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The Healthcare Update eNewsletters are issued on a bi-monthly or monthly basis (depending on the topic). Each eNewsletter is distributed to a highly selective list of individuals specifically interested in readmissions, care coordination, bundled payments, Medicare-Medicaid, patient safety, pay-for-performandce, accountable care, and related issues.

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  • Bundled Payment Update eNewsletter
  • MACRA MIPS/APM Update eNewsletter
  • Pay for Performance Update eNewsletter

From August 14, 2019
MACRA MIPS/APM Update eNewsletter #43

Getting the Most Reimbursement from MACRA/MIPS
An estimated 798,000 clinicians will be MIPS eligible in the 2019 performance period. CMS predicts 74% will earn an "exceptional performance" bonus for 2018 with a minimum distribution of 0.25%, while those choosing to not participate will be assigned a maximum penalty of 7%[3]. Fortunately, there are five steps you can take now to help streamline the MACRA/MIPS reporting process and achieve the best possible financial outcome.

  • Engagement and education. A commitment for continued performance improvement by all members of the practice is key as well as continued education. Knowing the major requirements under the program will help clinicians align their quality goals.
  • Use CMS's previous feedback to drive future quality-performance efforts. For example, check your Medicare reports from 2016, 2017, and preliminary 2018 reports, plus your 2016 QRUR reports and your 2017 cost analysis. This feedback can be invaluable for identifying organizational gaps and opportunities to help improve performance levels for 2021. Additionally, check your participation status on the CMS QPP site.
  • While it might be tempting, don't rely on the same set of measures year after year. Eventually, those measures will reach a topped-out list. Consider using new measurements that might be better matched to your specialty. MIPS offers more than 270 quality measures from which to choose. Another option is to work with a qualified clinical data registry (QCDR), which can provide additional measurements based on your practice's unique needs. A QCDR also offers a variety of additional pertinent details you may want to capture and report. Find what works best for you.
  • Leverage your revenue cycle management vendor to help ensure you have the analytics necessary to enable baseline measurements and continuous performance improvements. This is essential to your practice's success and to the effectiveness of your MACRA/MIPS efforts. Analytics are necessary to understand where you stand in comparison to previous quality measurements, as well as to those of other similar entities.
  • Finally--and this cannot be over-emphasized--make sure you submit your data. Neglecting to do so will result in a zero score from CMS, along with the maximum negative adjustment of -5% in 2020 and -7% in 2021.

(Tech Peek, July 29, 2019)

From July 23, 2019
Bundled Payment eNewsletter #125

The Seven Characteristics of Successful Alternative Payment Models: Designing, Evaluating and Modeling Value-Based Payment Arrangements

Marc Berg
Partner, Healthcare Innovation, McKinsey

Seema Parmar
Associate Partner and Senior Expert, McKinsey

Nick Bluhm
Senior Director, Strategy and Government Policy, Remedy Partners

From August 6, 2019
Pay for Performance Update eNewsletter #125

Investing in Primary Care
The PCPCC 2019 Executive Report provides quantitative data and analysis of primary care spend at the state and payer levels, as well as a window into the association between primary care spend and key patient outcomes. In short, the report shows that primary care investment as a percentage of total health care expenditures was low between 2011 and 2016, and it varied considerably across states and across payers. The analysis also shows an association between more primary care investment and better patient outcomes. Finally, the report includes a description of legislative/regulatory efforts in 10 states to measure and report on primary care spend and to shift more resources into primary care.

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