Why a Third of Orthopedic Surgeons and Gynecologists are Penalized for PQRS Reporting Failure…and What They Can Do Written by web_developers on July 13, 2017. Posted in Manage, Orthopedics. How PQRS Solutions Such as Patient Management Software Can Help Reclaim Lost 2% Payment Adjustments for Medicare/Medicaid Reimbursements If your hospital or clinic offers orthopedic surgery or gynecology and participates in Medicare or Medicaid, it’s likely that you already are aware of harsh fact: Failure to properly submit Physician Quality Reporting System (known more simply as PQRS) reports results in a two percent reduction of reimbursements. What you may not know is more than a third of participating orthopedic surgery and gynecology practices take advantage of PQRS reporting, according to a report released by the Centers for Medicare & Medicaid Services, 2015 Reporting Experience: Including Trends (2007-2015) Physician Quality Reporting System 2017. What is PQRS Reporting? The PQRS reporting program is the primary means by which CMS is implementing value-based purchasing (VBP), designed to reward quality over quantity when providing compensation for services provided for Medicaid or Medicare patients. Scheduled to sunset in 2018, the PQRS program measures quality via reported medical measures taken by qualifying physicians. Initially created with 74 reportable measures, the number of reportable measures and means by which a physician can report them has increased yearly based on participant feedback. As of 2015, there were 253 measures that could be reported to the system. Beginning in 2015, the PQRS program was also used to determine whether physicians receiving funds would be subject to a payment adjustment: a penalty of two percent. Physicians that did not participate in the program—or failed to report the required number and percentage of measures—were subject to the adjustment. Although the PQRS program is sunsetting in 2018, the focus on VBP is continuing. The PQRS program is being replaced by the Merit-based Incentive Payment System (MIPS), which retains many of the features that were present in PQRS, while also implementing a volume threshold. PQRS Reporting Failure PQRS reporting failure was, by far, the most common reason that physicians were subject to the payment adjustment in 2015. Of those that did report, reporting via electronic health records (EHR) resulted in the fewest percentage of payment adjustments, with only four percent receiving adjustments via that reporting method. This finding by CMS is in line with one of the primary goals of PQRS and MIPS: to increase the use of EHR by physicians to provide higher quality care for patients. According to the CMS report, this type of reporting was uncommon, with the highest percentage of use coming from: • Ophthalmologists (25.4%) • Orthopedic surgeons (11.5%) • Gynecologists (11.3%) While the initial report only covered 2007–2015, some additional statistics were provided for 2017 in the final release of the report. The most important statistic is the percentage of physicians subject to the penalty due to failing to satisfactorily report measures taken, broken down by specialty, which included: • Orthopedic surgeons (32.4%) • Gynecologists (36.8%) Both numbers represent a slight decrease from 2015, but still mean roughly a third of physicians in these specialties are being penalized. PQRS Solutions The fact that PQRS reporting methods correlate significantly with being subject to the penalty suggests it isn’t the standard of care lacking among most physicians being penalized, but rather that administrative abilities are lacking. That is a dilemma that can be solved in part with healthcare management systems and other healthcare IT PQRS solutions. The first step, if not already taken, is clearly to use EHR in daily practice. Use of EHR is both a factor in determining whether a practice or individual should be penalized and is strongly correlated with better quality of care for patients. The next step to improving the quality of reports is improving patient management. Streamlined administrative procedures will result both in better outcomes for patients and in reported measures that are more likely to pass muster. Professional Patient Management Once MIPS becomes the dominant program in 2018, every practice will need to provide quality care, have strong administrative practices, use EHR, and serve large numbers of patients. Although quality of care is entirely the responsibility of the physician, those other factors require professional administrative experience. It is a task that is simply beyond a single physician or administrative assistant. It is a task that requires a highly experienced team of professionals using patient engagement technology, like the Sequence healthcare SaaS (software as a solution). The best way to satisfy MIPs and avoid the penalty is to use the services of a patient management platform. A good patient management platform assists with all administrative functions, including patient acquisition and patient retention. This platform becomes an extension of the administrative staff of the practice, answering questions, verifying insurance, and providing reminders throughout the care of patients. Overall, this service eases the administrative burdens on physicians allowing them to provide higher quality care to a larger pool of patients, both of which will be essential requirements to avoiding the penalty starting in 2018. Good PQRS Reporting Requires Modernizing The conclusion of the CMS report is clear: Familiarity with the PQRS reporting system offers slight benefits, but modernizing offers the best benefits. Physicians that use electronic health records and incorporate outside administrative assistance are vastly more likely to avoid the penalty than those that don’t, because those physicians are providing higher quality care to their patients. And since the costs involved in modernizing are almost always countered by an increased patient base, there is little reason not to modernize. As Sequence Health’s Central/Western Regional Director, Chris Stearns is not only one of our healthcare IT experts, but he also provides specialized focus on Orthopedic Surgery and Women’s Health. Sequence Health is a cloud-based technology and services company that improves profitability and patient outcomes for hospitals and practices through end-to-end patient engagement solutions backed by clinical and non-clinical teams. Its HIPAA-compliant, SaaS platform improves care team workflows, automates patient communication and tracks patient progress to optimize the patient journey. Since 2004, leading healthcare providers have trusted Sequence Health to help acquire, manage and engage patients through complex episodes of care.
