The American Medical Association has criticized the new Medicare payment schedule proposed rule released last week by the Centers for Medicare and Medicaid Services, saying it fails to account for inflation in practice costs and “COVID-19-related challenges to practice sustainability.” The proposed 2023 Physician Fee Schedule (PFS) conversion factor is $33.08, a decrease of $1.53…
How you ramp-up to full-scale APMs is crucial. Even if your multi-specialty group or health system receives some value-based payments with downside risk, your success hinges both on financial viability and retention of your clinicians and patients. If you delay APM adoption only after reviewing the potential on your bottom line, you’ll need to pay…
CMS just set off summer fireworks, amping up incentives to adopt Value-Based Care in its just-released, 2,066-page 2023 Proposed Physician Fee Schedule Rule. By encouraging formation of new ACOs, the Proposed Rule establishes a pathway to expand beneficiaries’ access to accountable care. Last year, CMS committed that every Medicare beneficiary will be in an accountable…
Kenneth L. Davis, MD, believes that keeping patients healthy and ultimately out of the hospital is the key to making healthcare more affordable. That is why he is leading one of the nation’s top health systems down the path of value-based care adoption. Mount Sinai Health System has been at the forefront of the transition…
PART 1: Understanding the programmatic health equity components As the CMMI (Center for Medicare & Medicaid Innovation) Direct Contracting Program transitions to the ACO REACH Model in PY2023, many in the market have asked: “what has changed?” One notable change is the inclusion of one of the core tenants of the CMMI Strategic Plan announced…
The CMS is proposing an overhaul of the Medicare accountable care organization program in an effort to improve equity. The plan, which includes efforts to get more providers into ACOs and particularly ramp up rural participation, was applauded by ACO groups. The changes for ACOs in the Medicare Shared Savings Program would give some organizations more…
Community health workers (CHWs) have been garnering greater visibility in recent years as the field has placed heightened attention toward the role of social determinants of health in reducing health disparities and achieving health equity. CHWs aim to be a closer link into the community than traditional health care providers might be able to reach….
An internal analysis of three CMS Innovation Center models revealed instances of implicit bias in healthcare, which disproportionately impacted people of color and low-income individuals. CMS Innovation Center chief medical officer Dora Lynn Hughes, MD, MPH, and analyst Melissa Majerol, MPH, disclosed the results of the analysis of implicit bias in a Health Affairs Forefront blog…
An integrated county health system that spent more than $22 million on a social needs case management program for its adult Medicaid patients was rewarded with significant reductions in hospital admissions and a minor dip in emergency department visits, according to a new study published this week in Annals of Internal Medicine. However, reduced utilization…
Data is the backbone of every health care decision. Various regulations, initiatives, and platforms seek to unlock data from separate silos for free-flowing exchange that enhances the patient experience and enables data-driven improvements in health outcomes. Health plans and providers remain invested in using data to achieve improved care coordination while lowering costs, tenets of…