Aug 15, 2019 | Uncategorized
The residents of Colorado are working hard to improve our healthcare system throughout the state. A recent study ranked Colorado number 11 in the US based on several different variables, however, health care costs in Colorado were ranked 47. Read the article below recapping the results from the survey and other placement factors.nnA new study places Colorado’s health care system just outside the top 10 in the nation.nnThe study, released Monday by financial website WalletHub, ranked Colorado No. 11 on its list of best and worst states for health care.nnMinnesota, Massachusetts and Rhode Island took the top three spots, with Mississippi, North Carolina and Alaska coming in at the bottom of the list.nnThe report compared the 50 states and the District of Columbia across 43 measures of cost, accessibility and outcome, using data sets ranging from average monthly health insurance premium costs, hospital beds per capita, cancer and heart disease rates, and percentage of insured people ages 19 to 64.nnColorado ranked No. 47 in terms of health care costs for its residents, which considered factors such as average hospital expenses per inpatient day at a community hospital and average monthly health insurance premium costs.nnThe Centennial State ranked 12th in access to health care — which took into account the number of hospital beds per capita and the quality of the state’s public hospital system — and No. 3 in health care outcomes, which included life expectancy and infant, child and maternal mortality rates.nnToday, the average American spends more than $10,000 per year on personal health care, or about 17.9 percent of the U.S. GDP, according to the most recent estimates from the Centers for Medicare & Medicaid Services.nn“But higher costs don’t necessarily translate to better results. The U.S. lags behind several other wealthy nations on several measures, such as health coverage, life expectancy and disease burden,” the study states. “However, the U.S. has improved in giving more healthcare access for people in worse health, and health care cost growth has slowed somewhat.”nnOriginal article published on csbj.com.
Aug 8, 2019 | Uncategorized
MLNConnects, the official news of CMS, recently proposed 3 new payment rules. CMS released these proposed rules on July 29, which include payment updates for outpatient and physician services and also expanded price transparency initiatives. Read below to find out more information on these proposed rules. n
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- PFS: Proposed Policy, Payment, and Quality Provisions Changes for CY 2020
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- Medicare OPPS and ASC Payment System CY 2020 Proposed Rule
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- ESRD and DMEPOS CY 2020 Proposed Rule
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n1. PFS: Proposed Policy, Payment, and Quality Provisions Changes for CY 2020n
On July 29, CMS issued a proposed rule that includes proposals to update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2020. This proposed rule is one of several proposed rules that reflect a broader Administration-wide strategy to create a health care system that results in better accessibility, quality, affordability, empowerment, and innovation. It also includes proposals to streamline the Quality Payment Program with the goal of reducing clinician burden. This includes a new, simple way for clinicians to participate in our pay-for-performance program, the Merit-based Incentive Payment System (MIPS), called the MIPS Value Pathways.
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The proposed rule also includes:
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- CY 2020 PFS rate setting and conversion factor
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- Medicare telehealth services
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- Payment for evaluation and management services
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- Physician supervision requirements for physician assistants
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- Review and verification of medical record documentation
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- Care management services
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- Comment solicitation on opportunities for bundled payments
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- Medicare coverage for opioid use disorder treatment services furnished by opioid treatment programs
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- Bundled payments for substance use disorders
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- Therapy services
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- Ambulance services
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- Ground ambulance data collection system
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- Open Payments Program
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- Medicare Shared Savings Program
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- Stark advisory opinion process
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2. Medicare OPPS and ASC Payment System CY 2020 Proposed Rulen
On July 29, CMS proposed policies that follow directives in President Trump’s Executive Order, entitled “Improving Price and Quality Transparency in American Health Care to Put Patients First,” that lay the foundation for a patient-driven health care system by making prices for items and services provided by all hospitals in the United States more transparent for patients so that they can be more informed about what they might pay for hospital items and services.
