info/resources/" href="https://hanys-org.zoom.us/rec/component-page?hasValidToken=false&clusterId=us06&action=play&filePlayId=&componentName=recording-register&meetingId=Kbvr3qC4TUnY5DcjnyrY1ef_1t3GkMCgxgzv-f3Y1HA3sj2xgT4izFRls020a77y.wD8P6T6f46SHBHI2&originRequestUrl=https%3A%2F%2Fhanys-org.zoom.us%2Frec%2Fshare%2FlbYW6gUOiliCC90wztEPOXjEQCCu7Z0-7BlWW43q3UnTR06rNn4vvwSknP8zp2X5.4kQ1TSKI0uvH0rav" target="_blank">Market Disruption: Threat or Opportunity</a></em>, we’ll walk you through nine tactics to help you leverage disrupters.</p><h2>What are market disrupters?</h2><p>Market disrupters are defined as any person, product or idea that radically and permanently changes the way an industry operates, according to <a data-cke-saved-href="https://www.wgu.edu/blog/how-to-become-market-disruptor2109.html#close" href="https://www.wgu.edu/blog/how-to-become-market-disruptor2109.html#close" target="_blank">Western Governors University</a>. Healthcare market disrupters use multiple strategies to address challenges like physician burnout, patient satisfaction and electronic health record shortcomings.<br /></p><p>While not all disrupter solutions succeed, new care models and technology-enabled value-based care platforms have gained traction. Currently, hospitals and health systems are tailoring their strategies to reflect:<br /></p><ul><li>disrupters’ prime targets;</li><li>current service strength and diversity; and</li><li>local market dynamics, including value-based care acceptance and progress.</li></ul><h2>How to combat healthcare market disrupters </h2><h3>Understand your disrupter<br /></h3><p>Healthcare disrupters are gaining in-depth patient insights, developing care models to meet their needs and creating a better customer experience. Here are three ways you can better understand your disrupter.<br /></p><ol><li><strong>Know your competition </strong></li></ol><ul><li><em>Big tech</em>: Amazon, Microsoft, Apple and Google have leveraged their data depth.</li><li><em>Payors:</em> UnitedHealth Group-owned Optum and Humana have a footprint in post-acute care.</li><li><em>Retail: </em>CVS Heath, Walgreens Boots Alliance and Walmart have acquired and partnered with payors.</li><li><em>New medical groups:</em> The names matter less than the new models of care they represent — primary, specialty and VBC.</li></ul><ol><li><strong>Know the threats they represent</strong><br />Big tech data help predict patient needs. Payor home-based resources steer patients and their care. Retail settings have evolved beyond low-acuity convenience care to VBC models. New medical groups include provider-payer partnerships that deliver concierge care to seniors.</li><li><strong>Know if they’re in your market </strong><br /><a data-cke-saved-href="https://www.sg2.com/home/" href="https://www.sg2.com/home/" target="_blank">Sg2</a> data shows that payviders are the largest disrupters in New York City while investor-backed medical groups have grown in the state’s other urban centers like Buffalo and Syracuse. In rural areas, all four disrupter groups have grown their presence.</li></ol><h3>Understand your market<br /></h3><p>Disrupters like Amazon can already execute a seamless customer experience. Now they want to convert customers to patients just as easily. Size and scale allow CVS to mirror system-level capabilities as a provider and a payor. Here’s what you can do using your company size:<br /></p><ol><li><strong>Align better with patients</strong><br />Sg2 notes that health systems often lose as many patients as they gain. Their data shows a four-year health system market share at approximately 33% with 15-20% customer churn. The latter includes a 25-40% churn rate for new customers. This patient leakage can cost organizations $200-500 million per year.</li><li><strong>Align differently with physicians</strong><br />Physicians have more partnership options and will pursue them if they can solve long-standing problems. AI-driven EHR solutions from disrupters have increased chart speed, accuracy and detail.</li><li><strong>Align clearly with VBC</strong><br />Health systems must be on a path to value-based care or have a good reason not to be. The new medical group investors have made these pathways easier for physicians, including risk-based contracts.</li></ol><h3>Understand your data<br /></h3><p>Healthcare problems aren’t always simple to fix, especially without the right intelligence. Focus on your data in these three ways to better understand it:<br /></p><ol><li><strong>Evaluate metrics</strong><br />Look at traditional performance metrics but apply a broader lens to measure and improve customer engagement. Start with visit volume, unique patient count, inpatient market share and per-visit revenue. Then ask yourself, “How effectively do we attract and retain patients?” and “How well are we serving their needs, now and over time?” </li><li><strong>Re-evaluate service lines</strong><br />Identify a service line or lines that might be at risk. Next, apply the metrics and run if/then scenarios to strengthen market position or make partnership decisions.</li><li><strong>Assess the results</strong><br />A better understanding of patient acquisition, leakage and revenue impact lays the foundation for a more frictionless customer experience — the one that disrupters already know how to create.</li></ol><h2>3 questions to get started</h2><p>Disrupters are accelerating their activity, growth and success. Hospitals and health systems must respond now. Taking what you learned above, here are three questions you can ask to get started:<br /></p><ol><li>Which disrupters are most active in your market and which new care models and technologies have they introduced?</li><li>Do you know how to accelerate your market performance using all available levers?</li><li>How will you apply data to your care redesign strategies to meet changing patient needs?