The Centers for Medicare & Medicaid Services have announced a final rule to encourage more ACOs participate in the Medicare Shared Savings Program by streamlining payments and offering additional terms of participation to providers.
ROI Models + Funding
In a recent article for Becker’s Spine Review, Cordata CEO Gary Winzenread recounted meetings he had with two different spine groups, one of which had embraced intake care coordination whereas the other had not. The group using care coordination to filter patients had surgical conversion rates at nearly 30% — nearly ten times higher than the latter. From a patient’s perspective, non-coordinated… Read More
CMS released their proposed roadmap to a revamped Medicare physician payment system, which will reward providers for quality of care as opposed to how many patients they serve in one day.
Drs. Robert A. Benson and John D. Goodson, writing for the New England Journal of Medicine, emphasized the importance of the Medicare Physician Fee Schedule (MPFS), particularly as it pertains to the industry shift from fee-for-service to value-based systems: What payment reformers often fail to recognize is that the specific MPFS payment rates have important implications… Read More
A new study appearing in the American Journal of Managed Care confirms a commonly held theory presently driving many U.S. healthcare policy decisions: uncoordinated, fragmented care — particularly for patients with chronic conditions — leads to more hospital visits and higher healthcare costs. The authors write: The effects were sizable, and suggest that policy makers and clinical leaders may… Read More
A recent article from Physician’s Money Digest reports that although the Centers for Medicare and Medicaid Services (CMS) began paying physicians an average of $42 per-patient, per-month for non-face-to-face chronic care services, few doctors have taken advantage of the program. Despite roughly 35 million Medicare beneficiaries being eligible, CMS had received reimbursement requests for only 100,000… Read More
What is one way to reduce diagnostic errors? Pay for care coordination, according an Institute of Medicine report. The authors of the report, titled “Improving Diagnosis in Health Care,” wrote: “Fee-for-service Medicare and most commercial payers do not pay for time that a clinician spends contacting other clinicians by phone or email to facilitate the… Read More
CDPHP, a New York health insurer, has announced that a patient-centered medical home model produced nearly $21 million in savings. The model — called Enhanced Primary Care (EPC) — moves primary care physicians from fee-for-service to value-based payments, ultimately rewarding physicians for their efforts to keep patients healthy. As the Times Union reports, practices paid… Read More
Kelly Hancock, MSN, RN, NE-BC, Executive Chief Nursing Officer, Cleveland Clinic Health System, speaks to the importance of nurse navigators: “The value of having this navigator or care coordinator is that it’s really one-stop shopping … it’s two-way: they can reach out to you or you can reach out to them to make sure you are where… Read More
With CMS now reimbursing for patient care coordination, more healthcare organizations are examining their specific business cases and ROI models. This report outlines one approach, with appropriate big-picture context: “In order to truly serve the individual while using limited health care dollars efficiently, we need to understand the whole person and tailor services to meet… Read More