Preparing Your Organization for MACRA 1.0
This article provides an overview of MACRA and guidance about what health systems should do to prepare for MACRA now.
MACRA Overview
MACRA permanently replaces the unsustainable Sustainable Growth Rate (SGR) formula (created in 1997 to restrict growth in Medicare Part B spending) with a system that attempts to prioritize quality over quantity. It also replaces Medicare’s multiple quality reporting programs with a single Merit-Based Incentive Payment System (MIPS). Before MACRA, several programs such as Accountable Care Organizations (ACOs), bundled payments, and various value-based models existed for hospitals and eligi...
Source: The Health Care Blog - April 20, 2016 Category: Consumer Health News Authors: Simon Nath Tags: Featured THCB ACOs Bobbi Brown CMS HealthCatalyst Kate Goodrich MACRA MIPS SGR Source Type: blogs
Quality Measure Core Set Implementation Plan
Discussion on Medicare Part B Drug Payment Model DemonstrationMedPAC Votes for Sweeping Revisions to Medicare Part DMedPAC Meeting on Part B Drug Payment Policy (Source: Policy and Medicine)
Source: Policy and Medicine - April 17, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
Medical Homes May Help Improve Care for People with Mental Health Issues
In a given year, almost one in five U.S. adults lives with a diagnosable mental, behavioral, or emotional disorder, not including developmental disorders or substance abuse.
(Source: The Commonwealth Fund: Blog)
Source: The Commonwealth Fund: Blog - April 5, 2016 Category: Global & Universal Source Type: blogs
Brave New World: Medicare’s Advanced Payment Models
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established a new framework for Medicare physician payment. Under the law, beginning in 2019, health care professionals participating in the program will come to a crossroads on their path to reimbursement.
In one direction—the default direction—they will be subject to the Merit-Based Incentive Payment System (MIPS), a revamp of Medicare’s fee-for-service (FFS) payment system that consolidates existing quality programs into a unified reimbursement component. The MIPS is examined in considerable detail in another Health Affairs Blog post.
Medicar...
Source: Health Affairs Blog - April 4, 2016 Category: Health Management Authors: Billy Wynne and Max Horowitz Tags: Costs and Spending Featured Health Professionals Hospitals Insurance and Coverage Medicaid and CHIP Medicare Payment Policy Quality Alternative Payment Models EHRs MACRA meaningful use requirements MedPAC Source Type: blogs
How Solid Is The Primary Care Foundation Of The Medical Home?
The patient-centered medical home (PCMH) has received attention as an improved care delivery model for primary care physicians — and possibly also for specialists who serve as principle physicians for patients with particular chronic conditions. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) identified the PCMH model as a presumptively qualifying Alternative Payment Model (APM) that would give physicians higher payments. And a recent summary of the latest evidence found reason for optimism about the potential impact of the PCMH model, not only on quality but also physician morale — raising the...
Source: Health Affairs Blog - March 25, 2016 Category: Health Management Authors: Robert Berenson and Rachel Burton Tags: Featured Health Professionals Hospitals Population Health Quality ACOs Alternative Payment Models MACRA Patient-Centered Medical Home Physicians physicians perspective Primary Care Source Type: blogs
A New Arena For Reducing Antibiotic Misuse: Outpatient Care
Antibiotic resistance related to the misuse and overuse of antibiotics has emerged as a growing public health concern, with at least 2 million people infected with resistant bacteria each year. To date, most efforts to promote more judicious use of antibiotics have been based in the inpatient hospital setting, aimed at preventing hospital-acquired infections such as Clostridium difficile (C. difficile). But with more than half of the antibiotics prescribed in outpatient facilities unnecessary, addressing antibiotic misuse and overuse in those settings is critical. The Centers for Disease Control and Prevention has highligh...
Source: Health Affairs Blog - March 24, 2016 Category: Health Management Authors: Hillary S. Jalon and Anne-Marie J. Audet Tags: Drugs and Medical Technology GrantWatch Health Professionals Hospitals Quality Antibiotic Resistance Consumers Health Care Delivery Health Philanthropy Health Promotion and Disease PreventionGW Public Health Source Type: blogs
When Health Policy Gets Personal
Like most Health Affairs readers, I spend large parts of my day reading about, thinking about, and advocating for changes to health care. The flaws with our system are beyond obvious by now: access can be limited or nonexistent; health care costs too much; quality and safety are not guaranteed; care is not well coordinated; and, disparities are stubbornly hard to erase.
We compare ourselves to other industrialized nations—usually unfavorably—and wonder why we can’t be more like them, spending less and getting better outcomes. We celebrate mind-boggling scientific and medical advances but lament that they are ...
Source: Health Affairs Blog - March 21, 2016 Category: Health Management Authors: David Sandman Tags: Costs and Spending Featured Health Professionals Quality electronic medical record fee-for-service patient experience patient-centered care Physicians Primary Care value based care Source Type: blogs
Worksite clinics 2.0? Interview with Crossover CEO Scott Shreeve
https://healthbb.files.wordpress.com/2016/03/shreeve-crossover-mp3-3_20_16-1-59-pm.mp3
I first encountered Dr. Scott Shreeve about a decade ago when he put forth an expansive framework for Health 2.0. We caught up again recently to discuss his next generation worksite clinic company, Crossover Health. I really enjoyed the podcast interview and am bullish on the company. Here’s what we discussed:
(0:10) How does Crossover compare to a traditional primary care practice, patient centered medical home, concierge practice, urgent care center or traditional worksite clinic?