</li></ol><p>Don’t want to analyze your health market position and current disrupters? DataGen’s partnership with Sg2 allows you to leverage a robust suite of tools. Use Sg2’s MarketEdge <a data-cke-saved-href="https://datagen.info/solutions/community_and_market_planning/market_and_referral_pattern_analyses_nys/" href="https://datagen.info/solutions/community_and_market_planning/market_and_referral_pattern_analyses_nys/" target="_blank">market and referral pattern analyses</a> to better understand your health system’s market position based on historic utilization, demographic data and other user-defined specifications, such as geographies and hospitals. <a data-cke-saved-href="https://datagen.info/contact/" href="https://datagen.info/contact/" target="_blank">Contact DataGen today</a> to learn more.</p>Courtney Yulehttp://www.blogger.com/profile/15321700369247409594noreply@blogger.com0tag:blogger.com,1999:blog-2728411347274749489.post-36969188844565448482023-10-12T03:00:00.003-07:002024-03-27T07:38:00.085-07:00How to overcome SPARCS data changes: 3 most common challenges<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJJ86Cq_5BKFJt2eMX_tuxHodvK2JsWjHj0vlJ6ZKQyFGc8PxUUvQmKuRPWfY4y3IqRh2UR9xzyoBnw6J-P9VvA4jwoCLCrJtBIXN4kDiL1eaBc4W5Zv6STP1oSHtS49BSXDgVFJunJNIm4gjKwSWhXgEOjtvwGWsBjzRbZYTIXQnjv9t8kiy1S6j7Pec/s640/UDS%20Blog_October%202023.jpeg" style="margin-left: 1em; margin-right: 1em;"><img alt="SPARCS data changes" border="0" data-original-height="403" data-original-width="640" height="404" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJJ86Cq_5BKFJt2eMX_tuxHodvK2JsWjHj0vlJ6ZKQyFGc8PxUUvQmKuRPWfY4y3IqRh2UR9xzyoBnw6J-P9VvA4jwoCLCrJtBIXN4kDiL1eaBc4W5Zv6STP1oSHtS49BSXDgVFJunJNIm4gjKwSWhXgEOjtvwGWsBjzRbZYTIXQnjv9t8kiy1S6j7Pec/w640-h404/UDS%20Blog_October%202023.jpeg" width="640" /></a></div><p>This October 100% of Q1 2023 data is due to the Statewide Planning and Research Cooperative System of New York State. Whether you receive a Statement of Deficiency or not, you may be wondering if there are better ways to manage SPARCS data changes.</p><p>It’s not uncommon for hospitals and ambulatory surgery centers to experience challenges with SPARCS submissions, specifically with data updates and staying compliant. Even the most experienced, full-time SPARCS coordinator can have difficulties keeping up. </p><p>In this blog, we’ll outline how SPARCS requirements can change, submission error consequences and solutions to overcome these challenges. Before we dive in, let’s quickly review the history of SPARCS and its data changes. </p><h2>What is SPARCS and how does it change?</h2><p><a data-cke-saved-href="https://www.health.ny.gov/statistics/sparcs/" href="https://www.health.ny.gov/statistics/sparcs/" target="_blank">The New York State Department of Health</a> defines SPARCS as a comprehensive all-payer data reporting system. It requires hospitals and ASCs to submit clinical, billing, admission, discharge and transfer data. This often changes due to new state rules, changing formats and updated codes.<br /></p><h2>3 SPARCS data challenges and their solutions<br /></h2><h3>Challenge 1: Data needs are diverse, and sources change daily</h3><p>Healthcare data changes rapidly, from daily FDA drug and device codes to updated diagnostic codes. Conversely, the state only updates SPARCS data quarterly but changes reporting, quality and compliance mandates frequently — all while expecting error-free data at point of submission and in trends over time.<br /></p><p>New York’s <a data-cke-saved-href="https://news.datagen.info/2023/08/sparcs-updates-hospitals-on-injury.html" href="https://news.datagen.info/2023/08/sparcs-updates-hospitals-on-injury.html" target="_blank">SPARCS updates to the injury, cause and place code data remediation project</a> released in April is a perfect example. A broken arm corresponds to a single diagnostic code, but the state requires patient trend data that includes where and how the break took place. Because facilities must submit these requirements, having missing cause and place data is a large, well-known pain point.<br /></p><h3>Challenge 2: Health information managers bear multiple responsibilities</h3><p>Most facilities have a dedicated SPARCS coordinator, but the word dedicated is misleading. Hospital and ASC health information managers have multiple responsibilities. Tracking down SPARCS updates is just one. Something as simple as a ZIP code error can lead to a SPARCS submission rejection on reimbursement claims that insurers have already paid.<br /></p><p>The effect on revenue cycle performance can be cumulative and significant. There is already a workforce shortage. In addition, hospitals and ASCs face significant financial pressures from reimbursement cutbacks, insurer payment policies and value-based care demands.<br /></p><h3>Challenge 3: EHRs can’t validate data directly</h3><p>EHR vendors often sell their systems as one-stop shops for compliance reporting, but this isn’t often the case for SPARCS.<br /></p><p>EHRs can send data directly to SPARCS but cannot validate it. This can begin what feels like an endless cycle of data corrections and resubmissions, assuming the facility can identify and fix every error.<br /></p><p>What are the consequences? New York state can deny Certificate of Needs requests and assess monthly fines as high as $10,000 per patient type until a hospital or ASC submits fully accurate SPARCS data.<br /></p><h2>Don’t wait for deficiencies: Get a solution today!</h2><p>SPARCS deadlines are unavoidable, but that doesn’t mean you have to tackle them alone. There are data solutions available that take formatting, syncing and error sweeping out of the equation — like DataGen’s <a data-cke-saved-href="https://datagen.info/solutions/revenue_cycle_performance/sparcs_submissions_nys/" href="https://datagen.info/solutions/revenue_cycle_performance/sparcs_submissions_nys/" target="_blank">UDS (UIS Data System™)</a>.