Physician Payment Reform In A Post-SGR World: Challenges Remain
On April 16, 2015 President Barack Obama signed the Medicare Access and CHIP Reauthorization Act (MACRA) which, among other things, finally repeals the Sustainable Growth Rate (SGR) mechanism of updating fees to the Physician Fee Schedule (PFS). The SGR had been blamed for causing instability and uncertainty among physicians for over a decade and led to 17 overrides of scheduled fee cuts, at a cost well in excess of $150 billion.
The passage of MACRA, however, raises new questions about where the U.S. health care system is headed in the post-SGR world of payment and delivery reform. In addition to the changes in MACRA, the...
Source: Health Affairs Blog - September 3, 2015 Category: Health Management Authors: John O'Shea Tags: Costs and Spending Featured Health Professionals Medicare Payment Policy ACOs Alternative Payment Bundled Payments Burnout fee-for-service MACRA patient-centered medical homes pay-for-performance Payment Reform Physicians SGR Source Type: blogs
The Pathway To Sustainability: Aligning Ambulatory Patient Experience Survey Implementation
Across the United States health care system, there is a growing imperative to deliver more patient-centered care. Listening to the voice of the patient is increasingly recognized as an essential part of this transformation. Health care is late to the game; soliciting and incorporating consumer feedback is commonplace in most other industries.
However, the use of patient surveys as a measure of the patient care experience is expanding rapidly in public reporting and value-based purchasing programs. The Clinician and Group Survey (CG-CAHPS) has become the national standard for assessing patient experience in ambulatory care ...
Source: Health Affairs Blog - September 3, 2015 Category: Health Management Authors: Dale Shaller, Carla Zema and Fatema Salam Tags: Costs and Spending Drugs and Medical Technology Health Professionals Hospitals Quality AH4Q CAHPS culture of health Maine patients RWJF Surveys Source Type: blogs
How PAs Factor Into Improved CMS Patient Satisfaction Scores
When I started work as a certified physician assistant (PA-C) 30 years ago, I provided health care for the homeless as the medical officer for an outreach mobile health team in Brooklyn, N.Y. I literally treated patients on the street, and patient satisfaction was measured by having them simply tell me they felt better.
Today patient satisfaction is being dissected and analyzed many different ways by physician offices, hospitals, and Accountable Care Organizations (ACOs), driven largely by the Centers for Medicare and Medicaid Services (CMS) and a policy to tie reimbursement to patient perceptions and compliance with clini...
Source: Health Affairs Blog - September 2, 2015 Category: Health Management Authors: Dawn Morton-Rias Tags: Equity and Disparities Featured Health Professionals Hospitals Organization and Delivery Quality ACOs CAHPS HCAHPS patient satisfaction physician assistants Source Type: blogs
Community Health Center Strategies For Pursuing Accountable Care
Accountable care strategies are spreading from Medicare and commercial insurance arenas to Medicaid programs, thus extending the benefits of payment and delivery reform to the safety net. Medicaid Accountable Care Organizations (ACOs) are now emerging in 18 states and a quarter of all ACOs nationally have contracts with Medicaid. The Centers for Medicare and Medicaid Services (CMS) and many state Medicaid programs have committed to accelerate this movement toward accountable care.
Community health centers are well suited to pursue accountable care strategies and serve as the integrators of care on a community basis for a v...
Source: Health Affairs Blog - September 2, 2015 Category: Health Management Authors: James Maxwell, Rachel Tobey and Christine Barron Tags: Costs and Spending Equity and Disparities Hospitals Innovations in Care Delivery Medicaid and CHIP Medicare Organization and Delivery Population Health Quality ACOs Boston CMS Community Health Centers Safety Net SDH Urban Hea Source Type: blogs
Why physician assistants are critical as health systems evolve
I have a long history with family medicine as my father was an early pioneer – heading up the family medicine program at Chicago’s Cook County Hospital in the 1970s. Even back then my dad was using physician assistants (PAs) — many of them former military medics in the Vietnam War era — who were part of what was at that time a brand new profession.
Family medicine as a whole was early to recognize the value of PAs and how they could extend our ability to help people in an outstanding manner. As a family practice physician, I work with PAs on a daily basis to coordinate and deliver comprehensive care for our...
