Continuum

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Five ways to balance the cost side of the VBM equation

Posted by Continuum on Aug 2, 2016 11:00:00 AM

Continuum’s recent white paper, “How Physicians Can Win in the New Healthcare Environment,” explored several key strategies on how to transform the physician practice to capitalize on healthcare reform initiatives. In that paper, we examined five ways to maximize the value-based payment modifier adjustment, primarily from a quality perspective.

There’s another dimension to the quality improvement that value-based care aims for: there’s the means to reduce cost. Not just the cost to your practice, it’s the total cost of care. Here are five key methods to help reduce high costs in the value-based care world.

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Topics: Value-Based Modifer

Understanding Alternative Payment Models' (APMs) Impact on a Practice

Posted by Continuum on Jun 21, 2016 4:28:25 PM

As healthcare shifts from a fee-for-service to a value-based system, Medicare is making sweeping changes to how it reimburses physicians. The Centers for Medicare and Medicaid Services (CMS) has introduced new regulations and reporting requirements – as well as unprecedented potential for financial rewards and penalties.Commercial payers are adopting similar models, further expanding the potential impact of these changes.

Choose Your Path

The Medicare Access & CHIP Reauthorization Act (MACRA) of 2015 created the Quality Payment Program (QPP), which offers physicians a choice between two different reporting paths. Both start in the 2017 reporting year; the Merit-Based Incentive Payment System (MIPS)  and Advanced Alternative Payment Models (APMS). For more information on MIPS, see our previous blog post and read our whitepaper.

In this blog, we focus on APMs, payment arrangements in which clinicians accept financial risk for providing coordinated, high-quality care. As an incentive to take on this risk, CMS offers increased monetary rewards. CMS has designated specific payment models as Advanced APMs – including certain medical homes, accountable care organizations (ACOs) and bundled payment models -- and it will continue to approve new models. Advanced APMs are similar to one another, with variations based primarily on the different quality measures they use – such as those for primary care, oncology, and end-stage renal disease. 

The APM track offers higher financial rewards than the MIPS track, but requires more advanced levels of value-based activities. APMs also require physicians to be part of a larger group (such as an ACO or medical home), and to bear greater financial risk (more on that below). Most physicians who see Medicare patients will be required to report under either the MIPS or Advanced APM track starting in January 2017. Those in Advanced APMs must still complete MIPS reporting for the first year (2017) so CMS can determine whether they meet the Advanced APM requirements. Additionally, 2017 MIPS reporting will provide spending benchmarks for a prospective Advanced APM.


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Topics: value-based reimbursement, CMS, Alternative Payment Models

Alternative Payment Models (APMs) Preview

Posted by Continuum on Jun 7, 2016 11:00:00 AM

As healthcare shifts from a fee-for-service to a value-based system, Medicare is making sweeping changes to how it reimburses physicians. The Centers for Medicare and Medicaid Services (CMS) has introduced new regulations and reporting requirements – as well as unprecedented potential for financial rewards and penalties. 

Indeed, doctors who achieve the highest levels of “value” will earn substantial increases in their Medicare Part B payments. Conversely, those who do little or nothing to address the new requirements will incur significant reductions. Commercial payers are adopting similar models, further expanding the potential impact of these changes – positive or negative – on a practice.

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Topics: value-based reimbursement, CMS, Alternative Payment Models

Know Thy Patient: The Importance of Accurate Patient Attribution

Posted by Continuum on May 17, 2016 11:00:00 AM

As healthcare payment and delivery models continue to evolve, providers are increasingly being held more accountable for the health, quality of care, and overall costs associated with their patient population. Provider reimbursements are dependent on the quality of care delivered and the overall risk of their assigned patients. Attribution, or the process of assigning patients to primary care providers (PCP), has therefore become a critical component in maximizing reimbursement and succeeding under the rules and regulations of a shared savings contract.

Understanding Attribution

Unfortunately, there is no exact science for accurately defining a patient population. There are many variables to consider, especially when patients are free to seek care from any provider they choose. If a patient sees multiple providers in multiple networks, only the attributed provider (or provider group) is responsible for the patient’s cost and quality of care. For this reason, it is very important for physicians to understand who their patients are – prioritizing those who are sickest – and to coordinate care effectively in order to keep costs low and avoid duplicate services.

Effective care coordination, however, is only possible if the provided data is reliable. Attribution lists from payers typically depend on retrospective data, usually based upon the previous 12 months, which makes it difficult for physicians to predict and address patient needs in the year ahead. Most payers also attribute patients to PCPs, but a patient with chronic or urgent conditions may see a specialist physician more than a PCP.

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Topics: patient satisfaction, patient attribution, patient experience

Patient Satisfaction: A Key to Success in the New Healthcare Landscape

Posted by Continuum on May 5, 2016 1:41:41 PM

Physicians face increasing requirements from payers to provide “value” – high quality care at a low overall cost however, an important aspect of value that’s often overlooked is patient satisfaction. Today more than ever, doctors must ensure patients’ experiences with the practice are as positive as possible.

Benefits of satisfaction and engagement

Patient satisfaction is vital for many reasons:

  • High levels of satisfaction result in engaged patients – people who partner with their providers and actively participate in their own care. This leads to better health outcomes, higher quality and lower overall costs of care.
  • Patient expectations are rising. As consumers assume a growing portion of their cost of care, they’re demanding more information and a better experience in the practice.
  • Higher satisfaction levels lead to a better reputation for the provider, which helps attract more patients. This is especially true in today’s digital world, where online reviews can have a big impact – positive or negative.
  • Payers are starting to measure and reward doctors for patient satisfaction. The Centers for Medicare & Medicaid Services (CMS), for example, uses patient survey results as a component of its quality measures.
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Topics: patient satisfaction, patient experience

Tips to Maximize ICD-10 Coding Reimbursements

Posted by Continuum on Apr 27, 2016 4:28:14 PM

ICD-10: three letters and two numbers that caused much anxiety and stress for the medical community.                           Continuum’s coding team effectively prepared its clients for a smooth transition with little incident. It took approximately two years of hard work to prepare for the update to ICD-10, which went into effect in October 2015.

