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A beginner’s guide to MACRA

MACRA is perhaps the most significant piece of proposed healthcare regulation I’ve ever seen. We’ve had a series of webinars to help clients understand the key points, and distilled them here in a Q&A format. What is MACRA? MACRA stands for the Medicare Access and CHIP Reauthorization Act of 2015. It is Medicare payment reform designed to help lower the cost of health care, while delivering better quality and improving health outcomes. It creates a more comprehensive value-based framework for payment and combines different quality-based measures into one system. Is MACRA final? No. MACRA was enacted in April 2015, but a public comment period has been open from April through June 27, 2016. The government is estimating the final rule will be available in October 2016. If it’s not final, why should I worry about this now? MACRA includes many changes, […]

Near the end of 2015, the Centers for Medicare and Medicaid (CMS) published its final rule for Comprehensive Care for Joint Replacement (CJR), a bundled-payment model for hip and knee surgeries. CMS has signaled that there will be more of these programs as the industry shifts from fee-for-service to value-based care. Unlike other bundled-payment models, this program is not optional. In 2014, more than 400,000 Medicare beneficiaries received a hip or knee replacement. Post-acute care, such as skilled nursing or physical therapy, follows many of the hospital stays for these patients. Homecare can be an important contributor to ensure the patient is not re-hospitalized during this period. CJR goes into effect January 15, 2016 and is applicable on April 1, 2016, when the first model performance period begins. There has been a lot of discussion about what the CJR rule […]

On November 16, the Centers for Medicare & Medicaid (CMS) published the Comprehensive Care for Joint Replacement (CJR)* final rule, marking a significant milestone in the advancement toward value-based care. “Today, we are embarking on one of the most important steps we will take to improve the quality and value of care for hundreds of thousands of Americans who have hip and knee replacements through Medicare every year,” said Sylvia Burwell, secretary of Health and Human Services. CJR will test whether or not bundled payments to hospitals for lower extremity joint replacement (LEJR) surgery episodes will reduce Medicare expenditures and enhance the quality of care for beneficiaries.  Due to the high number of public comments, the rule has expanded from about 400 pages to more than 1000. What changed from the proposed rule to the final rule Our preliminary observations […]

The Health Care Payment and Learning Action Network (HCPLAN) recently held its first summit in Washington, D.C.  I joined about 250 healthcare industry leaders at this event, which demonstrated that this group will play a significant role in shaping health care’s transition from fee-for-service to value-based-care models. The U.S. Department of Health and Human Services (HHS) created the HCPLAN earlier this year towards the goal of moving 30% of Medicare reimbursements to alternative payment models in 2016 and 50% by 2018. Through the HCPLAN, HHS will work with private payers, employers, consumers, providers, states and state Medicaid programs, and other partners to expand alternative payment models into their programs. Two of the main topics at the summit were the Alternative Payment Model (APM) Framework and Medicare Access and Chip Re-authorization Act (MACRA). Here’s a summary of key points in each […]

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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 […]

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R.I.P. SGR

Nine years ago, when I started developing a government relations function at Allscripts, it was a different world. No HITECH, no CMMI, no significant government attention on health IT at all, really. To set my agenda, I learned from our clients what mattered most to them. The number one answer I consistently heard? The repeal of the Sustainable Growth Rate (SGR), which has been the means by which the CMS has had to calculate payments to physicians since 1997. It was universally – by providers and policy makers alike – reviled. In the years since, the number of healthcare IT topics in D.C. has grown exponentially, along with the associated level of interest by legislators and regulators alike. We’ve discussed the complexities and opportunities of interoperability, debated the challenges of building a trusted patient safety structure, explained the difference between […]

NursesWeek-blog-01

  Nursing is the world’s largest healthcare profession. As the industry evolves to new models (such as value-based care*), it significantly affects nurses in acute settings, home care, case management, clinics and all venues of care. To help honor the profession during Nurses Week (May 6 – 12), we interviewed nursing leaders around the world. Here are some of the highlights of what they shared on this subject: How is health care’s shift to value-based models affecting nurses in your organization? “I think in a positive way. We focus on communication and on setting and sharing expectations, using value-based equations to explain why these are the right things to do. We work hard to make sure our goals tie together – from the University of California, to the department, to the individual. “For example, about 18 months ago we held […]

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Global Healthcare Megatrends: Financial models

There are more than 7 billion people on the planet today. Our growing global population has triggered some of the biggest healthcare challenges we’ll ever face. Listening to clients in Australia, Canada, Singapore, United Kingdom and United States, I believe many of these issues are universal. This is the third post in a five-part series that explores the clinical, population health, financial, regulatory and technical challenges we share as a global healthcare community. Healthcare costs are rising around the world. Financial pressure may be the most uniform challenge we face as a global healthcare community. Every country is trying to find ways to deliver better care at a lower cost. Reimbursement models differ by country Each country has a different way of funding health care. For example, Canada has a single-payer system. Physicians bill the national health insurance plan for […]

On Wednesday we officially opened our annual client conference, ACE 13. There are about 3,000 Allscripts clients gathered in Chicago to exchange best practices through more than 400 educational sessions, user group meetings and special events. It’s my first ACE, and it’s off to a great start. People are excited to connect, collaborate and share ideas. In the opening session, I talked about what Allscripts and our clients are doing to lead the transformation in healthcare IT. Client insights have helped create our vision. Sharing our roadmap for the healthcare IT journey I’ve been talking with hundreds of clients in my first eight months as CEO. These conversations are shaping our path to better health care for all. Attesting to Meaningful Use – For many of us, the journey began with government incentives, such as ARRA and Meaningful Use. Looking […]

In a fee-for-service world, the emergency department (ED) brings value to hospitals and their communities in a couple of different ways. First, they provide a rapid response to urgent needs. They are skilled in trauma, triage and rapid diagnostics to get really sick and injured people the right care, right away. Second, EDs are the welcome mat for inpatient care. Hospitals get value from the volume that comes to them through the ED – both medical and especially surgical admissions, which typically have higher margins. What will happen to EDs when fee-for-value takes hold, when hospitals will not necessarily derive value from more volume? To answer that question, we must understand what is valued in a fee-for-value world. The rising value may be in its ability to keep patients from being admitted and to reconnect them with their accountable care […]