How Your Orthopedic Clinic, Hospital or Surgery Center Can Support Juvenile Arthritis Month Written by web_developers on July 6, 2017. Posted in Orthopedics. The painful and frustrating condition of arthritis is often associated with the elderly, however, it affects people of all ages—including children ages 16 and younger. And although arthritis treatment is most often associated with rheumatology, orthopedic surgery is one of several solutions for arthritis. Since orthopedic surgery is one of the specialties for which our patient management platform is tailored, we want to encourage you to support Juvenile Arthritis Month in July 2017 and expand awareness about your orthopedic clinic, hospital or surgery center, especially if it offers juvenile arthritis surgical treatments. Linking Orthopedic Surgery With Juvenile Arthritis (JA) According to the Arthritis Foundation, juvenile arthritis (JA) is not a disease, but instead, “an umbrella term used to describe the many autoimmune and inflammatory conditions or pediatric rheumatic diseases that can develop in children under the age of 16,” including an estimated 300,000 children in the United States alone. The Arthritis Foundation also explains how there are multiple types of orthopedic surgery solutions for arthritis, which include: • Arthroscopy • Joint Resurfacing • Osteotomy • Synovectomy • Arthrodesis, or Fusion • Total Joint Replacement (TJR), or Total Joint Arthroplasty • Minimally Invasive TJR • Joint Revision Therefore, if your orthopedic surgery center offers one of these joint procedures, you probably have already treated patients with juvenile arthritis, which perfectly positions you to explore opportunities to support Juvenile Arthritis Month while also increasing your orthopedic patient acquisitions. Share Your Patients’ Positive JA Orthopedic Surgery Outcomes Candidates for orthopedic surgery and their families are always eager to find both hope and confidence in their orthopedic clinic, which means they will likely turn to the Internet to find answers. As such, your Website is a superb way to share how your orthopedic clinic’s patients had positive results and outcomes. Testimonials—written or video—are the natural place to start, especially if they can support your orthopedic surgery center’s mission and vision statements for providing high standards of compassionate care. Better yet, case studies that deliver more in-depth exploration and validation of your juvenile arthritis orthopedic surgery outcomes is an excellent way to present your orthopedic surgery center as a viable and trusted solution. Go On the Record—and Beyond—as a Juvenile Arthritis Monthly Advocate Publishing a news release that explicitly states your orthopedic surgery center’s advocacy for Juvenile Arthritis Month is a solid first step in publicly stating your support. But don’t stop there! If your orthopedic surgery center or its surgeons, doctors and nurses are members of organizations that also advocate for JA, consider reaching out to those groups to ask for their support and to offer yours. This is particularly true if you can make a donation! Use Social Media Along with using social media to share and find useful information related to Juvenile Arthritis Month (including trending hashtags like #StrongerThanJA and #KidsGetArthritisToo), it’s also an excellent opportunity to expand your orthopedic hospital’s social networking. For instance, if you don’t already, here are some worthy Twitter accounts you might want to follow: • @ArthritisFdn, the official Twitter page for the Arthritis Foundation • @JAAssn, the official Twitter page for the Juvenile Arthritis Association Sequence Health proudly supports Juvenile Arthritis Month. Sequence Health is a cloud-based technology and services company that improves profitability and patient outcomes for hospitals and practices through end-to-end patient engagement solutions backed by clinical and non-clinical teams. Its HIPAA-compliant, SaaS platform improves care team workflows, automates patient communication and tracks patient progress to optimize the patient journey. Since 2004, leading healthcare providers have trusted Sequence Health to help acquire, manage and engage patients through complex episodes of care.