<br /></p><p>We’ll be the extra analyst on your team, ensuring 100% submission accuracy no matter how often requirements change. Plus, our system automatically loads code updates for you. This way you don’t have to worry about updating hundreds of new codes every quarter. <a data-cke-saved-href="https://datagen.info/solutions/revenue_cycle_performance/sparcs_submissions_nys/#contact" href="https://datagen.info/solutions/revenue_cycle_performance/sparcs_submissions_nys/#contact" target="_blank">Contact us today</a> to free up your time or <a data-cke-saved-href="https://datagen.info/contact/" href="https://datagen.info/contact/" target="_blank">request a demo</a>.</p>Courtney Yulehttp://www.blogger.com/profile/15321700369247409594noreply@blogger.com0tag:blogger.com,1999:blog-2728411347274749489.post-71270003644344950272023-10-06T06:54:00.000-07:002024-03-27T07:21:32.277-07:00How NCQA's Health Equity Accreditation impacts health disparities <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5RqNsKjW6HpgsqSMHfjY9xS8KCj7EuHhgGNax9IU6H3sDWSgGqujbcq98aUd-lSuw3S8_c7555VZXMm7HUnJ-kuulTPDcEaQ8Pf45JmlVpXHckP3goaDBhXGkfQnTri9zgt_2X5Kdn8Dpx5NdcaD-OIOyQo_6bwPBeVd9VaNV2Hy9JLcPNtbJblxuJY4/s1200/PAS%20Blog_October%202023.jpeg" style="margin-left: 1em; margin-right: 1em;"><img alt="ncqa health equity accreditation" border="0" data-original-height="754" data-original-width="1200" height="402" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5RqNsKjW6HpgsqSMHfjY9xS8KCj7EuHhgGNax9IU6H3sDWSgGqujbcq98aUd-lSuw3S8_c7555VZXMm7HUnJ-kuulTPDcEaQ8Pf45JmlVpXHckP3goaDBhXGkfQnTri9zgt_2X5Kdn8Dpx5NdcaD-OIOyQo_6bwPBeVd9VaNV2Hy9JLcPNtbJblxuJY4/w640-h402/PAS%20Blog_October%202023.jpeg" width="640" /></a></div><p>Multiple organizations have prioritized provider health equity requirements — from new CMS priorities in their Framework for Health Equity to accreditation standards from The Joint Commission. NCQA’s Health Equity Accreditation is one of its newest <a data-cke-saved-href="https://www.ncqa.org/programs/health-equity-accreditation/" href="https://www.ncqa.org/programs/health-equity-accreditation/" target="_blank">programs</a>.</p><p>Introduced in 2021, HEA expands accreditation from payers to multiple stakeholders including medical practices and health systems. A second NCQA accreditation, Health Equity Accreditation Plus, takes practices further into the social drivers of health and community partnerships.<br /></p><p>With so many existing demands, it’s natural for a medical practice to ask: Why should we pursue HEA or HEA+, and what are the benefits for our patients and practice? In this blog, we’ll cover three ways NCQA accreditation helps medical practices improve health equity and achieve full practice transformation under this new model of care.<br /></p><h2>How NCQA Health Equity Accreditation can reduce health disparities</h2><h3>1. Increase patient awareness<br /></h3><p>NCQA’s HEA standards help medical practices meet patients where they are. DataGen interprets these standards through five practice advancement strategies:<br /></p><ol><li><strong>Organizational readiness: </strong>An agile medical practice that seeks accreditation will become open (or ready” to identify and meet patient needs, quickly and more accurately.</li><li><strong>Patient characteristics:</strong> Practices must consistently collect more patient data in the areas of race, ethnicity and language; and sexual orientation and gender identity. Patients are more satisfied when they have a <a data-cke-saved-href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9754163/" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9754163/" target="_blank">positive doctor-patient relationship</a> and a doctor who understands their entire story, making them more likely to confide in them and follow recommended care that is tailored to their specific needs and preferences.</li><li><strong>Language resources: </strong>Meeting patients where they are means communicating in their preferred language. Resources can be internal or community-based, and they should aim to include verbal and written support. For example, a hospital with a large Chinese population can assess its resources and staffing and choose to hire more providers who speak Mandarin and make online interpretation services readily accessible in patient settings</li><li><strong>Practitioner network and cultural responsiveness: </strong>Patients are more likely to trust providers they can relate to. When medical practices publicize their provider and staff profiles, it can help patients commit to a provider and receive the preventive and chronic care they require.</li><li><strong>Quality improvement:</strong> By examining their practice’s general population and stratifying quality measures by diverse groups, practices can better identify and serve vulnerable populations.</li></ol><h3>2. Create personalized interventions<br /></h3><p>Personalized interventions require data at the individual and population health levels, stratified by condition, risk and patient characteristics. Improved data leads to more accurate assessments, more personalized interventions and enhanced follow-ups that prioritize health equity factors.<br /></p><h3>3. Support practice equity advancement and transformation<br /></h3><p>To advance <a data-cke-saved-href="https://www.cdc.gov/nchhstp/healthequity/index.html" href="https://www.cdc.gov/nchhstp/healthequity/index.html" target="_blank">health equity</a>, practices must understand these three components:<br /></p><ul><li>their aim and mission;</li><li>the patients they serve; and</li><li>their data and quality.