On Nov. 2, CMS finalized the calendar year 2024 Medicare Outpatient Prospective Payment System final rule . The 2024 OPPS final rule includes policies that will: add 10 services to the Inpatient Only list; establish an intensive outpatient program; expand the partial hospitalization program rate structure; update payment rates and policies for ambulatory surgical centers; update the requirements for the Hospital Outpatient Quality Reporting Program; outline quality program requirements for Rural Emergency Hospitals; and standardize the reporting of standard chart data using a CMS template. Read on to learn essential OPPS final rule information, important details and dates. We’ll also reveal how you can register for DataGen’s upcoming client exclusive OPPS rule analysis webinar . 4 key CMS 2024 OPPS final rule components 1. Expanded and updated rates CMS estimates a 2.1% rate increase for CY 2024, which represents a $6 billion increase in outpatient payments compared to the CY 2023 OPPS...

Six years after its launch, CMS’ Oncology Care Model ended on June 30, 2022. Oncology practices that participated and stayed through the entirety of the program had clinical buy-in for the delivery of value-based care for cancer patients. However, despite CMS’ desire for a replacement model to continue OCM’s practice transformation, its Enhancing Oncology Model didn’t attract critical mass. At this point, you may be asking yourself, “What happened to all the practices that participated in OCM? Why didn’t they choose to continue?” In this blog, DataGen will answer those questions with three observations about EOM. Observation #1: Failure to meaningfully incorporate clinical adjustments CMS failed to incorporate clinical adjustments into EOM’s target price methodology in a meaningful way, beyond what was demonstrated in the final performance periods of OCM . Instead of factoring clinical data elements into the underlying cancer-specific regression models, EOM continues to incorporate a ...

Tackling Statewide Planning and Research Cooperative System data is a large lift for New York state Article 28 hospitals and ambulatory surgery centers. This can be even more challenging when the state updates or adds SPARCS requirements and adjusts timeframes. In this blog, we’ll outline three SPARCS submission deadlines you need to know. Plus, we’ll cover how the Department of Health addresses statements of deficiency and what it could mean if your facility receives one. 2023 SPARCS data submission compliance deadlines As New York hospitals and ambulatory surgery centers know well, DOH requires SPARCS data submission for its comprehensive all-payer data reporting system. Facilities must submit 100% of required clinical, billing, admission, discharge and transfer data with 100% accuracy, on a quarterly basis and by a set date. 1. Quarter 1 2023 data Facilities that haven’t submitted their first quarter 2023 SPARCS data began receiving statements of deficiency last month. (See the “Wh...

Are you a primary care practice that’s considering joining the Making Care Primary model? If so, you may have concerns about the experience needed to participate in a value-based care model. In this blog post, we’ll explore whether VBC experience is a requirement to apply for MCP and what benefits you can expect from the program, regardless of your experience level. Is value-based care experience required for MCP? Primary care providers don’t need VBC experience to apply for MCP. However, since MCP is a multi-state initiative , you do need to be located in one of the following states: Colorado; Massachusetts; Minnesota; New Jersey; New Mexico; New York; North Carolina; or Washington. Note, in New York only upstate counties are included under the model. See Appendix D in the Making Care Primary Request for Applications for more information.  Is there an advantage for practices with little to no VBC experience? One of the key benefits of the model is that primary care providers who...

As of June 22, 2023, New York state hospitals and ambulatory surgery centers are among the New York Article 28 facilities that must file Health Equity Impact Assessment documentation when submitting a Certificate of Need application. The goal of this change is to “provide information on whether a proposed project impacts the delivery of or access to services for the service area, particularly medically underserved groups,” according to the New York State Department of Health . To help you better understand the CON HEIA requirement and its impact, we put together five fast facts to get you up to speed and ready to tackle the new requirement. Multiple facilities are subject to the new requirement Under the new requirement, the following New York state Article 28 facilities must complete an HEIA requirement criteria form to determine whether they are subject to the new equity assessment: hospitals; ambulatory surgery centers; nursing homes; select diagnostic and treatment centers; and mi...

The Making Care Primary model presents a unique new opportunity for practices to deliver advanced primary care over 10.5 years. As a primary care provider, you may be wondering whether you should take on the risk and how you’ll manage the program requirements, especially if you’ve never participated in a value-based care model before. In this blog, we’ll cover four noteworthy model benefits you may not have considered. These model design elements aim to reduce historic participation barriers and provide an on-ramp for primary care practices to transition to value-based care.   Benefit #1: New structure that encourages participation Unlike other alternative payment models, MCP aims to reduce financial exposure and some of the upfront infrastructure challenges for primary care practices with no or limited value-based care experience. CMS created these flexibilities to encourage more primary care clinicians to participate, especially small, independent, rural and safety net organizat...

In the last three years, market disrupters in healthcare have increased their activity and deepened their presence. Although they bring about change, not all market disrupters are negative. Using the strategies discussed in Market Disruption: Threat or Opportunity , we’ll walk you through nine tactics to help you leverage disrupters. What are market disrupters? Market disrupters are defined as any person, product or idea that radically and permanently changes the way an industry operates, according to Western Governors University . Healthcare market disrupters use multiple strategies to address challenges like physician burnout, patient satisfaction and electronic health record shortcomings. While not all disrupter solutions succeed, new care models and technology-enabled value-based care platforms have gained traction. Currently, hospitals and health systems are tailoring their strategies to reflect: disrupters’ prime targets; current service strength and diversity; and local market d...