It’s here. The 2023 CMS Physician Fee Schedule Final Rule has been released, and in a mere 3,304 pages, CMS has largely finalized its proposals from over the summer. To save you from pouring through all the minutiae, here’s what you need to know. Overall, in this Final Rule, CMS has codified principles to fulfill…
The Biden administration wants primary care and specialty providers to work closer together, including via new population-based payment models to bolster referrals to specialists. The Center for Medicare and Medicaid Innovation (CMMI) released a report Monday updating its strategic vision for implementing value-based care, including detailing its progress since the vision was released last year….
Many providers hesitate to embark on the transformation into accountable care organizations (ACOs) for two major reasons: anxiety about downside risk-based payments models and the challenge of balancing fiscal performance with the mission of delivering high-quality care. To successfully transition into an ACO, providers must constantly refine workflows, processes, and performance indicators. To this end,…
One of the most consequential shifts I’ve seen during 20 years in the biopharmaceutical industry is happening right now: A combined focus on patient-centricity and health equity is changing how companies approach end-to-end drug development and how we reach patients who’ve historically been left behind. As the child of immigrant parents, who has lived in…
Orville Newton Ray Bignall,MD, FASN, pediatric nephrologist, Nationwide Children’s Hospital, Columbus, Ohio,discusses social determinates of health with Pharmacy Times. As a first-generation American, he is empathetic with all types of families who come to receive treatment. Bignall highlights groups of patients that may be considered disadvantaged in the healthcare system, and why awareness is so…
A patient’s social determinants of health will influence access to chronic kidney disease screening and diagnosis and treatment of CKD, researchers reported here. “Clinical guidelines suggest regular chronic kidney disease (CKD) screening after diagnosis of hypertension (HTN) or type 2 diabetes (T2DM), as both are risk factors,” Marybeth Ingle, PhD, MPH, and colleagues wrote. “Monitoring…
More than 40 House lawmakers have asked congressional leaders to support value-based payment incentives and extend the 5 percent bonus for Alternative Payment Model (APM) participation. In a bipartisan letter sent to House Speaker Nancy Pelosi and Minority Leader Kevin McCarthy, the House members emphasized how the APM incentive payments help providers shift from fee-for-service…
Value-based payment (VBP) is a powerful and widespread health care transformation movement that has potential to improve health equity. The care delivery and payment flexibility possible under VBP (for example, to address social needs or hire community health workers), and the care coordination emphasized, are difficult at best or impossible at worst under fee-for-service reimbursement….
Getting access to timely and quality healthcare can be a challenge for the average person. But for patients in rural areas, underserved communities, and certain marginalized racial or ethnic groups, the problems are even greater. A limited number of providers in the community, difficulty finding transportation to and from doctors’ offices, and even communication challenges…
Accountable care organizations (ACOs) were handed a big win in the 2023 Physician Fee Schedule (PFS) with several changes to the shared savings program that will likely encourage participation. The Centers for Medicare and Medicaid Services (CMS) finalized changes to the Medicare Shared Savings Program, which is the nation’s largest ACO program that covers more…