While it's been only six months, experts say much of the trepidation and hype were oveblown. The fear of denials, lost revenue, and work flow is nowhere to be seen.

A Physicians Practice survey revealed that 47.3 percent of readers say they are having no problems with the ICD-10 transition and have not seen an increase in claims rejections. Another survey found that 60 percent of practices said they have not seen an impact on monthly revenue1.

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Topics: coding, icd-10, payer reimbursement

Managing Patients' Cost of Care Essential Under New Reimbursement Models

Posted by Continuum on Apr 18, 2016 11:00:00 AM

Quality. Cost. Patient Satisfaction.

There are the three main areas in which physicians will be measured, as our healthcare system shifts from volume to value. The Centers for Medicare and Medicaid Services (CMS) has already begun tying reimbursement to these measures, and commercial payers are creating similar, value-based models.

In a previous post, we discussed how doctors can succeed under the new quality metrics. Here, we’ll explain how physicians can meet cost benchmarks.

Defining “cost”

The cost that’s relevant to payers is the annual amount spent by patients and their insurance providers for the patients’ care. It is not the provider’s cost of doing business, such as overhead costs. Moreover, “cost” is the total amount received by all of a patient’s providers.

To illustrate: Dr. Smith is a primary care physician with 100 attributed patients. He received $10,000 for their care. Dr. Smith’s patients also spent $90,000 with other providers. Therefore, Dr. Smith’s cost of care is $100,000.

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Topics: value-based reimbursement, medicare, CMS, lower cost of care

Continuum Service Spotlight: Credentialing

Posted by Continuum on Apr 12, 2016 11:00:00 AM

A Quick Overview

Physician practices often underestimate the importance (and timing) of credentialing, the process of maintaining medical credentials and privileges for all providers. Continuum’s Credentialing team handles the initial licensure and all renewals, ensures that all providers are enrolled with payers and receive privileging at area hospitals, confirms National Provider Data Bank (NPDB) status, and tracks all items with regular expirations, such as malpractice insurance, certifications and licenses.

Advance Planning & Meticulous Records Are Key

During the second quarter of the year, Continuum’s Credentialing team often sees a flurry of activity, as practices hire providers completing their residency in June. A new provider will take approximately 120 days to credential from the time they complete their residency, since payers have no record of them in their system. If all required submission elements are ready and the licensing is granted quickly, the process could be accelerated to 90 days.

Providers obtaining credentials for the first time or who are joining a new practice should provide the following information:

  • CDS: A Controlled Dangerous Substance license (many providers are unaware this is required)
  • DEA number: The Drug Enforcement Administration number allows providers to prescribe medications
  • NJ License: New physicians or those coming from another state must have a NJ License, which generally takes a minimum of four to six weeks
  • Continuum also requests access to the provider’s Council for Affordable Quality Healthcare (CAQH) account, which allows the team to review existing documentation within the preferred database of most insurance companies
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Topics: credentialing, payer reimbursement

Understanding Quality Metrics Under New CMS Reimbursement Models

Posted by Continuum on Apr 5, 2016 11:00:00 AM

As our healthcare system shifts from fee-for-service to value-based reimbursement, physicians face increasing requirements to report on the quality of the care they provide.The Centers for Medicare and Medicaid Services (CMS) has established a complex system of financial rewards and penalties tied to quality and costs of care. And commercial payers are starting to follow suit. For these reasons, doctors need to understand the quality metrics against which their performance will be measured, and how to optimize the quality results they report.

Under the Group Practice Reporting Option (GPRO) Web Interface, CMS requires primary care physicians to report annually on several point-of-care measures – from how many patients received flu vaccines, to the number screened for colorectal cancer. 

Know the requirements

On the plus side, most doctors already provide high-quality, evidence-based medicine. Where they typically fall short is in understanding the requirements for meeting the quality standards -- including proper documentation.

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Topics: quality metrics, value-based reimbursement, medicare, CMS

Is Your Practice Ready for CMS Reimbursement Changes?

Posted by Continuum on Mar 29, 2016 11:00:00 AM

Changes to Medicare will soon have a major impact on physicians’ bottom lines.The Centers for Medicare and Medicaid
Services (CMS) is fast-tracking its shift to value-based payments, with the introduction of new regulations, reporting requirements and financial consequences.

As a result, physicians could experience a substantial difference in their Medicare Part B payments. Whether that change is positive or negative,though, depends upon their preparedness.

For most private-practice physicians, the situation demands immediate attention. That’s because each year’s reported data – for 2016 and beyond – will affect payments two years later. Moreover, Medicare is switching from an incentive-based system to one with mounting penalties. Independent practices are especially vulnerable due to the complexity of these changes. Larger practices will be affected first, then smaller groups, and finally, solo practitioners.

Act Now -- Or Lose Ground

Doctors can take incremental steps to get ready, but it's vital to move forward now. For physicians, it’s sink-or-swim time. The waters of this paradigm shift are about to surge dramatically and will continue to rise each year after 2016.Virtually all doctors will be affected by these changes, which include substantial penalties for those who underperform on quality and cost measures in comparison to their peers. On the plus side, physicians who perform well under the new rules will receive additional reimbursement from Medicare.

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Topics: Value-Based Modifer, Merit-Based Incentive Payment System, MIPS, CMS, Medicaid

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