</li></ul><p>Together, they create the quality-equity connection, requiring a practice to examine their outcomes and identify contributing factors. For instance, a patient with persistent uncontrolled HbA1c may live in a food desert and lack the transportation that would give them access to fresh fruits and vegetables. Using this example, you can see why it’s important to consider social drivers of health to improve patient outcomes.<br /></p><h2>Discover key patient insights with quality data</h2><p>NCQA’s HEA and HEA+ send a strong signal: major healthcare institutions and medical practices are prioritizing equity and identifying resources to eliminate care gaps for optimal patient care and experiences.<br /></p><p>If you’re interested in advancing methods to promote health equity in your institution or medical practice, DataGen has multiple years of experience partnering with for quality improvement and NCQA’s accreditation programs. We bring <a data-cke-saved-href="https://datagen.info/solutions/medical_practice_consulting/" href="https://datagen.info/solutions/medical_practice_consulting/" target="_blank">high-quality analytic tools and consulting services</a> to achieve and maintain accreditation in HEA and HEA+.<br /></p><p>For a free practice advancement consultation, <a data-cke-saved-href="https://datagen.info/contact" href="https://datagen.info/contact" target="_blank">contact DataGen today</a>. Take the step toward better outcomes through a health equity-based model of care.</p>Courtney Yulehttp://www.blogger.com/profile/15321700369247409594noreply@blogger.com0tag:blogger.com,1999:blog-2728411347274749489.post-7866740878516602652023-09-26T03:00:00.001-07:002024-03-27T07:06:19.738-07:002024 IPPS final rule announced: 3 changes you need to know<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTuYXqljQ8MUlwa4JKtLnTaeZpMHhenJTzFG2Zee68P9DFbY6aZ_WjSOBW5Xw48SwvgQuIrK6APpFrC796DFbFom5JfnYgt_eVW-fnOf0ySmIhluHqfH7ulDuO_2zLntdQ7vlJQVHOGyzzBTd0H1twAhYf-jSpMJNReoreoDiRz5sHPGCZGRcOH3q8OaA/s1200/KeySTATS%20Blog_September%202023%20(1).jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="ipps final rule 2024" border="0" data-original-height="754" data-original-width="1200" height="402" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTuYXqljQ8MUlwa4JKtLnTaeZpMHhenJTzFG2Zee68P9DFbY6aZ_WjSOBW5Xw48SwvgQuIrK6APpFrC796DFbFom5JfnYgt_eVW-fnOf0ySmIhluHqfH7ulDuO_2zLntdQ7vlJQVHOGyzzBTd0H1twAhYf-jSpMJNReoreoDiRz5sHPGCZGRcOH3q8OaA/w640-h402/KeySTATS%20Blog_September%202023%20(1).jpeg" width="640" /></a></div><p>In August, CMS published the <a data-cke-saved-href="https://www.federalregister.gov/documents/2023/08/28/2023-16252/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-and-the" href="https://www.federalregister.gov/documents/2023/08/28/2023-16252/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-and-the">final</a> Medicare Inpatient Prospective Payment rule for the federal fiscal year 2024. Most changes announced in the <a data-cke-saved-href="https://www.federalregister.gov/documents/2023/05/01/2023-07389/medicare-program-proposed-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals" href="https://www.federalregister.gov/documents/2023/05/01/2023-07389/medicare-program-proposed-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals" target="_blank">proposed rule</a> were adopted and several are significant, including:</p><ul><li>Disproportionate Share Hospitals payment cuts; and</li><li>a Rural Wage Index recalculation with diverse impacts.</li></ul><p>In this blog, we’ll cover these updates, the IPPS rule's total payment increase and how CMS continues to prioritize health equity in its rulemaking.<br /></p><h2 style="text-align: left;"><strong>The most significant</strong> <strong>IPPS final rule impacts</strong></h2><h3 style="text-align: left;"><strong>1. DSH UCC pool payment cuts</strong></h3><p>For FFY 2024, DSH uncompensated care pool payments will decrease by $595 million due to decreased funding projections and a big adjustment to Factor 2 (see below), even though the DSH methodology is the same.<br /></p><p>This means DSH hospitals will need to find a way to recoup these losses, a challenge given the disadvantaged areas where they operate. If Affordable Care Act Marketplace plan enrollment continues to increase, Factor 2 cuts will continue.<br /></p><p>DSH UCC pool payments are based on three factors:<br /></p><ul><li><strong>Factor 1 – </strong>Represents 75% of the traditional DSH payment calculation for uncompensated care.</li><li><strong>Factor 2 – </strong>Adjusts Factor 1 using estimated annual national insurance coverage rates.</li><li><strong>Factor 3 – </strong>Applies the ratio of an individual hospital's uncompensated care costs to the national UCC total.</li></ul><p>Because fewer Americans are uninsured, Factor 2 cut payments by more than 40%. That number was 34% in FFY 2023 and 31% in FFY 2022. Overall FFY 2024 DSH UCC pool payments will be $5.938 billion, less than the $6.713 billion CMS projected in the proposed rule.</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmk1mOgPW9-IfyTNlN7N29xxYsO0Ad6y5Bkz1wgRfLlfgsY840DwaWwXOPIDngN2IGcoHPf5s7i3XHevIdgJgK8M9PhpgotNPFy1oNJnBorzrBovLc4PGbibAml098ZPus_yTn8TVbXAUib3E3lGfSXoTgUqW5wfspMu-oRO3KjIFjgwCOwriFpo2QqE4/s1200/CHA%20Blog_September%202023%20(1).jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="IPPS Factor 2 Payment Cuts Chart" border="0" data-original-height="450" data-original-width="1200" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmk1mOgPW9-IfyTNlN7N29xxYsO0Ad6y5Bkz1wgRfLlfgsY840DwaWwXOPIDngN2IGcoHPf5s7i3XHevIdgJgK8M9PhpgotNPFy1oNJnBorzrBovLc4PGbibAml098ZPus_yTn8TVbXAUib3E3lGfSXoTgUqW5wfspMu-oRO3KjIFjgwCOwriFpo2QqE4/w640-h240/CHA%20Blog_September%202023%20(1).jpeg" width="640" /></a></div><h3 style="text-align: left;"><strong>2. RWI updates impact hospitals differently</strong></h3><p>Since the courts determined that HHS cannot establish a rural floor lower than a state's RWI, CMS had to comply and recalculate. Thus, CMS finalized the RWI <a data-cke-saved-href="https://news.datagen.info/2023/06/rural-wage-index-changes-grab-headlines.html" href="https://news.datagen.info/2023/06/rural-wage-index-changes-grab-headlines.html" target="_blank">as proposed</a>.