Source: Kevin, M.D. - Medical Weblog - August 31, 2015 Category: Journals (General) Authors: Francisco Prieto, MD Tags: Physician Primary care Source Type: blogs
How pre-visit planning saves time and helps the bottom line
A guest column by the American College of Physicians, exclusive to KevinMD.com.
I love pre-visit planning.
OK, “love” may be too strong a word — I like pre-visit planning. Pre-visit planning isn’t new. Many of you have done it for years, even before it had a name, for example when pre-ordering labs before a visit.
I did not begin to use pre-visit planning until my practice became a patient-centered medical home (PCMH) in 2011. In fact, I was quite resistant to it before then. First, I felt I had no time (or staff time) to do it. Second, I was always concerned that if I pre-ordered lab tests, something would com...
Source: Kevin, M.D. - Medical Weblog - August 28, 2015 Category: Journals (General) Authors: Yul Ejnes, MD Tags: Physician Primary care Source Type: blogs
New Jersey’s Approach To Medicaid ACOs Is An Experiment Worth Watching
As the July issue of Health Affairs recognized, Medicaid has become a hotbed for health care transformation, with states increasingly turning to Accountable Care Organizations (ACOs) and medical homes to reduce costs and improve care delivery in their Medicaid programs. New Jersey joined the ranks in July by certifying three of six applicants for the New Jersey Medicaid Accountable Care Organization Demonstration Project — the Camden Coalition of Healthcare Providers, the Healthy Greater Newark ACO, and the Trenton Health Team.
Although the New Jersey ACOs were authorized by a 2011 law signed by Governor Chris Christ...
Source: Health Affairs Blog - August 25, 2015 Category: Health Management Authors: Joan Randell Tags: Costs and Spending Featured Health Professionals Medicaid and CHIP Medicare Organization and Delivery Population Health Accountable Care Organizations ACOs Chris Christie Medicaid Managed Care New Jersey The Nicholson Foundation Source Type: blogs
Recap – The Intersection of Health and Housing: Opportunities and Challenges Panel
It was an honest, eye-opening remark during the Alliance for Health Reform panel on Friday, when speaker Barbara DiPietro talked about a common obstacle for patients when they receive a prescription for an illness: many drugs have side effects, some of which may lead to a few more visits to the restroom. For most people with a permanent home or workspace, especially when it comes to making a recovery from an illness or condition, this is an inconvenient, but necessary, reality.
However, for homeless people who do not have access to bathroom facilities 24/7, they do not have the luxury of taking a treatment with such side e...
Source: Disruptive Women in Health Care - August 12, 2015 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Access Disparities Source Type: blogs
Advancing Integrated Behavioral Health Care In Texas And Maine: Lessons From The Field
Conclusion
Texas and Maine are among the many states in which foundations have supported the establishment and spread of integrated care through grants, augmented with learning communities, policy advocacy, and evaluation. The evaluations related to initiatives that promote integrated care already reveal critical elements that facilitate successful integrated care and will develop more refined lessons as integrated care becomes the standard of care across America. Sharing lessons learned across states can accelerate the spread of integrated care until it becomes the standard of care.
Related Resources
Cohen, Deborah. Addre...
Source: Health Affairs Blog - August 11, 2015 Category: Health Management Authors: Becky Hayes Boober and Rick Ybarra Tags: GrantWatch Health Professionals Organization and Delivery Behavioral Health Health Care Delivery Health Philanthropy integrated care Maine Mental Health Primary Care Texas Workforce Source Type: blogs
A More Cohesive Home: Integrating Primary And Palliative Care For Seriously Ill Patients
Treatment for Mr. M’s advanced heart failure was no longer extending or improving his life. He was becoming increasingly short of breath and confused -and hospital stays provided only short-term relief. Mr. M’s cardiologist contacted Dr. P, his long-time primary care physician, to initiate a discussion about his goals of care. Dr. P met with Mr. M and his family at their home. Mr. M was adamant that he would rather spend time with his family than go to the hospital again. Dr. P referred Mr. M to hospice and collaborated with hospice nurses to manage his pain and breathlessness. Mr. M later died peacefully a short while...
