DataGen

CMS has issued its first evaluation report for Primary Care First . The report offers a window into: key attributes of advanced primary care practices; strategies for lowering costs and reducing hospitalizations; and new strategies that signal practice transformation. Future PCF program evaluations will include which practice implementations worked and how they improved quality. In the meantime, even if your medical group is not a PCF participant, you can glean insight into what CMS is looking for as it evolves its Alternative Payment Models and how practices committed to value-based care are prioritizing and evolving their practice transformation strategies. First, some background on PCF. PCF: Focus areas, risk models and payments PCF is designed to improve care quality and patient experience, increase access to advanced primary care services and reduce expenditures. PCF builds upon CMS’s Comprehensive Primary Care Initiative (CPC Classic) and Comprehensive Primary Care Plus by adding

To build a better medical practice, you must transform and then sustain the change. Through customized engagements and best practice experience, Practice Advancement Strategies guides clinical teams through the following challenges and opportunities: staff shortages/burnout; practice culture; payer negotiation and contracting; and value-based care outcomes These will be hot topics at the next Medical Group Management Association event: the Medical Practice Excellence: Financial and Operations Conference , just around the corner in Orlando, March 19-21. To help you prepare — for the conference or progress in general — DataGen Practice Advancement Strategies offers the following insider tips for practice advancement. 1.   Transformed teams can transform patient care. Research shows that earning Patient-Centered Medical Home Recognition from the National Committee for Quality Assurance can reduce staff burnout by more than 20%. While workforce shortages clearly impact burnout, careful wo

The Centers for Medicare and Medicaid Services Innovation Center recently announced approved applicants for the new Enhancing Oncology Model. If your facility has been selected by CMS, are you still weighing your options during the current baseline evaluation period?  Two deciding factors may include the program data that CMS provides and whether EOM is enough of an improvement over the prior Oncology Care Model to make your investment worthwhile. Another factor to consider: Will you have the resources in place to conduct a baseline evaluation before EOM’s program start on July 1, 2023? How EOM differs from OCM EOM aims to improve the coordination of oncology care, drive practice transformation and reduce Medicare fee-for-service spending through episode-based payment. It includes three major updates: Fewer cancer types. Compared with OCM’s 21, EOM will be limited to seven common cancer types: breast, prostate, lung, small intestine/colorectal, multiple myeloma, lymphoma and chronic le

The Bundled Payment for Care Improvement (BPCI) Advanced Model is now open for applications until May 31, 2023. This model provides a unique opportunity to acute care hospitals and physician group practices who are looking to: evaluate their bundle performance; rejoin if they have previously dropped out due to being under a convener; or take advantage of the changes to the model. With a small window to sign the participation agreement, you’ll need experts to process data quickly and accurately for evaluation. BPCI Advanced Program Details The Centers for Medicare & Medicaid Services (CMS) announced in October 2022 that this program will extend from January 2024 to December 2025. Data used for evaluation will be taken from the baseline period between October 2018 and September 2022. A participation agreement will be sent out in September 2023 and needs to be signed by October 2023 in order to participate. Those who apply before the May 31 deadline will benefit

CMS will implement a new Rural Emergency Hospital provider type on Jan. 1. REHs will be able to provide certain outpatient hospital services including emergency department and observation services. CAHs and small rural acute care hospitals with no more than 50 beds are eligible to enroll as REHs under Medicare if they meet certain criteria. If you're considering converting a rural hospital or Critical Access Hospital to an REH, you can submit your application . You can also learn more about becoming an REH Medicare provider . REHs will be paid under the Medicare Outpatient Prospective Payment System payment rates, plus 5.0%. CMS will also include a fixed monthly payment, based on the excess of the total amount paid to all CAHs in 2019 over the estimated total amount that would have been paid to CAHs in 2019 if payment were made for inpatient, outpatient and skilled nursing facility services under the PPS. In the future, the monthly payment will be based on 2023 data, increase

Achieving Patient-Centered Medical Home recognition sets your practice apart from others as you focus on the quadruple aim: continual improvement of outcomes, decreased expenditures and increased patient and staff satisfaction. PCMH adopts repeatable processes, policies, communication, documentation and reporting, which is ─ the backbone of value-based incentive programs and payer initiatives nationwide. Using a team approach to best understand patient populations and meet patients where they are leads to more equitable healthcare across all patient populations. To keep the benefits of PCMH recognition, practices must keep their medical homes current and sustain the program from year to year. Sites must demonstrate in Q-PASS (the National Committee for Quality Assurance’s web-based evaluation tool) that their medical home workflows are in place by their stated reporting date. NCQA updated the PCMH standards, guidelines and annual reporting requirements for 2023. Standards and Guideline

The last three years have forced health systems to realign services; first, to address the demands of COVID-19 and later to meet pent-up demand for care, all while addressing community health needs, competitive positioning and right-sizing of services. With the pandemic as a catalyst, today's healthcare market is increasingly influenced by new business models aimed at delivering superior healthcare experiences. Healthcare is seeing a rapid shift to consumer-centric care models — fundamentally changing how healthcare systems compete for market share and revenue.  Is your health system constantly asking: Are there service lines that we should add or remove? Are there physician groups that we should align with? Are there hospitals with which we should align? Should we add a new facility or program based on the shift of procedures to outpatient? Strategic planning is vital for revenue growth. But what do you need to know to get there? To truly understand and move your market position,