Healthcare providers face difficult choices that can pit their number one priority ─ care quality ─ against the need to reduce costs and increase efficiency. Healthcare providers can achieve all of these goals using data analytics. An analytics-first strategy enables hospitals, health systems and state hospital associations to make data-informed decisions, not best guesses. This proactive approach can illuminate trends and provide real-time insights that are often hidden or seen too late to change outcomes. Data from your Medicare quality programs tell a compelling story, 24 hours a day, 365 days a year. DataGen uses Medicare impact modeling, expert analysis and visualizations to reveal data-informed narratives about your performance on three CMS programs: Value-Based Purchasing (VBP); Readmission Reduction Program (RRP); and Hospital-Acquired Conditions (HAC) Reduction Program. Do you know your organization’s stories? The biggest and best tool in your healthcare management toolkit: ...

Doing something the way you’ve always done it gets you the results you’ve always gotten. When it comes to the Agency for Healthcare Research and Quality’s Survey on Patient Safety Culture™ (SOPS®), is that enough? Not in today’s competitive, post-COVID-19 market. Your SOPS® scores matter far beyond basic compliance with The Joint Commission and other accrediting organizations. With the public’s growing awareness of patient safety issues, an unfavorable reputational impact can quickly spread across the patient and provider community. Here are five secrets designed to help you get better SOPS® insights, improve your scores and transform your organization 1.  Start by asking yourself three few simple, direct questions What is your current SOPS® response rate? Is it near the minimum required response of 60%? Has your hospital’s rate stayed in the same stubborn response range for multiple survey cycles? 2. “One and done” will get you nowhere Results are only worthwhile if your staff can...

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. Primary Care First (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 Primar...

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, ca...

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 chroni...

The Bundled Payment for Care Improvement (BPCI) Advanced Model is now open 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 orde...

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...