Last week The Centers for Medicare and Medicaid (CMS) Acting Administrator Andy Slavitt issued an official blog post announcing proposed reporting options for the Quality Payment Program (QPP), the program stemming from the Medicare Access and CHIP Reauthorization Act (MACRA), for program year 2017. The intent of these options is to give participants more flexibility during the initial year of this significant program. For 2017, the blog post identifies four options: 1) Submit “test” data to CMS for any period of time within 2017. Choosing this option will eliminate any penalties from the MIPS program. 2) Submit complete data for a portion of program year 2017. Choosing this option will provide the opportunity for a partial incentive payment, if any is earned. 3) Submit complete data for all of program year 2017. Choosing this option provides the opportunity for a […]

0 comments

The reality of CCJR: Understanding new risks facing hospitals

The projected debut of the Comprehensive Care for Joint Replacement (CCJR) Model is less than three months away, and it represents an entirely new approach for care and cost management. Affected hospitals are beginning to realize that the financial, operational and clinical risk they are responsible for managing is a much larger task than they had originally envisaged. When the Centers for Medicaid & Medicare Services (CMS) first proposed the program, CMS wanted to demonstrate a new way to achieve better care, smarter spending, together with healthier people and communities through coordination of care across inpatient and outpatient healthcare providers. Hospitals are realizing their internal resources are not well-aligned with the requirements for analyzing and administering a CCJR program. What is the risk hospitals must manage? A large proportion of services included in a CCJR episode are non-hospital based. In […]

0 comments

What is the Comprehensive Care for Joint Replacement (CCJR) program?

  • Jeff Goldstein, MD, MS FACHE
  • 09/29/2015

In July 2015 the Centers for Medicare & Medicaid Services (CMS) announced the proposed CCJR program, a five-year initiative for addressing bundled inpatient and outpatient payments for patients who have lower-extremity joint replacement surgeries. Perhaps the most important aspect is the endpoint for the episode of care, which is 90 days after discharge. During this period CMS will pay all providers, inpatient and outpatient, using the current fee-for-service model. However, the proposed rules would hold the hospital accountable for the cost of services (both inpatient and outpatient) relating to the patient’s procedure and post-surgical care. This new risk/reward arrangement presents significant financial implications for the hospital. If a hospital can control costs and demonstrate quality during both the hospitalization and post discharge, then it can receive a bonus payment. Conversely, if the aggregate cost of care during the 90-day window […]

This week, the Centers for Medicare & Medicaid Services announced 2014 results for 333 Medicare Accountable Care Organizations (ACOs). It’s pretty exciting news; 56% of ACOs reduced costs and improved quality measures and reporting, which is up from 40% in previous years. The downside of the report is that only 29% of ACOs participated in shared savings, which is simply not enough. The ACOs are saving money, but they’re not earning revenue at the same rate. It’s clear that we, as in industry, have to do more to facilitate success. Think like a payer To earn shared savings, ACOs need to think more like payers. Unlike traditional fee-for-service models, new value-based-care models require providers to balance risk scores and quality measures for better patient care. They have to manage patient coding to account for risk, which is what payers do […]

A pilot program to improve primary care is showing signs of success at SAMA Healthcare, a family practice serving southern Arkansas. Centers for Medicare & Medicaid Services (CMS) selected SAMA as one of 497 practices to participate in its Comprehensive Primary Care Initiative (CPCI). Funding from the program enabled SAMA to make several improvements, including new color-coordinated care teams.   What the CMS is doing to improve primary care CPCI is a four-year pilot project. It is a collaboration among public and private payers to strengthen primary care. By investing more in primary care practices, the partners hope to achieve better health, better care and lower healthcare costs. The CPCI aims to improve primary care in two ways: 1)      Practice redesign. These providers must comprehensively address five primary care functions: risk-stratified care, access and continuity, population health management, patient engagement, […]