How to Get More CJR and Orthopedic Surgery Patients with the Right Strategies and Tools Written by web_developers on June 23, 2017. Posted in Manage, Orthopedics. There is no shortage of statistics that explain the indisputable fact that CJR and orthopedic surgery patients are increasingly turning to online resources to find the best orthopedic hospitals and doctors. However, although there is no single online strategy that best addresses how to get more orthopedic patients. For that matter, that includes “traditional” marketing strategies—printed advertisements and collateral, for example—when seeking answers about how to get new orthopedic surgery patients. One of the best pieces of advice for how to get more orthopedic surgery patients was mentioned in Becker’s Healthcare article, “8 Tips to Develop Orthopedic & Spine ASC Marketing Strategies With High ROI.” We couldn’t agree more with this sentiment: “Use several different marketing tactics to reach your target audience.” Yes, that may seem to oversimplify the solution for improving orthopedic patient acquisition rates. However, with the countless ways available to promote your orthopedic surgery center and engage with new patients, it is often too easy to arbitrarily choose a set without actually developing an honest to goodness strategy that is both effective and efficient. Rather than treating them as autonomous activities in hopes of just finding new orthopedic patient leads, it is better to corral them into an integrated system explicitly designed to guide them through the so-called “sales funnel.” So, in that context, which is the best way to do this? [poll id=”12″] Components of an Integrated Orthopedic Surgery Patient Acquisition Strategy One of the easiest and free ways to begin the process of developing an integrated orthopedic surgery patient acquisition strategy is to look at Websites for patient management companies like Sequence Health that specialize in orthopedic surgery patient management platforms. For instance, on our Website, our patient management platform is divided into three core categories: • Patient Acquisition • Patient Management • Patient Retention Our Patient Acquisition section is essentially a checklist of tactics your online orthopedic marketing strategy should be using: • Website Design & Development • Search Engine Optimization (SEO) • Pay Per Click (PPC) and Paid Search • Video Production • Online Education • Electronic Forms • Re-Engagement Campaigns Of course, there are many others not in that list. For example, we recently wrote about a new breed of medical SEO for virtual personal assistants, and of course, constantly evolving trends in social media healthcare marketing are important too. However, there is good reason that the outlined tactics are the perennial featured components of our premium patient management platform, and why it’s valid to suggest they are essential components of any orthopedic patient acquisition strategy. The Importance of Having the Right Tools for Getting More Orthopedic Patients Another point the aforementioned Becker’s article makes is one for which we also completely agree: “Executing a true marketing strategy means building a marketing team and using several different tactics to reach patients.” The emphasis is on “building a marketing team,” which doesn’t need to only use people from your marketing department. Similar to the notion that finding out how to get more orthopedic surgery patients involves exploring multiple tactics, it should also involve multiple resources for building and executing your strategy. Who else in your orthopedic surgery center has a unique or different perspective about what differentiates you from other centers? Who else disseminates (or can disseminate) your messages—perhaps on the phone or with handing out printed materials or on social media? For that matter, this introduces the value of third-party resources, which includes anything from our Sequence patient management platform to outbound healthcare call centers to contract content creators. But the bottom line is there are an abundance of new orthopedic surgery patients that are looking for the best solutions…and there are ways for them to find you and vice versa. The challenge is to do it in a way to optimizes your resources and maximizes your ROI. John Richmond is Sequence Health’s CEO. Sequence Health is a cloud-based technology and services company that improves profitability and patient outcomes for hospitals and practices through end-to-end patient engagement solutions backed by clinical and non-clinical teams. Its HIPAA-compliant, SaaS platform improves care team workflows, automates patient communication and tracks patient progress to optimize the patient journey. Since 2004, leading healthcare providers have trusted Sequence Health to help acquire, manage and engage patients through complex episodes of care.
