Garrett Schmitt | VBCExhibitHall Library

New Opportunities for Provider Collaboration Stark and Anti-Kickback Statute Standards for Value-Based Care, Part 2: Creating a Value-Based Enterprise

May 6, 2021Garrett SchmittNo Commentsprovider collaboration, vbc

The first step in qualifying to meet the requirements of a value-based Stark exception or a valuebased Anti-Kickback Statute safe harbor is that the parties establish a “value-based enterprise.” The concept of a value-based enterprise is very definitionally driven, so before attempting to create a value-based enterprise it is imperative to fully understand the regulatory…

Rising costs, low-value care linked to hospital-employed physicians, studies show

May 5, 2021Garrett SchmittNo CommentsAHA, CMS, group practice, healthcare costs, HHS, low-value care, Medicare claims, Medicare Payment Advisory Commission, physician acquisition, physician employment, physician-hospital integration, physicians, private practice, vertical integration

Healthcare costs and low-value care tend to increase when hospitals acquire physicians, new studies published in Health Affairs show. The number of diagnostic and lab tests performed in hospitals versus unaffiliated facilities increased after doctors were acquired by hospitals, which inflated healthcare costs, according to an analysis of 30 million imaging procedures and 341 million…

AMA: Most physicians now work outside of private practice

May 5, 2021Garrett SchmittNo Commentsacquisitions, AMA, mergers, physician employment, physician practices, physicians, private equity, private practice, student debt

For the first time, most physicians worked outside of physician-owned practices in 2020, as doctors continue to gravitate toward employment by hospitals and other organizations, according to a new American Medical Association survey. The trade group’s latest Physician Practice Benchmark Survey found that 49.1% of patient care physicians worked in physician-owned practices in 2020, a…

How to Avoid Falling From Grace: Strategies for MA Plans to Sustain & Improve Performance

May 4, 2021Garrett SchmittNo CommentsMA, Medicare Advantage

Having helped several Medicare Advantage plans achieve significant quality performance improvements (up to 1.1 stars improvement YoY in 2020 alone), Stellar Health (Stellar) is sharing its perspective on what it takes to sustain and improve Star Ratings for health plans and why there is a need for action despite even a few years of success….

The 53 participants in CMS’ direct contracting model

May 4, 2021Garrett SchmittNo CommentsACOs, CMS, CMS Innovation Center, direct contracting, Medicare ACOs

CMS recently named the 53 organizations that are participating in the 2021 performance year for the Global and Professional Direct Contracting Model. The model’s 2021 performance year starts April 1. The goals of the model include allowing more types of organizations to participate in risk-sharing arrangements and build off of Medicare ACO efforts like the…

ABCs of VBC: CMS Value-Based Initiatives – A Current Review and Future Perspective

May 3, 2021Garrett SchmittNo CommentsACOs, Advanced Alternative Payment Models, Answers Media Network, Azara Healthcare, BPCI, CMS, David Smith, direct contracting, Medicaid, Medicare, MIPS, Third Horizon Strategies, vbc

Industry expert David Smith, Founder and CEO of Third Horizon Strategies, provides an overview of CMS’s value-based initiatives with specific perspectives on the new administration’s Medicare/Medicaid philosophy, the rise of complex care management, and Medicaid Advanced Payment Models. He also shares an update on the core CMS payment models including MIPS, ACOs, and BPCI, as…

New Opportunities for Provider Collaboration Stark and Anti-Kickback Statute Standards for Value-Based Care, Introduction

May 3, 2021Garrett SchmittNo Commentsprovider collaboration, vbc

In November of 2020 the Centers for Medicare & Medicaid Services (“CMS”) finalized value- based exceptions under the Stark Law and the Office of Inspector General (“OIG”) finalized value- based safe harbors under the Anti-Kickback Statute, in an effort to accommodate and facilitate the evolution of value-based care arrangements among health care providers. “Value-based care”…

Profiling ACO Success: What Drives High Performance in the Medicare Shared Savings Program?

May 3, 2021Garrett SchmittNo CommentsACOs, ACP, AWVs, Care Management, CMS, E&M, ED admissions, expenditures, IP admissions, MSSP, savings, SNFs, TCM, Transition of care

The Medicare Shared Savings Program (MSSP) is the largest value based care program from the Center for Medicare & Medicaid Services (CMS) to date. Since its inception in 2012, Accountable Care Organization (ACO) participation has doubled; providing care to over 10 million beneficiaries, generating $1.94 billion in total savings, and earning over $1.47 billion in…

NLP’s role in linking social determinants to heart disease

May 2, 2021Garrett SchmittNo Commentscardiology, data organization, heart disease, NLP, SDOH

Even with significant medical advances and greater access to healthcare, heart disease still remains the leading cause of death globally. While this is cause for concern alone, the risks of heart disease and other chronic illnesses have been amplified due to the impact of the COVID-19 and its links to harmful effects on the cardiovascular…

Best Practices for Integrating SDOH Data into the EHR

April 30, 2021Garrett SchmittNo Commentsdata organization, Data sharing, EHR, HIEs, Interoperability, SDOH

Identifying and implementing social determinants of health (SDOH) data into the EHR is critical to finding answers to a state’s most significant issues. Once identified, SDOH data helps healthcare providers make social services referrals, but the process for doing so using technology is challenging. “It’s not that physicians have totally ignored social determinants of health,…