You can’t prevent a Meaningful Use audit. It’s one way Centers for Medicare & Medicaid Services (CMS) follows up on Meaningful Use (MU) incentive payments and confirms that providers are doing the right thing for patients. But you can be prepared for an audit if you take a few simple steps before and during your attestation period. Before you receive the notice, you can: 1.  Monitor emails for notification – The 14-day clock starts ticking the moment the email arrives from the CMS auditor, Figliozzi & Co.  You don’t want it sitting undiscovered in a physician’s inbox. Consider creating an email rule for accounts involved with the attestation to catch these notices early. 2. Record EHR identification numbers – Record the CMS EHR certification ID and Certified Health IT Product List (CHPL) numbers on your MU attestation application.  Auditors often […]

The Centers for Medicare & Medicaid Services (CMS) conducts audits to follow up on Meaningful Use (MU) incentive payments.  These audits can intimidate providers, even ones that have meticulous reporting habits. Soundview Medical Associates, a 22-physician, multi-specialty practice in Connecticut, faced two consecutive MU audits for 2011 and 2012. The responsibility for completing them fell to the organization’s only IT person and executive director, Eileen Smith. In this video, Eileen Smith describes how Soundview Medical Associates successfully responded to two Meaningful Use audits.   Keep calm and respond to CMS Upon receiving the first audit notice in the spring of 2013, Eileen reacted the way many providers might, “What did I do wrong?” The answer: probably nothing. Some audits are targeted, but many are random. It’s an opportunity for the government to exercise due diligence over its investments in incentive […]

Joy greeted yesterday’s CMS announcement that 500 practices have been enrolled in a new public-private initiative to support the nation’s struggling primary care physicians. That was the reaction, anyway, of Pamela Coyle-Toerner, CEO and President of Queen City Physicians in Cincinnati, one of many Allscripts EHR clients to be selected for the program. “It’s fun to see primary care providers getting the attention and respect they deserve,” Coyle-Toerner told It Takes A Community. “The government gets it, now we need the rest of the care community to get it. … We’re trying to make sure that primary care survives as a profession.  These providers can truly help us, as a country, survive the cost crisis that we have.” CMS seems to agree. The Comprehensive Primary Care initiative (CPC) is the latest in a series of federal efforts to reinvigorate primary […]

0 comments

The Path to EHR Interoperability

The long-anticipated interoperability of Electronic Health Records has at last been codified (or nearly) by CMS’s proposed Meaningful Use Stage 2 requirements. As veteran healthcare IT journalist Ken Terry writes in Information Week, interoperability is the “linchpin of MU Stage 2” as well as CMS’s proposed rule on 2014 certification of EHRs. How difficult will it be to achieve CMS’s interoperability goals? According to the proposed rule, to be certified as meeting Stage 2 requirements, EHRs will need to exchange Continuity of Care Documents (CCD) with the EHRs of other vendors; use Direct secure messaging to exchange patient data across enterprises; use certain standard medical terminologies such as SNOMED CT; and use the HL7 2.51 messaging format to submit reportable lab data, immunizations, and syndromic surveillance to public health agencies. While many providers will struggle to meet the new requirements for […]

0 comments

Meaningful Use: One Health System’s Journey

While most hospitals are focused on CMS’s release of the draft Stage 2 rules for Meaningful Use last week, now seems a good time to take a look back at how one health system managed to succeed with Stage 1. After all, more than half of all hospitals have yet to attest to Stage 1. Summa Health System, where I work as lead quality and clinical analyst, is one of the largest integrated healthcare delivery systems in Ohio, serving more than 1 million patients each year in comprehensive acute, critical, emergency, outpatient and long-term/home-care settings. Summa includes eight hospitals, more than 1,500 physicians and 11,000 employees overall. Nationally renowned for excellence in patient care, Summa implemented the Sunrise Acute Care Electronic Health Record (EHR) from Allscripts in 2003.  (Editor’s Note: Steve Shaha, Ph.D. wrote last week about Summa’s success using Sunrise […]