What’s Up With CMS’ Cardiac and CJR Bundled Payment Delays? Written by web_developers on March 22, 2017. Posted in Orthopedics. An Overview of Facts and Opinions About CMS Delays for Cardiac and CJR Bundled Payments from Leading Healthcare Voices Yesterday, healthcare news and blog outlets were virtually tripping over each other to announce the Centers for Medicare & Medicaid Services’ decision to delay two bundled payment program deadlines. CMS’ first delay relates to Cardiac Care. In short, CMS changed the original July 1, 2017 effective date for mandatory bundled payment programs for heart attacks and bypass surgeries to October 1, 2017. [poll id=”3″] The second relates to Comprehensive Care for Joint Replacement, a topic that we’ve been discussing for months—including a recent blog, “Bundled Payments and CJR Among Key Topics of Interest at ACPM’s 2017 Orthopedic Value Based Care Conference.” CMS is delaying the expansion of the CJR bundled payment program from the original July 1, 2017 date to October 1, 2017. If that explains the “what” and “when” factual reasons for the delay, what about “why”? CMS’ announcement explains it is to: • Extend review time • Potentially modify the policy • Ensure participants understand the policy However, there is much more being said about the delays, especially from the aforementioned healthcare news and blog outlets that have cast some compelling analyses. For instance, Healthcare DIVE.com speculated “the recently released interim rule casts doubt on the future of bundled payment initiatives,” even after President Donald Trump’s February 2017 executive order to delay the new rules. The reason for the sudden doubt is that, according to the American Journal of Managed Care: “…even if the coverage elements of the Affordable Care Act (ACA) are repealed, payment reform would move forward under the Trump administration, in part because Republicans voted overwhelming with Democrats for the Medicare Access and CHIP Reauthorization Act (MACRA).” The delays are also possibly having real-time impacts for healthcare providers not expecting delays, much less potential rollback of the programs. As Managed Health Care Connect.com suggested: “Although CMS originally envisioned the bundled-payment programs would help clinicians accrue incentives under the Alternative Payment Model, delays may have implications for providers who were hoping to use the bundled payment models during their MACRA verification.” In sum, the confusion about the health of current and proposed CMS programs—especially those closely tied to the Affordable Care Act—is and was to be expected, which we touched in at the beginning of the year in our blog, “How Might Repealing Obamacare Affect Medicare Reimbursements?.” And, as stated in that blog, the best advice is perhaps to “do what you can now to ensure the best outcomes for your Medicare patients, which can be improved with a reliable and efficient patient management system.” Derek Rudnak is a freelance healthcare marketing content creator that frequently contributes exclusive blogs to Sequence Health.
Three Key Metrics To Control Post-Acute Care Costs And Optimize CJR Reimbursements Written by web_developers on January 27, 2017. Posted in Orthopedics. After spending last weekend with a group of clinicians, administrators and healthcare executives at the Interdisciplinary Conference on Orthopedic Value-Based Care, one thing is clear: Bundled payments implemented by Medicare’s Comprehensive Joint Replacement program are shaking up the foundation of how every stakeholder must address joint replacement therapy. The Comprehensive Joint Replacement Program represents much more than reimbursement reform — value-based care is transforming how healthcare is delivered, leaving many wondering how to best position themselves to maximize revenue and mitigate risk. With so many stakeholders involved, it seems extremely complicated to identify and manage the drivers of expenses that CJR seeks to control. The first step to a sound bundled payment strategy begins with an examination of current processes and realignment to create a multi-disciplinary and team-based system of coordinated care that is centered around the patient. Then, the data shows that most of the variation in episode costs, and thus the opportunity for improvement, can be tracked to post-acute care (PAC) utilization. Optimizing this portion of the episode is a key focal point for hospitals operating under CJR regulations, and tracking metrics associated with this recovery period is core to any successful CJR strategy. There are three important metrics related to PAC that should be analyzed to help identify and eliminate the barriers to maintaining healthy margins when subject to bundled payments for joint replacements. Percentage of patients discharged directly to their homes – It’s fairly obvious that patients discharged to private homes cost much less than those that require institutional post-acute care, so tracking that data is imperative. As a rule of thumb, hospitals that discharge 50 percent or more of joint replacement patients to their homes are healthy programs. Increasing this metric over time will require coordination with all stakeholders. Dashboards are effective tools to tracking this important driver of success. Length of stay in institutional facilities – PAC spending accounts for 44 percent of total episode costs for knee replacements, and length of stay in skilled nursing facilities (SNF) is the largest driver of that cost. Tracking this metric in the aggregate is important, but also examine average length of stay by facility, particularly for your largest volume SNF’s, and look for variations. This data will help you make informed decisions about your network and engage with your partners to reduce unnecessary costs. Hospital readmission rates – Hospital readmission rates vary considerably among diagnoses, and knee replacement surgery is fortunate to enjoy low rates with an average of only 7 percent. Targeting a readmission rate of 5 percent or less is a worthy goal. However, you need to also examine the costs of your readmissions, which is available in the data the Centers for Medicare & Medicaid Services provide to CJR hospitals. It is possible to have a low readmission rate, but high readmission costs due to catastrophic readmissions. Parsing the data on readmission rates and costs will help pinpoint issues that you can then go tackle. With the five year long trial of Comprehensive Joint Replacement Program bundled payments not even a year old and uncertainty surrounding the future of healthcare policy with the newly elected administration, many healthcare providers have not begun learning how to best comply with these changes. As of now, CMS remains committed to using alternative payments for 50 percent of all Medicare reimbursement by next year, and most hospital leaders believe value-based care is here to stay. It makes sense to begin planning for this eventuality because it involves redesigning processes and care delivery, and results in better outcomes and a better patient experience. At Sequence Health, we believe that simple low-cost technology solutions that provide real-time insight into how patients are recovering from surgery are beneficial to all healthcare providers, whether they are working within CJR requirements or simply dedicated to providing the highest quality care and reducing expenses. Let us show you how you can increase patient satisfaction, lower costs, and position for value-based care changes associated with Comprehensive Joint Replacement program.
