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The 4 benefits of analyzing shadow bundles

Want to supercharge your health and total cost of care strategy? Medicare Accountable Care Organizations can now access CMS shadow bundle data.   This is a unique opportunity for ACOs and clinically integrated networks to reap benefits without assuming any additional financial risk. These benefits include:  improving care delivery;  managing episodes of care within their population; and  promoting engagement with specialists as partners.  If you're ready to do more with your data, continue reading for a complete shadow bundle data overview. We'll examine the four main benefits and discuss how they can help supercharge your analyses. 4 Main shadow bundle benefits  Before we dig in, here’s a brief outline of shadow bundles. Also, use our shadow bundles opportunity analysis info sheet for a quick overview.  What? Shadow bundles capture episodes of care within a defined patient population. CMS’ shadow bundle data for ACOs mirrors the specifications of the Bundled Payments for Care

Patient safety culture survey: Why collect data?

The Agency for Healthcare Research and Quality defines patient safety culture as "the extent to which an organization's culture supports and promotes patient safety." Patient safety culture is influenced by the values, beliefs and norms of healthcare practitioners and other staff. Since these concepts tend to be abstract, organizations looking to improve their patient safety culture must focus on identifying and measuring patient safety-related behaviors.  In this introductory blog, we'll touch on the importance of patient safety data and how it can help create a baseline. From there, you can gain a clearer idea of how to benchmark your facility to create effective patient safety culture improvement strategies.  Why collect patient safety data?  The best way to examine patient safety culture at the department, organization and system levels is to measure data. An organization can implement many different patient safety culture strategies. However, for them to be most

New York’s 1115 Medicaid Waiver: PCMH Enhanced Payment from CMS

On Jan. 9, the Biden administration and CMS approved New York state's $7.5 billion Medicaid Section 1115 demonstration amendment. This New York Health Equity Reform amendment includes nearly $6 billion in federal funding, effective until March 31, 2027.   Using these funds, "NYS seeks to build on the investments, achievements, and lessons learned from the Delivery System Reform Incentive Payment (DSRIP) 1115 waiver program to scale delivery system transformation, improve population health and quality, deepen integration across the delivery system, and advance health-related social need (HRSN) services," according to the New York State Department of Health .  Under CMS’ 1115 waiver, participating New York state primary care practices with Patient-Centered Medical Home recognition from the National Committee for Quality Assurance are eligible to receive increased Medicaid Incentive Payment.   Specifically, under Population Health, one of the three main NYHER programs, these

3 benefits of automated SPARCS data submission 

Statewide Planning and Research Cooperative System (SPARCS) data resubmissions impact a hospital or ambulatory surgery center’s ability to meet New York state requirements for clean patient discharge and visit records. But if you can resolve friction points created by SPARCS errors, you’ll have more resources available to focus on delivering affordable, quality care.   In this blog, we’ll go over how inefficient SPARCS data processing can impact your facility. Then, we’ll cover how you can optimize the process to achieve the three main benefits of automated SPARCS data submission.   How inefficient SPARCS data processing impacts facilities  SPARCS data provides DOH with details on each hospital’s inpatient stays and outpatient and ASC visits. If a facility submits data with errors, it must dedicate additional time to rework and resubmit claims data. This could lead to increased  compliance risks , DOH formal Statement of Deficiency and delay your  Certificate of Need process . It could

BPCIA: 4 fast facts for a successful Model Year 7 kickoff

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.  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.   4 Fast facts on BPCIA Model Year 7  1.   Focus on clinical episodes and episode volume  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.    During

Avoid SPARCS Compliance Risks: 3 Deadlines to Know Now

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.  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.  March and April SPARCS compliance deadlines  A hospital’s quarterly SPARCS submission isn’t “done” until it is submitted error-free. DOH publishes SPARCS Audit and SPARCS Compliance Reports 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.   The state monitors error resolution through monthly compliance reports. Hospitals with outstanding SPARCS errors receive three warnings before

Navigating the Impact of Medicare Cuts on Hospital Providers

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.  That's why DataGen released the Enacted Medicare Cuts Analysis as part of our legislative analyses suite, 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.  In this blog, we'll cover the enacted legislative cuts, enacted regulatory cuts and quality programs analyzed in the Enacted Medica