Medicare Advantage Star Rating & the Provider: Rewarding, Complex & Competitive

Posted by Michael Renzi, DO, FACP on May 22, 2018 8:40:27 AM

CMS created the Star Ratings system in 2008 to help seniors compare quality and performance among Medicare Advantage (MA) Part C plans and Part D prescription drug plans (PDPs). Insurance companies also benefit, as a plan’s star rating influences patients and directly affects membership growth. In 2012, CMS upped the ante by linking premiums and bonus payments to each plan’s star rating. Roughly, each half-star change in a plan’s rating affects bonus revenue by 25-30%, with the most significant reductions occurring when a plan drops under 4 stars. In real dollars, a plan increasing their star rating from 3.5 to 4.0 would result in double the annual bonus payment (referred to as a “rebate percentage”). Bonus payments are substantial, with an average amount between $700 - $1,000 per patient per year.

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Topics: CMS, patient experience, payer contracts, quality care, Medicare Advantage

Physicians: Increase Patient Loyalty by Improving Customer Service

Posted by Sherry Anderson on Jan 17, 2017 11:05:00 AM

5 Quick Tips for Your Practice

Consumers are taking a more proactive role today in choosing their healthcare providers. These decisions often have little to do with medical care, but result from patients’ experience with the practice. Friendliness of the staff, wait times and cleanliness of the office, among other factors, play a big role in whether patients stay with a doctor. 

Moreover, most people choose a new physician based on word-of-mouth from friends, relatives and colleagues. A negative experience, especially, will be passed along to your potential patient base. And with the rise of social media, word spreads faster than ever.

Therefore, physicians must build loyalty among their patients by providing excellent customer service, a.k.a. “patient experience.”

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Topics: patient satisfaction, patient experience, patient loyalty, customer service

Quality Where it Counts -- Focusing on Care & Patient Satisfaction

Posted by Michael Renzi, DO, FACP on Dec 20, 2016 1:59:00 PM

The amount of change hitting the healthcare industry is enough to make any provider dizzy. For primary care providers especially, implementing and optimizing new workflows and
technology to capture every healthcare dollar you’ve earned can easily make you lose focus on the single most important aspect of your practice: patient satisfaction.

New alternative payment models (APMs) are supposed to refocus patient care by incentivizing for the quality and cost of care delivered. To succeed in the new healthcare world, providers need to ask themselves: how can they help their local healthcare network deliver high quality care to their patients, when and where the patients need it, at the right price? We’ve put together a list of three key factors to help providers—and patients—make the most of APMs.

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Topics: quality of care, patient experience

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

Patient Satisfaction Begins with Good Manners

Posted by Continuum on Mar 22, 2016 11:00:00 AM

Patient satisfaction is becoming a key phrase in healthcare, and physicians are learning first-hand just how important it is to make their patients not only healthy, but also happy. The patient experience is a critical factor in measuring the quality of care, and now that quality is tied to reimbursement, patient satisfaction scores have a direct impact on a physician’s bottom line.

In addition to the physician, the medical staff plays a vital role in improving the patient’s experience. Excellent customer service encompasses many facets, but one of the surest ways to increase satisfaction levels is to practice proper etiquette. Simple gestures such as making eye contact and smiling while interacting with patients makes them feel welcome and leaves them with a positive impression of your practice.

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Topics: quality of care, patient satisfaction, patient experience

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