Bundled Payments and CJR Among Key Topics of Interest at ACPM’s 2017 Orthopedic Value Based Care Conference Written by web_developers on January 17, 2017. Posted in Company Overview, Orthopedics. This week, Sequence Health founder Rich Rosenzweig and I will be making a cross-country journey to the West Coast to represent Sequence Health as an exhibitor at the American College of Perioperative Medicine’s Interdisciplinary Conference on Orthopedic Value Based Care in Newport Beach, California, on January 21–22. As one might expect, our primary objective as an exhibitor at healthcare conferences is to create awareness about our company and its patient management software and medical call center. However, we also attend these events for the same reasons as the healthcare professionals, which is to engage and learn. This is essential for us to have the expertise for developing our core services—the Sequence patient management platform and our medical call center—and to meet the constantly evolving needs of our customers. [tweet “We attend for the same reasons as the healthcare professionals: to engage and learn.”]. With that in mind, prior to attending these conferences, various departments within our company will examine the agendas for lectures and presentations that best relate best to our objectives. The very robust ACPM agenda—which includes three tracks, 21 speakers and 39 topic in just two days—features several highly relevant topics, especially for anybody that follows our blog and is aware of our interest in these concepts. Top Bundled Payments Topics Our Director of Marketing and Creative Kris Altiere is eager for us to learn more about bundled payments, which was recently discussed in our blog, BPCI Initiative Year 2 Lessons Learned. Kris identified four excellent bundled payments topics that will be explored at ACPM: • The Bundle Payment Health Care Environment, Recent, Current, Future (Kevin J. Bozic, MD, MBA | Saturday, Jan. 21 from 8–8.40 a.m.) • Perioperative Surgical Home & Enhanced Recovery in the World of MACRA/MIPS & Value Care World (Zeev Kain, M.D., MBA | Saturday, Jan. 21 from 8.40–9.20 a.m.) • Understanding Post-Acute Care in the World of Bundling (Kelly C. Price | Sunday, Jan. 22 from 8.45–9.30 a.m.) • Bundle Payment: The Orthopedic Surgeon View (James D. Slover, MD, MS | Sunday, Jan. 22 from 10.20–10.50 a.m.) She is particularly enthused about the last topic because of its valuable insight into how orthopedic surgeons are responding to the bundled payments model. [tweet “Valuable insight into how orthopedic surgeons are responding to the bundled payments model.”] Top CJR Topics Comprehensive joint replacement (CJR) has become a focus of interest for us we are routinely fine-tuning the Sequence platform for orthopedic hospitals and clinics so that they can improve outcomes and reduce costs. In fact, we also recently wrote a blog that discussed this very concept, How are MACRA and CJR Connected? [tweet “…for orthopedic hospitals and clinics so that they can improve outcomes and reduce costs.”] Naturally, we are keen to learn as much as we can from these four CJR topics: • Fundamentals of the CJR Rule & Coming Bundles (Kelly C. Price | Saturday, Jan. 21 from 1.45–2.15 p.m.) • Using Data to Develop CJR Strategies: 5 Steps to Take Now (Jonathan W. Pearce, CPA, FHFMA | Saturday, Jan. 21 from 1.45–2.15 p.m. • Implementing CJR: Have You Taken the Steps? (David Janiec | Saturday, Jan. 21 from 3.35–4.05 p.m.) • Performing in CJR: What to do Next (David Janiec | Sunday, Jan. 22 from 1.15–1.45 p.m.) The third topic is of particular interest because we promote our capabilities in guiding orthopedic facilities to implement CJR. John Richmond is Sequence Health’s CEO. Please let us know if you’d like to schedule some time to meet with him or Rich at ACPM’s conference to learn more about our solutions for orthopedic patien