(0:54) You have an onsite model and near site ...
Source: Health Business Blog - March 21, 2016 Category: Health Management Authors: dewe67 Tags: Entrepreneurs Physicians Podcast norwest venture partners primary care Source Type: blogs
A New Role For The Veterans Health Administration
The Veterans Health Administration (VHA) is transforming into a major health care payer in addition to its role as a provider. In 2014, in response to scandals in the Department of Veterans Affairs (VA) related to access to care, Congress opened the door to a marked expansion of VA-paid care in the community with its “Choice” program and a $10 billion appropriation. A 2015 law then mandated consolidation of the VHA’s many established community care programs into one – the Veterans Choice Program.
The VA, with forward-thinking leadership, responded with an ambitious plan to alter its approach to care. The plan w...
Source: Health Affairs Blog - March 18, 2016 Category: Health Management Authors: Joel Kupersmith Tags: Featured Insurance and Coverage Medicare Congress Veterans Veterans Choice Program Veterans Hospitals Veterans' Health Care Source Type: blogs
PCMH Fails Natural Experiment
By AL LEWIS
Medical Homes Fail Yet Another “Natural Experiment”
Three “natural experiments,” three failures. Such is the fate of patient-centered medical homes (PCMH), a well-intentioned but unsuccessful innovation now kept afloat by the interaction of promoter study design sleight-of-hand with customer innumeracy.
By way of review, a natural experiment is an experiment in which the design is outside the control of investigators, yet mimics an experiment. The first two natural experiments below involve applying the intervention across entire states. The third involves a stimulus-response experiment in one spec...
Source: The Health Care Blog - March 14, 2016 Category: Consumer Health News Authors: Simon Nath Tags: Featured OP-ED THCB Source Type: blogs
A New Understanding Of Health System Performance For Older Adults
The number of people age 65 and older in the U.S. will almost double between 2012 and 2050, increasing from 43.1 million in 2012 (one in seven Americans) to 83.7 million (one in five Americans). At the same time this large demographic shift is occurring, we are also in the midst of great health care system change, as payments become value-based, and systems focus more on population health. Given the large simultaneous changes, we have an opportunity to pay closer attention to the special needs that come with an aging population and redesign the system to address them.
As we age, our bodies and our priorities change. Our bo...
Source: Health Affairs Blog - March 14, 2016 Category: Health Management Authors: Julie Bynum Tags: Featured Health Professionals Long-term Services and Supports Medicare Population Health Quality Aging Cancer Dartmouth Atlas End-of-Life Care patient-centered care readmisisons specialty care Source Type: blogs
CMS approval another national nod to the power of telehealth
By KOFI JONES
Approximately 12 million Americans utilize some type of home health care every year. From home health aides visiting the infirmed in their homes, to physical therapy services to aide in recovery, to medical equipment being used to treat the chronically ill, home health has been a critical component of care management for decades.
One of the Medicare payment requirements for these services is for the prescribing practitioner to have a “face to face” encounter with the patient within a reasonable timeframe. This has widely been viewed as a burden on patients, many of whom face mobility issues and other ba...
Source: The Health Care Blog - March 8, 2016 Category: Consumer Health News Authors: Simon Nath Tags: Featured THCB Kofi Jones Source Type: blogs
Why We Know so Little About ACOs: The Managed Care Culture at Work
By KIP SULLIVAN
This is the third essay in a three-part series in which I explore the answer to that question. In the first installment I blamed this problem on the flimsy definition of “ACO.” ACO proponents “defined” the ACO in terms of their hopes for it, not in terms of the mechanisms ACOs would use to accomplish those hopes.
In the second installment I reviewed a paper published by the Center for Health Care Strategies (CHCS) to document my statement that we have no useful information on ACOs and to illustrate the quandary the hope-based “definition” of “ACO” creates for researchers. I criticized t...
Source: The Health Care Blog - March 6, 2016 Category: Consumer Health News Authors: John Irvine Tags: OP-ED Source Type: blogs
New Health Care Symposium: Transformation To High Value Health Care—Build On Your Core Competence
Editor’s note: This post is part of a Health Affairs Blog symposium stemming from “The New Health Care Industry: Integration, Consolidation, Competition in the Wake of the Affordable Care Act,” a conference held recently at Yale Law School’s Solomon Center for Health Law and Policy. Links to all posts in the symposium will be added to Abbe Gluck’s introductory post as they appear, and you can access a full list of symposium pieces here or by clicking on the “Yale Health Care Industry Symposium” tag at the bottom of any symposium post.
With the Institute of Medicine’s estimate that 30 percent of...
Source: Health Affairs Blog - March 4, 2016 Category: Health Management Authors: Lewis Sandy Tags: Costs and Spending Insurance and Coverage Population Health Quality ACOs Health Care Learning and Action Network PCMHs Yale Health Care Industry Symposium Source Type: blogs