<br /></p><p>To recap, CMS will now calculate each state’s RWI with data from rural hospitals and reclassified hospitals, even if those facilities are not rural geographically. State RWI impacts will vary, with higher hospital payments where the index increases and lower where it decreases. Additionally, RWI payments are budget neutral, meaning that even hospitals otherwise unaffected by the RWI will have payments decreased to pay for it. Hospitals in lower RWI states that are also DSH eligible will face a greater payment cut.</p><h3 style="text-align: left;"><strong>3. Additional significant updates</strong></h3><p>In addition to DSH and RWI, you should take note of four important updates:<br /></p><ol><li><strong>IPPS platform update </strong><strong>–</strong> DataGen's broader IPPS analysis now includes every major rule shift, allowing you to get the most accurate data.</li><li><strong>IPPS overall increase – </strong>CMS finalized net rates at lower than proposed, but payment will still increase by about $2.2 billion. This is good news for hospitals whose already tight margins suffered during the pandemic.</li><li><strong>Social determinants of health pause </strong><strong>– </strong>While the agency sought input on Z code severity levels and did alter three homelessness codes, it stopped short of broader implementation.</li><li><strong>Quality and payment moves </strong><strong>–</strong> CMS had proposed a health equity bonus to the Value-Based Purchasing Program. Its approach was unclear, however, and it won't implement the bonus until FFY 2026. Overall, CMS' focus on SDOH and health equity will help make these drivers a priority for hospitals and value-based models, perhaps just not as quickly.</li></ol><h3 style="text-align: left;"><strong>What the final IPPS rule means for you</strong></h3><p>The IPPS changes will be effective on or after Oct. 1, 2023, unless otherwise noted. With the IPPS rule now final, hospitals can safely project their FFY 2024 budgets.<br /></p><p>Looking for help with the final IPPS rule? <a data-cke-saved-href="https://datagen.info/solutions/medicare_fee_for_service_policy_analytics/pps_annual_regulatory_rules/" href="https://datagen.info/solutions/medicare_fee_for_service_policy_analytics/pps_annual_regulatory_rules/" target="_blank">DataGen’s PPS annual regulatory rules solution</a> can help. Our comprehensive analytics platform will analyze major components of rules, providing you with granular estimates, national comparisons and more. Get the insights you need and <a data-cke-saved-href="https://datagen.info/contact/" href="https://datagen.info/contact/" target="_blank">contact us today for a free consultation</a>.</p>Courtney Yulehttp://www.blogger.com/profile/15321700369247409594noreply@blogger.com0tag:blogger.com,1999:blog-2728411347274749489.post-20842445315799605252023-09-21T07:23:00.002-07:002024-02-05T08:14:25.680-08:00The hardest Community Health Assessment step and how to overcome it<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiQt2jG6MqNQIxht85cI8_SFu7NKs6kvuPAK0Mo43guzDl4tjtzw701iUMKCcQK-JsLZxM1Wfjmi0nLKB7On-tGRxmISXs7mQ7JCe4nX26SKb83jJSKoO_tj1aNL_0vn-A_EB5zh2-IotgLCtPBKxCFmvSPu2BfNd1_31fCD5716VZsaqpbdEj-Ggz1gU/s1200/CHA%20Blog_September%202023.jpeg" style="margin-left: 1em; margin-right: 1em;"><img alt="Community Health Assessment step" border="0" data-original-height="754" data-original-width="1200" height="402" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiQt2jG6MqNQIxht85cI8_SFu7NKs6kvuPAK0Mo43guzDl4tjtzw701iUMKCcQK-JsLZxM1Wfjmi0nLKB7On-tGRxmISXs7mQ7JCe4nX26SKb83jJSKoO_tj1aNL_0vn-A_EB5zh2-IotgLCtPBKxCFmvSPu2BfNd1_31fCD5716VZsaqpbdEj-Ggz1gU/w640-h402/CHA%20Blog_September%202023.jpeg" width="640" /></a></div><p>Data is at the heart of a <a data-cke-saved-href="https://datagen.info/solutions/community_and_market_planning/community_health_assessment/" href="https://datagen.info/solutions/community_and_market_planning/community_health_assessment/" target="_blank">Community Health Assessment</a>. CHAs exist to collect community input, use that feedback to identify unmet needs and intervene effectively. A CHA cannot be fully effective without accurate, community-focused data.</p><p>But these data are not easy for public health departments to locate, acquire, format or interpret — even if it comes from a single, reliable source. CHA data must be high-volume, high-quality and diverse. That takes time, staff and expertise which are often in short supply at public health departments.<br /></p><p>Faced with this daunting effort, health departments may rush past data to intervention, which could be a costly mistake. They may lose sight of the CHA's purpose beyond accreditation, make incorrect assumptions about community needs and ignore better resources.<br /></p><p>While data may be the most difficult CHA step, there are three ways you can help minimize the complexity.<br /></p><p>Overcome CHA data collection challenges<br /></p><p><strong>1. Remember why it matters</strong><br /></p><p>Improved community health drives the spirit and intention of a CHA. If you’re feeling challenged, it’s important to remind yourself of the CHA’s significance — and the <a data-cke-saved-href="https://publichealth.tulane.edu/blog/why-community-health-is-important-for-public-health/" href="https://publichealth.tulane.edu/blog/why-community-health-is-important-for-public-health/" target="_blank">importance of community health</a>. Some methods you can use to inspire yourself, include:<br /></p><ul><li>remembering your health department’s role in improving outcomes at the population level;</li><li>thinking about the lives you’ll improve;</li><li>creating scenarios on how you can positively impact community health; and</li><li>looking over your specific goals and desired outcomes.