BPCI Initiative Year 2 Lessons Learned Written by web_developers on November 29, 2016. Posted in Orthopedics. Top Results from CMS’ Bundled Payments for Care Improvement Initiative Progress Report The Centers for Medicare and Medicaid recently published CMS Bundled Payments for Care Improvement Initiative Models 2-4: Year 2 Evaluation & Monitoring Annual Report. If you have been following the recent developments of either the BPCI initiative or the Comprehensive Care for Joint Replacement mode (CJR), you are likely aware of their functions and similarities. If not, here’s a quick overview. First, the BPCI initiative is a voluntary pilot program that is testing an alternative to the traditional fee-for-service reimbursement model that pays a hospital or clinic whenever it provides treatment—regardless of outcome. Bundled payments, on the other hand, link all healthcare providers for an episode—such as hip or knee replacement surgeries that involve various treatments—and then evaluates outcomes of cost and performance. CJR was introduced earlier this year to test a new reimbursement model for Medicare hip and knee replacement surgeries. Also known as lower extremity joint replacements (LEJRs), it is one of Medicare’s most common inpatient surgeries. Both BPCI and CJR are designed to reward hospitals (or participant physician groups, in the case of BPCI) for improving care coordination and achieving cost savings aligned with a target price determined by CMS based on the participant’s historical performance. When the hospital reduces episode costs below the target price, they receive a share of the savings. If payments remain above the target price, the hospital may owe a reconciliation payment to CMS. Since the CJR program and the BPCI initiative are similar in structure and design (with 83 percent of BPCI episodes included in the CMS report identified as orthopedic episodes) there are lessons to be learned in the report and applied to organizations affected by CJR and other burgeoning bundled payment initiatives. Some top takeaways: Post-Acute Care Management is Key to BPCI Episode Spending BPCI initiative participants that saw the most reduction in episode spending were those that achieved a marked decrease in SNF (skilled nursing facility) utilization, some up to almost five percent reduction compared to baseline. BPCI Care Quality is Not Suffering The BPCI initiative has its share of critics that are justifiably concerned about its potentially negative impacts on quality. However, the orthopedic BPCI data is thus far indicating that quality outcomes have remained high for participants, with no significant changes from baseline. BPCI is Resulting in Episode Payment Savings This early data shows that almost 90 percent of BPCI participants achieved a decline in episode payments. There has been an estimated $2000 per-episode average decline in payments correlated with appropriate utilization of post-acute care facilities and decrease in length of stay, among other factors. Patient Management Proving to be Crucial BPCI Success Factor Those that are targeting patient management resources are seeing the successes outlined above. This includes: • Workflow redesign • Care coordination • Case management • Patient navigation Although there is still not a universally agreed upon set of best practices for patient management and BPCI success, the data is indicating that a combination of activities are pulling healthcare providers in the right direction, such as: • Leadership buy-in • Resource allocation • Patient-centered care teams With these lessons learned from the BPCI Year 2 Evaluation, do you have the tools you need to be successful in CJR? Contact Sequence Health to learn how you can optimize the patient care coordination process using the Sequence platform.
