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, ...

New trends and change agents are increasingly challenging health systems’ volume and revenue growth. To compete and stay relevant, they must take a more balanced approach to their near-, mid-and long-term growth. DataGen and Sg2 recently joined forces to host  Optimizing strategic planning for revenue growth: DataGen and Sg2 resources. This webinar featured customers' experiences using Sg2's suite of analytical tools and how, when partnered with DataGen's customized customer service and training, these tools helped their organization optimize its strategic planning for enhanced revenue growth.  We broke down five common questions asked during the session. 1.       What disruptors are you keeping an eye on?  We are keeping an eye on four major disruptors: Retail clinics, big tech/digital, VC-backed medical groups and payers as providers.  2.       What downstream effects have these disruptors had on inpatient...

Z codes that document patients' non-medical needs are rarely used and often misunderstood. Yet they’re vital to address social determinants of health, which are responsible for 80% of a person's health outcomes. New developments make it easier to incorporate Z codes into an organization’s health equity strategy. These include patient e-screening, leveraging an enhanced Community Health Needs Assessment, use of robust social risk intelligence data and new efficiencies that capture insights from these sources and make them actionable. By using a combination of "push and pull" strategies, health systems can start these efforts now. But first, a brief introduction to Z codes and why they're important. What are Z codes and why are they important? Z codes are a subset of ICD-10-CM diagnostic codes to document a person's SDOH, defined by Healthy People 2030 as "the conditions in the environments where people are born, live, learn, work, play, worship and age th...

CMS recently made several major announcements about the Bundled Payments for Care Improvement Advanced Model.  The model, which was due to expire at the end of 2023 (Model Year 6), will be extended for an additional two years through Dec. 31, 2025.  New applications will be accepted in 2023 for the two-year extension. Participants still active in Model Year 6 can continue without reapplying by signing an amended and restated participation agreement for Model Year 7.  New methodological changes will be implemented for Model Year 6, which starts on Jan. 1, 2023. Methodological changes include that: the CMS Discount Factor for medical clinical episodes will be reduced from 3% to 2%;  the Peer Group Trend Factor Adjustment cap for all clinical episodes will be reduced from 10% to 5%; the Major Joint Replacement of the Upper Extremity clinical episode category will become a multi-setting episode category by allowing episodes to be triggered when the procedure is performed...

The good news: The Medicare Shared Savings Program (MSSP) has reported a fifth consecutive year of savings while delivering high-quality care for Medicare beneficiaries in accountable care organizations (ACOs). The tricky news: With participation dropping since performance year 2018, ACOs will need places to pivot as success becomes more dependent on risk progression, benchmarking and equity goals. The 2021 MSSP results CMS reported the following highlights from the 2021 MSSP performance year : 99% of participants met the quality targets required for shared savings; 58% earned shared savings; ACOs outperformed non-MSSP providers in metrics related to diabetes, blood pressure, select cancers, fall risk, flu vaccination, tobacco screening and smoking cessation, and screening/remission for depression. ACOs with specific characteristics saved more than their counterparts. This includes ACOs labeled low revenue and those dominated by primary care providers. For example, low-revenue ACOs sa...