</li></ul><p>On top of realigning your efforts, the process may also generate new ideas and questions such as, ”Is the CHA data pointing to where there’s a greater need?” or “Where are hunger and transportation insecurity the highest?” or “Is affordable housing a bigger issue for a different set of ZIP codes?”<br /></p><p><strong>2. Validate your data and partners</strong><br /></p><p>Health departments often rely on data from hospital <a data-cke-saved-href="https://datagen.info/solutions/community_and_market_planning/community_health_needs_assessment/" href="https://datagen.info/solutions/community_and_market_planning/community_health_needs_assessment/" target="_blank">Community Health Needs Assessments</a> to conduct their own CHA. However, hospitals may also struggle with the same concerns as health departments, e.g., insufficient data, staff and fact-based community knowledge, so the hospital-sourced data may also need validation<br /></p><p>To help validate hospital CHNA data and ensure health improvement efforts remain focused and effective, health departments can ask these five questions:<br /></p><ol><li>Who are our community members and partners?</li><li>What are our local health needs?</li><li>What data do we already have and is it organized, current and accurate?</li><li>Do we have the resources to improve it?</li><li>What is missing and can we figure it out?</li></ol><p>Health departments should also collaborate closely with their partners. Community-based organizations may know what solutions will work on a localized scale compared to their health department, which has a broader focus. This is a common practice used to validate collected data from partners while generating additional insights.<br /></p><p><strong>3. Get external help</strong><br /></p><p>Meeting the spirit of CHA requires a lot of work and patience. With health departments already being stretched, adding more tasks to your plate can feel overwhelming. However, you don’t have to go through your CHA alone.<br /></p><p>Analytics-first partners like DataGen can guide public health departments through data collection and analysis and collaboration with hospitals and CBOs, including validation of their data contributions. Many of the questions and processes are the same as those in step two, e.g., identifying meaningful data, populations and interventions.<br /></p><p><strong>Make the hardest step easier </strong><br /></p><p>Accurate CHA data reflects a community’s health realities. This in turn helps to ensure a valid and effective CHA. In other words, you need accurate external information and internal data to reflect your community’s entire health landscape. <a data-cke-saved-href="https://datagen.info/contact/" href="https://datagen.info/contact/" target="_blank">Contact DataGen</a> to learn more about our <a data-cke-saved-href="https://datagen.info/solutions/community_and_market_planning/community_health_assessment/" href="https://datagen.info/solutions/community_and_market_planning/community_health_assessment/" target="_blank">CHA Advantage</a> solution.<br /></p><p>Want to see exactly how you can obtain CHA information? <a data-cke-saved-href="https://datagen.info/contact/" href="https://datagen.info/contact/" target="_blank">Request a free demo today</a> and let us demonstrate our key product features, such as affordable data analysis, process design and assessment templates.</p>Courtney Yulehttp://www.blogger.com/profile/15321700369247409594noreply@blogger.com0tag:blogger.com,1999:blog-2728411347274749489.post-61730583734598433542023-09-19T02:00:00.001-07:002024-02-05T08:14:35.378-08:00How to conduct a Community Health Needs Assessment: 3 keys to simplify the process <div class="separator" style="clear: both; text-align: left;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCEcavI-uzEvGPR6Xq1b7VTJsZSjqLX5kRSxN8lgvgyZyHGnYVLbwe9b75dV9F5PZLHu3FY1GDzhXzMfRdhbpy9ZzOBbgRtCiXLZxW8yMuTFBa_ZjiD7aWQOGeVNRzg39Kvh7Gecw9FzGdeJuz48ySa8pFCzUgWqFf3Jpvamyf7SVT__5LZr8rDh3Lr2k/s1200/CHNA%20Blog_September%202023-1.jpeg" style="margin-left: 1em; margin-right: 1em;"><img alt="how to conduct a community health needs assessment" border="0" data-original-height="754" data-original-width="1200" height="402" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCEcavI-uzEvGPR6Xq1b7VTJsZSjqLX5kRSxN8lgvgyZyHGnYVLbwe9b75dV9F5PZLHu3FY1GDzhXzMfRdhbpy9ZzOBbgRtCiXLZxW8yMuTFBa_ZjiD7aWQOGeVNRzg39Kvh7Gecw9FzGdeJuz48ySa8pFCzUgWqFf3Jpvamyf7SVT__5LZr8rDh3Lr2k/w640-h402/CHNA%20Blog_September%202023-1.jpeg" width="640" /></a></div>Assessing the needs of a community — through preparation, coordination and implementation — does more than check a box. It provides hospitals with insight into where time, money and resources should be dedicated to improve population health.</div><p>This is the purpose of the Community Health Needs Assessment. Per the <a data-cke-saved-href="https://www.aha.org/system/files/2018-01/Engaging-patients-communities-health-needs-assmt.pdf" href="https://www.aha.org/system/files/2018-01/Engaging-patients-communities-health-needs-assmt.pdf" target="_blank">American Hospital Association’s guide</a>, the CHNA includes multiple moving parts and contributors who:<br /></p><ul><li>interview community leaders;</li><li>hold stakeholder meetings;</li><li>conduct patient surveys and query results;</li><li>establish and participate in community focus groups; and</li><li>analyze population health metadata.</li></ul><p>These steps can be time-consuming and unclear, leaving many to question whether they’re accurately evaluating their community’s needs — or just trying to meet compliance requirements. But, what if there’s a better way?