How are MACRA and CJR Connected? Written by SQHealth-admin on November 22, 2016. Posted in Orthopedics. Most people involved in healthcare—especially as it relates to Medicare reimbursements—are generally familiar with with MACRA (the Medicare Access and CHIP Reauthorization Act of 2015) and CJR (Comprehensive Care for Joint Replacement). However, what might they might not fully understand is how MACRA and CJR are connected. The simplest answer is that MACRA and CJR are connected by the Centers for Medicare & Medicaid’s goals for improving outcomes and reducing costs through value-based reimbursement and bundled payment models rather than the traditional fee-for-service model. A critical path for achieving this is to ensure that your hospital or clinic is prepared for better patient communication and management. However, to more fully understand the connections between MACRA and CJR—and how patient management technology fits in—it’s best to first briefly examine these concepts and what they strive to change or improve. Fee-for-Service vs. Value-Based Reimbursement Care Models More thorough examinations of fee-for-service vs. value-based reimbursement care models can be found on this blog and throughout the Internet. But most simply, the key differentiator between fee-for-service and value-based care is the difference between “quantity vs. quality,” respectively. The fee-for-service model rewards healthcare providers based how many patients and treatments a healthcare provider sees and provides (read: quantity), as where the value-based model rewards providers based on how well it treats them (read: quality)—as determined by CMS standards that include outcomes and satisfaction. What is MACRA? Enacted by the U.S. Congress in 2015, MACRA is a value-based payment system (also known as a “quality payment program”) to be associated with Medicare services. More can be learned about MACRA’s quality payment program rollout for January 2017, but one of its primary features is the introduction of two payment tracks: • Merit-Based Incentive Payment System (MIPS) • Alternative Payment Models (APMs) Another primary MACRA feature will be the replacement of three existing quality reporting systems with a streamlined, more effective alternative. What is CJR? CJR was introduced earlier this year to test a new reimbursement model that encourages and rewards efficiency and satisfaction for Medicare hip and knee replacement surgeries. Also known as as LEJR (short for “lower extremity joint replacements”), it is one of Medicare’s most common inpatient surgeries. Putting It All Together: Linking MACRA, CJR and Value-Based Care LEJR treatment and recovery requires care from a spectrum of caregivers, including hospitals and post-acute care. Rather than reimbursing each with the fee-for-service model, CJR utilizes a “bundled payment” model for each “episode”—which is designed to encourage all caregivers to work together towards the same goals for which MACRA is intended: • To reduce visit frequency and in-patient procedures • To increase satisfaction, rewards, and patient-reported outcomes Those that are prepared for the MACRA/CJR transition will be better positioned to be rewarded economically; those that aren’t may be penalized. A crucial factor for being well positioned is to have technologies and systems that can streamline patient care coordination with workflow management. Are you prepared to deliver and document value-based care to ensure you maximize your earning potential under reimbursement models that feature bundled payments? If not, contact a Sequence Health representative to learn about our CJR bundled payment program solutions.
Fee for Service vs Value Based Care in Healthcare Payment Reform Written by web_developers on September 30, 2016. Posted in Orthopedics. Payments in the medical world have long been a point of debate, especially as the cost of health care continues to rise. Fee-for-service payment structures have historically been the norm, allowing physicians and medical centers to bill for each appointment, test, and procedure performed. However, as quality of service evolves and demands for standards of care increase, so do the possibilities for payment. Lead by CMS, or Centers for Medicare and Medicaid Services, the medical culture in the United States is moving away from its roots and into a new era of value-based pricing. Deviating from traditional norms is generally a challenge, especially for hospitals whose staff and technology support fee-for-service care. However, with support from the right software platform, it’s possible to bring any medical facility into the new horizon of patient-focused care. Fee-for-Service In the wide world of medical payments, fee-for-service has been the standard throughout much of the modern world of medicine. Under this systems, billing and payments are determined based on the procedures performed by a doctor as opposed to the outcome achieved through medical care. While initially a strong concept, the current climate has shifted. Increasingly, physicians are feeling pressure to perform ancillary testing and optional procedures for the purpose of billing insurance companies rather than generating results. Value-Based As the name implies, value-based care is assessed, and rewarded, based upon the value practices and procedures offer patients. Instead of taking a numbers-based look at the services performed, value-based healthcare delves deeper, providing payments based on successful outcomes and healthy patients rather than the number of procedures used to get there. With a marked emphasis on lower costs of care and reduced time spent in in-patient facilities, this approach attempts to qualify, not quantify, the medical climate in the United States. While value-based systems are still in their infancy, numerous medical bodies, including CMS, are pushing for complete industry reform. Deciphering the Difference In an ideal world, fee-for-service and value-based systems will not at odds with one another, but rather working in tandem to provide the best