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The proposed changes also encourage site-neutral payment between certain Medicare sites of services. Finally, the proposed rule proposes updates and policy changes under the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. The proposed polices in the CY 2020 OPPS/ASC Payment System proposed rule would further advance the agency’s commitment to increasing price transparency, (including proposals for requirements that would apply to each hospital operating in the United States), strengthening Medicare, rethinking rural health, unleashing innovation, reducing provider burden, and strengthening program integrity so that hospitals and ambulatory surgical centers can operate with better flexibility and patients have what they need to become active health care consumers.
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In accordance with Medicare law, CMS is proposing to update OPPS payment rates by 2.7 percent. This update is based on the projected hospital market basket increase of 3.2 percent minus a 0.5 percentage point adjustment for Multi-Factor Productivity (MFP).
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In the CY 2019 OPPS/ASC final rule with comment period, we finalized our proposal to apply the hospital market basket update to ASC payment system rates for an interim period of 5 years (CY 2019 through CY 2023). CMS is not proposing any changes to its policy to use the hospital market basket update for ASC payment rates for CY 2020-2023. Using the hospital market basket, CMS proposes to update ASC rates for CY 2020 by 2.7 percent for ASCs meeting relevant quality reporting requirements. This change is based on the projected hospital market basket increase of 3.2 percent minus a 0.5 percentage point adjustment for MFP. This change will also help to promote site neutrality between hospitals and ASCs and encourage the migration of services from the hospital setting to the lower cost ASC setting.
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The proposed rule also includes:
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- Proposed definition of ‘hospital,’ ‘standard charges,’ and ‘items and services’
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- Proposed requirements for making public all standard charges for all items and services
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- Proposed requirements for making public consumer-friendly standard charges for a limited set of ‘shoppable services’
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- Proposals for monitoring and enforcement
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- Method to control for unnecessary increases in utilization of outpatient services
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- Changes to the Inpatient Only list
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- ASC covered procedures list
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- High-cost/low-cost threshold for packaged skin substitutes
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- Device pass-through applications
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- Addressing wage index disparities
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- Changes in the level of supervision of outpatient therapeutic services in hospitals and critical access hospitals
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- Hospital Outpatient Quality Reporting Program
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- Ambulatory Surgical Center Quality Reporting Program
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- CY 2020 OPPS payment methodology for 340B purchased drugs
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- Partial Hospitalization Program rate setting and update to per diem rates
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- Revision to the organ procurement organization conditions for certification
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- Potential changes to the organ procurement organization and transplant center regulations: Request for Information
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3. ESRD and DMEPOS CY 2020 Proposed Rulen
On July 29, CMS issued a proposed rule that proposes to update payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2020. This rule also:
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- Proposes updates to the Acute Kidney Injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities to individuals with AKI
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- Proposes changes to the ESRD Quality Incentive Program
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- Includes requests for information on data collection resulting from the ESRD PPS technical expert panel, on possible updates and improvements to the ESRD PPS wage index, and on new rules for the competitive bidding of diabetic testing strips.
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In addition, this rule proposes a methodology for calculating fee schedule payment amounts for new Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) items and services and making adjustments to the fee schedule amounts established using supplier or commercial prices if such prices decrease within five years of establishing the initial fee schedule amounts. This rule would also:
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- Make amendments to revise existing policies related to the competitive bidding program for DMEPOS
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- Streamline the requirements for ordering DMEPOS items, and create one Master List of DMEPOS items that could potentially be subject to face-to-face encounter and written order prior to delivery and/or prior authorization requirements
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The proposed CY 2020 ESRD PPS base rate is $240.27, an increase of $5.00 to the current base rate of $235.27. This proposed amount reflects a reduced market basket increase as required by section 1881(b)(14)(F)(i)(I) of the Act (1.7 percent) and application of the wage index budget-neutrality adjustment factor (1.004180).