<br /></p><p>In this blog, we’ll break down three steps you can use to simplify your CHNA, so you can drive the best outcomes for patients and providers.</p><h2 style="text-align: left;"><strong>Three ways to simplify the CHNA </strong></h2><h3 style="text-align: left;"><strong>1. Prepare</strong></h3><p>Not-for-profit hospitals must conduct and submit a CHNA every three years to maintain their tax-exempt status. Without a flexible and scalable process, the time gap between assessments can feel like starting over. A successful CHNA begins with a timeline and a framework. Standardization can help hospitals collect, organize and streamline disparate data. This includes tools, templates and programming that imports new requirements and maintains existing ones.<br /></p><p>By staying ahead and well organized, you’ll give yourself enough time to administer a quality CHNA.<br /></p><h3 style="text-align: left;"><strong>2. Coordinate</strong></h3><p>According to the <a data-cke-saved-href="https://nnphi.org/wp-content/uploads/2015/08/PrinciplesToConsiderForTheImplementationOfACHNAProcess_GWU_20130604.pdf" href="https://nnphi.org/wp-content/uploads/2015/08/PrinciplesToConsiderForTheImplementationOfACHNAProcess_GWU_20130604.pdf" target="_blank">National Network of Public Health Institutes</a>, an <a data-cke-saved-href="https://nnphi.org/wp-content/uploads/2015/08/PrinciplesToConsiderForTheImplementationOfACHNAProcess_GWU_20130604.pdf" href="https://nnphi.org/wp-content/uploads/2015/08/PrinciplesToConsiderForTheImplementationOfACHNAProcess_GWU_20130604.pdf" target="_blank">effective CHNA</a> involves “cooperation, collaboration and partnership to help achieve common priorities and inform partners’ investment strategies.” Together these elements help create a shared sense of ownership.</p><p>To achieve this, it’s important that hospitals identify which community partners should be invited to participate, what roles they can play in the assessment and what they would be responsible for and when. These partners range from public health agencies and community-based organizations to local businesses, employers and health plans.<br /></p><p>When so many people are involved, superior coordination can move a CHNA exponentially forward. For example, this could come internally from a hands-on coordinator or externally from DataGen’s team of population health analysts. It’s also crucial for the assessment of proposed initiatives and review of prior results. With skill and experience, each CHNA report can create built-upon gains.<br /></p><h3 style="text-align: left;"><strong>3. Implement </strong></h3><p>The CHNA drives community health improvement from community data. These metrics are used as evidence to create health interventions that help people thrive.<br /></p><p>Before you can implement a CHNA plan, it is crucial to capture and collect data in a meaningful way, taking great care to make sure your analyses are interpreted accurately. This way you can identify the best ways to make important care interventions.<br /></p><p>While past CHNA results can still evolve community infrastructure, they can also bias future analysis. If you use past information, make sure that it’s still relevant to your new community-based data and identifies unmet needs. Also, be prepared to explain why some interventions may have a lower priority and how you’ll address them nonetheless.<br /></p><h2 style="text-align: left;"><strong>Don’t simplify your CHNA alone</strong></h2><p>Hospitals that prepare well and in advance for their CHNA launch can generate maximum results. If your hospital feels underprepared for your next CHNA, <a data-cke-saved-href="https://datagen.info/solutions/community_and_market_planning/community_health_needs_assessment/free_consultation/" href="https://datagen.info/solutions/community_and_market_planning/community_health_needs_assessment/free_consultation/" target="_blank">contact DataGen</a> for best-in-class CHNA preparation. Our experts will be there to help you throughout every stage of the process with toolkits, templates and expertise, ensuring you hit essential requirements while identifying vital community health needs.</p>Courtney Yulehttp://www.blogger.com/profile/15321700369247409594noreply@blogger.com0tag:blogger.com,1999:blog-2728411347274749489.post-61753640338327493382023-09-07T03:00:00.042-07:002024-03-27T07:07:03.483-07:00Home Health Prospective Payment System: More catch-up cuts in 2024 annual rule<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQJOrh1-tpLq80kkSP5_Ijjnsdp0Sh3pjA6lBX8kpbN46kDhnskz6UjxcMMcxlQIDkOZapFwM_w2TlTq5EYHJlr3Dd90aBythFSOTX5IiNceXEfiDnGA0ISuYKVVE8NUa1_yAthTRqGnjDCPcSt2D4Z5hTcj1fhbd1U8G3DxdHrglvkK9vZirMSD_xXcc/s1200/KeySTATS%20Blog_September%202023.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="Home Health Prospective Payment System: More catch-up cuts in 2024 annual rule" border="0" data-original-height="754" data-original-width="1200" height="402" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQJOrh1-tpLq80kkSP5_Ijjnsdp0Sh3pjA6lBX8kpbN46kDhnskz6UjxcMMcxlQIDkOZapFwM_w2TlTq5EYHJlr3Dd90aBythFSOTX5IiNceXEfiDnGA0ISuYKVVE8NUa1_yAthTRqGnjDCPcSt2D4Z5hTcj1fhbd1U8G3DxdHrglvkK9vZirMSD_xXcc/w640-h402/KeySTATS%20Blog_September%202023.jpeg" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: left;">CMS’ proposed Calendar Year 2024 <a data-cke-saved-href="https://www.federalregister.gov/documents/2023/07/10/2023-14044/medicare-program-calendar-year-cy-2024-home-health-hh-prospective-payment-system-rate-update-hh" href="https://www.federalregister.gov/documents/2023/07/10/2023-14044/medicare-program-calendar-year-cy-2024-home-health-hh-prospective-payment-system-rate-update-hh" target="_blank">Medicare Home Health Prospective Payment System rule</a> includes updates to:</div><ul><li>the Patient-Driven Groupings Model, Low Utilization Payment Adjustment thresholds, functional levels and comorbidity adjustment subgroups;</li><li>estimated aggregate payments based on the 30-day payment rate to account for assumed versus actual behavior changes;</li><li>the HH Value-Based Purchasing and Quality Reporting programs;</li><li>home intravenous immune globulin items and services, and disposable negative pressure wound therapy device payment rates;</li><li>medical equipment and supplies, including competitive bidding, as outlined by the Consolidated Appropriations Act of 2023; and</li><li>provider and supplier enrollment requirements and oversight.