possible patient experience. For example, a standard annual physical cannot necessarily be evaluated in a value-based manner, requiring a fee-for-service approach. These changes are instead intended to provide a uniform standard of care in surgical and procedural cases, such as CMS’s proposed Comprehensive Care for Joint Replacement program and the passage of the Medicare Access and CHIP Reauthorization Act of 2015. Making the Transition With countless medical records platforms and billing systems built around a fee-for-service model, incorporating value-based payment bundles into a practice can be exceptionally daunting. Transitioning away from fee-for-service may be beneficial in the big picture, reducing patient stay durations, costs of care, and penalties from payers, but the implementation process can be both time consuming and costly. Rather than facing extra fees and billing complications, the right software support system can ease the burdens of applying a new approach to billing and payment collection. View our archived webinar: How Sequence Can Help You Succeed in the Balance of Volume-based and Value-based Outcomes by Measuring these Four Pillars of Care Sequence Health specializes in meeting and maintaining the needs of medical practices and hospitals of all shapes and sizes, ensuring a simple transition for your needs. By streamlining the changeover, reducing paperwork, and saving time, our proprietary system can assist you in taking your healthcare into the future. When you’re ready to adopt value-based payments as a part of your practice, Sequence Health can make the process as easy and possible. Contact us today to learn more about our unique approach to medical innovation. Sequence Health Phone: 888.986.3638 Fax: 770.234.3815 Email: [email protected]
Know Your Earning Potential with Bundled Payments and Value-based Care Written by web_developers on September 15, 2016. Posted in Orthopedics. The increase in value-based care initiatives tied to bundled payments indicates big changes in the healthcare industry that affect the way patients receive care and providers measure success. As technology and medicine continue to advance, so does the way doctors engage patients to create meaningful relationships resulting in better patient outcomes. Traditionally in the United States, payment for healthcare treatment has been based on a fee-for-service model – the more patients receiving service, the more reimbursement for the provider, but that model is quickly changing. Hospitals, practices, and even clinicians are now paid according to value-based care reimbursement models. Quality and outcome standards are used to determine pay rates in response to a need for care that improves health rather than demands services. Organizations, and even individuals, are rewarded for meeting target costs and improving patient satisfaction and outcomes, while penalties are assessed for those unable to meet standards set by CMS. Sequence Health offers a suite of solutions allowing doctors and patients alike to benefit from new standards in efficient care delivery, effective patient experiences, and payment models that make sense under today’s value-based care programs. What Is Value-Based Care? Historically, doctor’s services are charged on a per-procedure or appointment basis. As such, many doctors feel pressured to perform a long list of procedures and tests that may or may not be necessary. In time, this cycle leads to longer patient hospital stays, more patients at one time, and often unnecessary ancillary testing. Instead of putting pressure on healthcare providers to perform potentially-needless procedures, value-based care focuses on medical decisions with the patient’s health and best interests in mind. When properly incorporated, this approach to medical treatment can ultimately reduce visit frequency and in-patient procedures while increasing satisfaction, rewards, and patient-reported outcomes. CMS Leads the Transition to Value-based Care For facilities that work with Medicare, complying with value-based mandates may or may not be required by CMS, or Centers for Medicare and Medicaid Services. CMS currently oversees a number of value-based bundled payment models, including CJR that affects orthopedic practices in 67 different regions across the country, and will be rolling out the new MACRA incentive-based payment system in 2017. Comprehensive Care for Joint Replacement (CJR) Commonly known as CJR, Comprehensive Care for Joint Replacement seeks to address one of the most common orthopedic inpatient procedures for Medicare patients: knee and hip replacements. Designed in an effort to standardize quality and cost of care, CJR replaces fees for related services with a bundled payment method, regulating the procedure, recovery duration, and more. Medicare Access and CHIP Reauthorization Act (MACRA) Passed in 2015, the Medicare Access and CHIP Reauthorization Act, or MACRA, is an incentive-based payment system to be associated with Medicare services. Utilizing two tracks for payment, Merit-based Incentive Payment System (MIPS), and Alternative Payment Models (APMs), MACRA is intended to replace three existing quality reporting systems with a streamlined, more effective alternative. Leveraging the Sequence Platform By treating healthcare technology as a tool, not an industry, it’s possible to increase quality of care while reducing paperwork and honing the focus on paying for what works rather than what can increase billing. Sequence Health can streamline this transition, easing the workflow impact of physician teams and making workflow management, patient engagement, and care plan adherence painless. With our unique technology related to hospital and provider management, our suite of solutions alleviate your burden, increase efficiencies, and simplify your care team’s day-to-day routine. Are you prepared to deliver and document value-based care to ensure you maximize your earning potential under reimbursement models that feature bundled payments? Contact Sequence Health today to learn more!