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The proposed rule also includes:
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- Annual update to the wage index
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- Update to the outlier policy
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- Eligibility criteria for the Transitional Drug Add-on Payment Adjustment (TDAPA)
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- Basis of Payment for the TDAPA for calcimimetics
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- Average sales price conditional policy for the application of the TDAPA:
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- New and innovative renal dialysis equipment and supplies
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- Discontinuing the application of the erythropoiesis-stimulating agent monitoring policy
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- Impact analysis:
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nOriginal and complete article published on cms.gov
Aug 8, 2019 | Uncategorized
New changes are coming regarding evaluation and management guidelines. Some of these new changes include updates on medical decision making and code selection. We will be seeing these much needed updates in 2021. Read the article below to get updated on all the other changes that are coming.nnIn an ongoing effort to reduce clinician burden, the “counting” of qualifiers in history and exam will soon be a thing of the past. Exciting changes are on the horizon for evaluation & management guidelines, including updates to how medical decision making (MDM) is determined. Although E/M codes will no longer be selected based on how much history or exam is documented, clinicians should still expect to document when the medically necessary pieces of work was done to fully address the patients presenting problem(s).nnStarting in 2021, code selection will be determined by the number/complexity of presenting problems, data reviewed and the risk of complications. Time will also be another method for appropriate E/M selection. With the new coding guidelines, clinicians will be able to count DAY OF face-to-face time AND non-face-to-face time they personally spend on a patients care. Reviewing tests, other records, ordering medications performance of medically necessary exam can all be used for time calculation.nnOffice visit codes will have new time ranges when the implementation takes place. Fine-tuning clinically relevant documentation, telling clear stories about patient encounters and getting better at time-based capture/reporting now will help prepare for these much needed changes we will be seeing just around the corner in 2021.
Aug 6, 2019 | Uncategorized
Welter Healthcare Partners has successfully completed yet another important project for the State of Colorado. We were asked by the Colorado State Innovation Model (SIM) to create a curriculum to help primary care practices better understand how to integrate behavioral health services into their commercial payer contracts such that these services will be reimbursed and as a result remain sustainable.nnThere are six chapters for this curriculum, made up of both workbooks and webinars to help guide you through the program. This content was developed and produced using funding from the Colorado State Innovation Model, a federally funded, Governor’s Office initiative. Click here to learn more.nnYou may follow this link to the Welter Healthcare Partners website where you can view the videos and workbooks for this curriculum and you can also check out our YouTube channel.
Aug 6, 2019 | Uncategorized
As difficult as it may be, embracing change is essential to growing as an individual, being a better employee and a better person than you were yesterday. Focusing on a positive perspective when faced with difficult challenges or changes can help us adapt when we are pushed out of our comfort zones. The following article focuses on this subject and includes great examples of situations that require adaptability and exercises to help you improve your acceptance to change.nn
Is This Me?nnThink about these statements, and choose A or B:n
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- A) I tend to think of change as bad. B) I tend to see change as an opportunity.
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- A) I dislike change. B) Some change can be worthwhile.
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- A) I feel uptight when plans change at home or work. B) I find changes in plans energizing.
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- A) I hate making adjustments in my routines. B) I make adjustments to routines easily.
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- A) I feel threatened when a challenge arises. B) I like a challenge.
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- A) I often get “locked in” to an idea or approach to solving a problem. B) I’m open to new information when solving a problem.