</li></ul><p>The HH PPS rule also proposes to add a new Special Focus Program for low-performing hospices.<br /></p><p>CMS estimates that the rule will cut aggregate HH agency payments by $375 million nationally. This includes a -1.81% adjustment in the HH annual standard payment rate. These cuts are of critical concern to agencies already facing higher operating costs, a shrinking workforce and the need to manage the downstream patient impact of these factors.<br /></p><h2 style="text-align: left;"><strong>How the proposed HH PPS cuts impact home health providers </strong></h2><h3 style="text-align: left;"><strong>1. Continued PDGM and behavior change adjustments drive deeper payment cuts</strong></h3><p>In the CY 2024 rule, CMS proposed more changes to the Patient-Driven Grouping Model and 30-day standard payment unit implemented in CY 2020. These changes reflect behavior assumptions related to the switch from a 60-day payment rate and to Clinical Group Coding, Comorbidity Coding and Low Utilization Payment Adjustment threshold updates.<br /></p><p>CMS believes these changes better align payments and patient care needs, especially for beneficiaries with clinically complex conditions. However, the CAA of 2023 requires that CMS study their impact. As a result, CMS implemented a -3.925% adjustment to the base payment rate adjustment for CY 2022 and proposes a further -5.653% adjustment for CY 2024. It’s important to note that the behavior adjustment is statutory, and there could be more adjustments through CY 2026.<br /></p><p>CMS believes this modification may reduce future permanent adjustments and intends to delay additional temporary adjustments to other payment years. These temporary adjustments are to reconcile overpayments that arose from the payment differences between assumed and actual behaviors tied to the 30-day rate unit for CYs 2020 to 2022. The estimated overpayment is $3.439 billion.<br /></p><h3 style="text-align: left;"><strong>2. Fewer patients may receive home healthcare</strong></h3><p>CMS expressed concern about patient access in the proposed rule based on fewer HH aide service claims and anecdotal evidence. CMS issued a Request for Information on its <a data-cke-saved-href="https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-home-health-prospective-payment-system-proposed-rule-cms-1780-p" href="https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-home-health-prospective-payment-system-proposed-rule-cms-1780-p" target="_blank">Fact Sheet</a> to ensure that:<br /></p><ul><li>beneficiaries have access to all entitled HH services;</li><li>agencies address barriers and obstacles to hiring HH aides; and</li><li>HH aide wages equal those in other care settings.</li></ul><p>Since the HH payment model changed in 2020, 500,000 fewer Medicare patients have accessed home health services. This is according to the <a data-cke-saved-href="https://www.nahc.org/2023/07/06/the-national-association-for-home-care-hospice-sues-medicare-to-preserve-the-home-health-service-benefit/" href="https://www.nahc.org/2023/07/06/the-national-association-for-home-care-hospice-sues-medicare-to-preserve-the-home-health-service-benefit/" target="_blank">National Association for Home Care and Hospice,</a> which filed suit in July to stop CMS’ payment cuts and asserted that these cuts have indeed “precipitated services limitations or access to care.”<br /></p><h3 style="text-align: left;"><strong>3. More VBP and quality reporting changes could strengthen programs</strong></h3><p>CMS proposes changes to metrics, data sets and reporting requirements for the Home Health Value-Based Purchasing Model and the Home Health Quality Reporting Program. These changes would help streamline and align CMS quality measures. Program performance impacts HH agency Medicare payments by up to ± 5% for HHVBP and can lead to a ≤2% marketbasket reduction for HHQRP.<br /></p><p>CMS expanded HHVBP in 2021 due to strong results. CMS’ analysis showed an annual average improvement of 4.6% in HH agency quality scores and $141 million in savings, all without beneficiary service cuts. In future years, the agency intends to add health equity components to both programs and seeks input on multiple HHQRP measures. This includes cognitive function, behavioral and mental health, patient experience and satisfaction, chronic conditions and pain management.<br /></p><h2 style="text-align: left;"><strong>Get help on the rule update: contact DataGen today! </strong></h2><p>DataGen hospital and health system clients already received their in-depth analysis of the proposed HH PPS changes.<br /></p><p>If your facility needs <a data-cke-saved-href="https://datagen.info/solutions/medicare_fee_for_service_policy_analytics/pps_annual_regulatory_rules/" href="https://datagen.info/solutions/medicare_fee_for_service_policy_analytics/pps_annual_regulatory_rules/" target="_blank">key PPS data insights</a> backed by an analytics-first approach, contact DataGen for a <a data-cke-saved-href="https://datagen.info/contact/" href="https://datagen.info/contact/" target="_blank">free consultation</a>.</p>Courtney Yulehttp://www.blogger.com/profile/15321700369247409594noreply@blogger.com0