In April, we wrote about the updated New York state Section 1115 Medicaid Redesign Team (MRT) Waiver and how it was a game changer for New York state primary care practices.   Almost a year later, we have updates to share so you can drive meaningful change for your practice — while solving some of the biggest pain points in primary care. Keep reading for key summaries or to check out our complete New York 1115 Medicaid Waiver white paper that includes:    an essential summary of the 1115 Medicaid Waiver;  enhanced payment overview;  anticipated challenges and how to navigate them;  next steps for practices with or without NCQA Patient-Centered Medical Home (PCMH) status; and  how DataGen can help you achieve and retain NCQA PCMH status.  [Access it here] New York 1115 Medicaid Wavier updated summary  Primary care practices in New York state have an unprecedented opportunity to boost their revenue, improve care quality and strength...

Why hospitals and providers should leverage episodes of care data before TEAM begins  As CMS continues to advance value-based care initiatives, including the Transforming Episodes Accountability Model (TEAM) , hospitals and health systems face increasing pressure to adapt to episodic payment models. To help overcome this pressure, opportunity analysis, which includes simulated TEAM episodes of care, provides a low-risk, data-driven way to prepare for these changes in payment policy and care delivery before TEAM’s formal implementation.  In this blog, we’ll explain why integrating simulated episodes of care into your strategic planning can set your organization up for success under the CMS TEAM model. We’ll also cover the basics of episodes of care and how DataGen helps providers nationwide to access bundled payment opportunity analyses to better understand the expected impact of TEAM, reduce risk and drive improvement.  What are simulated TEAM episodes of care? ...

The pursuit of health equity in the United States has become more critical as healthcare disparities continue to affect millions of Americans. Socioeconomic status and access to healthcare services are pivotal in determining health outcomes, leaving underserved populations at a disadvantage. To address these issues, the Centers for Medicare and Medicaid Services (CMS) introduced changes in the Medicare Value-Based Purchasing (VBP) Program to incentivize quality care for all.  In this blog, we provide an update, discuss recent data and analyze the national impact. Read on for our interpretation of the CMS VBP Program and how it aims to advance health equity.   Understanding the Hospital VBP Program  The Hospital VBP Program aims to reward acute care hospitals with incentive payments based on their quality of care. This initiative ties a portion of Medicare payments to performance on quality measures, putting 2.0% of a hospital's base operating IPPS revenue at risk. CM...

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), has finalized a mandatory six-year model called the Increasing Organ Transplant Access (IOTA) Model .   This model,  finalized by the Biden-Harris administration,  is designed to address critical challenges in the nation’s kidney transplant system and significantly improve access to kidney transplants.  IOTA Model background  CMS has implemented various initiatives to improve care for patients living with kidney disease and address access to kidney transplantation. The IOTA Model builds on these efforts, enhancing organ availability and providing better education for patients, their families and caregivers.   The model aligns with previous CMS initiatives like the ESRD Treatment Choices (ETC) Model, launched in 2021, which emphasizes the use of home dialysis and increased access to kidney transplantation to improve the quality of...

As healthcare providers, understanding the specific health needs of the communities we serve has never been more important. A comprehensive Community Health Needs Assessment (CHNA) is an invaluable tool that enables healthcare organizations to evaluate the health priorities of a region, make data-driven decisions and ultimately offer more effective, equitable care.  What is a Community Health Needs Assessment?  A CHNA is a structured process in which healthcare organizations collect and analyze information about community health status, resources and needs. It’s an essential step for any healthcare provider committed to delivering patient-centered care that addresses acute and chronic health conditions and proactively supports community wellness. Learn how to get started with a CHNA.   The value of a comprehensive approach  Unlike basic health assessments, a comprehensive CHNA goes deeper, gathering extensive data on social determinants of health, demographic trends,...

How does a CHA improve health equity in communities and beyond?   As county and municipal public health departments strive to understand and meet the unique needs of their populations, Community Health Assessments (CHAs) have become essential tools in guiding effective, data-driven healthcare. More than just a data collection effort, CHAs are pivotal in shaping public health priorities, addressing inequities and building lasting improvements in health outcomes across communities.   This blog explores what CHAs are, the frequently asked questions around them and the transformative impact they have on healthcare systems and the communities they serve.   What is a Community Health Assessment (CHA)?  Defining CHA   The Centers for Disease Control and Prevention (CDC) defines a Community Health Assessment (CHA) as a "state, tribal, local, or territorial health assessment that identifies key health needs and issues through systematic, comprehensiv...

Coding outpatient visits might sound straightforward, but when it comes to Statewide Planning and Research Cooperative System (SPARCS) submissions, even minor errors can lead to major complications.   SPARCS plays a critical role in New York state’s healthcare system by collecting data that impact health policies, funding allocations and quality improvement initiatives across the state. However, with the constant evolution of guidelines and the high volume of outpatient encounters, healthcare providers face unique challenges to ensure compliance and data accuracy.  Keep reading to get a better sense of what’s needed to improve outpatient visit coding processes across various your organization.  Main SPARCS challenges surrounding outpatient visits  1. Record nuances  For SPARCS data managers, one of the biggest challenges lies in translating the nuances of outpatient visits into compliant, accurate codes. Outpatient visits often include routine care, which ...

On Nov. 25, the Centers for Medicare and Medicaid Services (CMS) released Performance Year (PY) 2022 evaluation findings for the Kidney Care Choices (KCC) voluntary model. The evaluation of the first performance year revealed mixed outcomes.  Kidney Care Choices model evaluation findings for PY 2022  Participation: 30% of Medicare fee-for-service beneficiaries with chronic kidney disease or end-stage renal disease eligible for the model are aligned with a KCC participating entity.    Encouraging trends: CMS reported , “The KCF model option increased the proportion of patients with ESRD dialyzing at home (20%). Home dialysis training increased in CKCC (32%). Both model options increased peritoneal dialysis, the primary modality for home dialysis (KCF: 26% and CKCC: 8%).”  Stable measures: Most quality measures showed no significant changes.  Financial outcomes: There was no measurable impact on overall Medicare costs, savings or losses.  The road a...

Third quarter 2024 Statewide Planning and Research Cooperative System (SPARCS) data submissions are due. In addition, the third final warning and Statement of Deficiency issue date for Q2 2024 is here. Keep reading for key dates that hospitals, ambulatory surgery centers and health systems need to know to remain SPARCS compliant.  [Download our quarterly calendar here]   Key compliance dates for SPARCS data: Q2 and Q3 2024  Q2 2024 SPARCS compliance deadlines  Dec. 15  Final third warning for Q2 2024 data   Hospitals that have not resolved their Q2 2024 data errors after receiving three warnings will be issued an SOD.   Jan. 15  SOD issued for Q2 2024 data   Hospitals will be issued an SOD.  Q3 2024 SPARCS compliance deadlines   Dec. 31  Submission deadline for Q3 2024 data   The deadline for submitting Q3 2024 SPARCS data falls on this date. Ensure your data are accurate and submitted on time to avoid penalties....