Source: Health Affairs Blog - August 3, 2015 Category: Health Management Authors: Ravi Parikh, Anya Lepp and Russell Phillips Tags: Equity and Disparities Health Professionals Long-term Services and Supports Organization and Delivery Population Health Quality Dying in America End-of-Life Care integrated care Palliative Care patient-centered medical homes Ravi Par Source Type: blogs
The Impending Revolution
By DR. ROB LAMBERTS
This weekend I attended (and spoke at) the Concierge Medicine Assembly in Atlanta. My role was to give the perspective of a “successful” DPC practice. This being the second such conference in three weeks, I’ve learned that my panel of 600+ patients and survival for two and a half years puts me in the higher ranks of solo DPC practices. The Atlanta conference was actually a combination conference, catering to both the more recent “direct care” style of practices like mine, and the more traditional “concierge” practices, with their higher fees and smaller...
Source: The Health Care Blog - August 3, 2015 Category: Consumer Health News Authors: suchandan roy Tags: THCB Dr. Rob Lamberts Source Type: blogs
Dynamic Vision Is A Cornerstone Of State Payment Reform Initiatives
Faced with rising health care costs, states are designing and implementing payment reforms that fundamentally transform how the health care market provides and pays for services. Two states in particular, Ohio and Oregon, have developed an overarching vision to guide their multi-payer payment and delivery system transformations.
Along the way, these states have placed an emphasis on leadership, multidisciplinary engagement, availability of federal resources, and investment in infrastructure to realize their goals. As a result, both Ohio and Oregon are implementing initiatives based on the framework of the Triple Aim and ar...
Source: Health Affairs Blog - July 28, 2015 Category: Health Management Authors: Ledia Tabor, Tess Shiras and Neva Kaye Tags: Costs and Spending Featured Health Professionals Insurance and Coverage Medicaid and CHIP Medicare Organization and Delivery Payment Policy Population Health Health Care Delivery Health Policy Ohio Oregon Payment Reform Primary Source Type: blogs
Reducing Practice Variation At Crystal Run Healthcare
Research has shown wide variation in per capita spending among different states and among different counties within the same state. Some of this variation can be explained by the health status of the population, local pricing, patient cultural and demographic factors, and the local liability environment.
However, the vast majority of variation in spending is unexplained and likely due to a failure of health care providers to follow established best practice guidelines. This type of variation is associated with unnecessary over-utilization, while reducing variation leads to reductions in utilization and improvements in qua...
Source: Health Affairs Blog - July 23, 2015 Category: Health Management Authors: Scott Hines, Jonathan Nasser and Linda Green Tags: Costs and Spending Equity and Disparities Health Professionals Innovations in Care Delivery Medicaid and CHIP Medicare Organization and Delivery Population Health Quality ACOs chronic conditions Crystal Run Healthcare NCQA Physic Source Type: blogs
Public/Private Partnership To Address Housing And Health Care For Children With Asthma
Mary (not her real name) is an elementary school student with moderate to severe asthma. She struggles to manage her condition and uses her rescue inhaler frequently. Mary’s mother is concerned about several problems in their apartment, including an unresolved pest infestation and bedbugs. As Mary’s pediatrician learned during a recent appointment, the family faces eviction for non-payment of rent.
Stories like Mary’s are common in Worcester, Massachusetts, where more than one in ten children suffer from asthma. Kids with uncontrolled asthma have poor health and development, and they miss a large number of school day...
Source: Health Affairs Blog - July 22, 2015 Category: Health Management Authors: Ted Kremer, Monica Lowell and Valerie Zolezzi-Wyndham Tags: Costs and Spending Equity and Disparities Health Policy Lab Long-term Services and Supports Population Health Public Health Quality asthma Children Commonwealth Medicine Community Health medical-legal partnership Prevention and Wel Source Type: blogs
We May Already Know How To Reduce The High Cost Of Covering New Medicaid Enrollees
Last week, the Centers for Medicare and Medicaid Services’ independent Office of the Actuary released its 2014 Actuarial Report on the Financial Outlook for Medicaid.
Unlike previous years, this annual report is making headlines because the actuaries project that for 2014 the newly eligible Medicaid expansion population will have costs greater than the non-newly eligible Medicaid population. Continue on to the next paragraph of the report and the actuaries write that a major contributor to this increased cost projection is that states anticipated and, in their managed care contracts, accounted for high first-year costs ...
Source: Health Affairs Blog - July 20, 2015 Category: Health Management Authors: Emma Sandoe Tags: Costs and Spending Equity and Disparities Featured Medicaid and CHIP Organization and Delivery Payment Policy Population Health Public Health ACA Care coordination Coverage Emma Sandoe Enrollment Health Care Coverage Initiative Source Type: blogs