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nIf you find yourself agreeing with most of the A statements, you may be someone who is uncomfortable with change. If you find yourself agreeing with more of the B statements, you may be more able to adapt as changes demand.nnLooking at your own beliefs and judgments can be an important first step toward greater adaptability. If you are fixed in your thinking, you may struggle against change rather than turning it into an opportunity. Learning to sit with discomfort amidst uncertainty is something every human can benefit from.nnAn agile mindset is one that recognizes that adapting to change is the price of admission for living a meaningful life. Let’s face it, any time you try something new, you face uncertainty and there is risk involved. You never know exactly how things will turn out. For example, you may have to make a decision about whether to take a new job or stay where you are. There are no guarantees the job will be a good fit. If it is, great! You took the leap and it paid off. If the new job isn’t great–you chalk it up to learning. You are wiser, you gain new skills, new connections, and you’re able to translate that into a better decision next time. The bottom line: change is difficult, uncomfortable, and at times downright painful. Our ability to effectively handle the discomfort of change improves through experimentation and repetition.nnHere’s how rigidity, the opposite of adaptability, can show up at work: Imagine an executive who quickly shuts down an idea suggested by a team member for a more tech-based system of project management that could increase productivity. The executive may not realize this “shut-down” reflex has become an unconscious habit, triggered by any suggestion of change, which results in his automatically coming up with reasons the new idea won’t work, rather than why it might. Such a habit keeps things as they are and squelches innovation. This lack of adaptability keeps inefficient practices in place, and, maybe worse, sends a message not to question the status quo. Over time, this results in stagnation, reduced passion, and energy and weaker financial results.nnHowever, imagine if that executive had been more adaptable and asked the rest of the team how they feel about the new idea and whether it’s worth trying. If they express enthusiasm, the adaptable executive might give it a chance to see how it goes. If it works, progress is made. If it doesn’t, something useful could still be learned. There is acknowledgement that innovation and change carry emotional and financial outlays. And the emotional outlay can be lessened with an emotionally agile mindset.nnAdaptability is at the heart of innovation in any environment.nnPeople who demonstrate adaptability combine curiosity and problem solving skills to achieve their goals. Persistence leads them to try new behaviors or methods of getting things done. They are resourceful and creative, especially when budgets are tight. These key building blocks to adaptability–agility, persistence, and trying multiple strategies–are vital skills for success.nnIncreasingly, adaptability is a key differentiator of effective leadership in highly tumultuous industries, such as technology and finance. Leaders who show strong adaptability recognize that their industry is continually changing and are better able to evolve. They realize they can’t be stuck doing the same old thing over and over. They think creatively and take calculated risks.nnThere are numerous case studies of once-thriving companies whose leaders were unable to embrace change, such as Blockbuster, Sears, and Kodak. Alternatively, we all know companies that make phenomenal examples of adaptability, including Apple and Google, who created new products we didn’t even know we needed. They were attuned to shifting trends and feedback from customers.nnConsider current workplace norms: teams are no longer fixed and steady, they form and disassemble; work is increasingly meted out in short-term contracts. And leaders are attempting to prepare a workforce for jobs that don’t yet exist. It should not be surprising then that employers are putting a high priority on the skill of adaptability.nnBy staying adaptable and open-minded, you continue to reinvent yourself and experience significant growth along the way.nnKeep in mind, there are times when there’s a good reason not to change, like preserving quality standards or time-tested effective strategies. The trademark of an adaptable leader, however, is the ability to balance core values with responsiveness in the face of a changing world.nnTry this exercise for developing your adaptabilitynnThink of a change in either your personal or professional life you have recently experienced or are currently experiencing. How do you feel about the change? How are you responding to the change?nnHere are some examples of situations that require adaptability:nnWe are launching a new service line. I’m excited about the possibilities it creates, but a little nervous about whether we’ve thought of everything. I’m doing significant research to position myself as an expert.nnMy daughter just turned 12 and is suddenly becoming moody and withdrawn, spending lots of time in her room and not talking to me or her Dad. I’m scared something might be going on that she’s not telling us.nnNow, ask yourself a series of questions to help find a positive perspective on that change:n
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- What opportunities does this change represent?
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- What positive outcome could I find in this change?
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- What is outside of my control?
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- What is within my control?
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- What is the next (small) action I can take to move in a positive direction?
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- What is the best outcome that might result?
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nAvoiding change is impossible. Instead we can change our relationship to change. We can learn to turn toward what scares us, and in turn, we gradually adapt and grow amidst uncertainty and discomfort in life.nnOriginal article posted on keystepmedia.com
