Healthcare Snapshot

November 2023

PSW Value Spotlight:

Digital Technology and Data Management

The importance of data and technology in healthcare services cannot be overstated, having revolutionized decision making and offering opportunities to improve patient care and increase efficiency. The continued development and integration of data into the healthcare system holds the potential to drive better outcomes, reduce costs, and enhance the overall quality of healthcare services.


The scope of the data and technology department is far-reaching and includes the following areas:


  • Receiving and ingesting data into the PSW databases.
  • Provide reporting and analytics from multiple sources for PSW.
  • Provide support on the Innovaccer population health platform for the PSW Care Management team.
  • Guidance to the organization on best practices and strategies around data management.
  • Supporting internal customers who utilize our various reporting tools.
  • Develop and maintain custom application to meet business needs.

Tamra Ruymann currently serves as the Chief of Digital Health for PSW. She is responsible for leading the Data Management & Analytics and Innovaccer Support teams.


In her 15 years at PSW she has overseen data management, analytics and business intelligence and clinical interfacing as well as led the development of PSW’s customized population health platform.


Interested in hearing more about our population health platform services or data capabilities? If so, please contact communications@pswipa.com.  

CMS Releases 2024 Medicare Physician Fee Schedule Final Rule

CMS has officially released the final 2024 Medicare Physician fee Schedule Rule. Many important changes to the Medicare Shared Savings Program (MSSP) were finalized, including:


  • The creation of a new quality reporting option in 2024: Medicare CQMs.
  • Will include more than just ACO assigned beneficiaries.
  • CMS will share a list of eligible patients quarterly with ACOs.
  • Finalizing the proposal to eliminate the negative regional adjustment.
  • Introduces the new V28 Risk Adjustment Model with a 3-year phase in approach.
  • Adds a third step to the assignment process beginning January 1, 2025, that expands the window for a physician visit to two years.
  • QP determinations will remain at the APM entity level.
  • Implements a 1-year delay to the requirement for ACO participants to report MIPS Promoting Interoperability requirements.


PSW continues to advocate alongside our partner groups in favor of the Value in Healthcare Act. This act would extend the Advanced Alternative Payment Model (AAPM) bonus and many other important policies for ACOs.


To view the final rule, click here.

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Patient Success Story

A PSW patient with a complicated medical history, including gastroparesis following a GJ tube placement, received outreach from PSW following a visit to the Emergency Department (ED). The patient was seen in the ED for abdominal pain that was so severe they were unable to complete their scheduled home enteral nutrition.

During the PSW outreach, the nurse care manager identified that the patient had recently moved out of the area and was out of nutritional supplies. The nurse care manager was able to assist the patient in finding a new nutritional supplement provider and order more supplies.

 

Unfortunately, the patient continued to have severe abdominal pain while receiving services in the home and was unable to tolerate their enteral nutrition. They began to lose weight and were declining in level of mobility and strength. Despite having their tube evaluated and determined to be working properly, the patient continued to raise concerns over their abdominal pain that was not being addressed. This began to have an impact on the patient's mental health by increasing anxiety and depression.

 

The PSW nurse care manager continued regular follow-up to support their physical and emotional needs. The nurse care manager advocated for the patient's concerns about pain, and helped to secure an appointment at a local facility to have their tube replaced. The patient's pain was relieved following the procedure, and they are working with the PSW nurse care manager to support needs related to weight management and nutrition. The patient has also reported that having the PSW nurse care manager's support was very important to help reduce their anxiety and depression.

Resources

2024 Medicare Physician Fee Schedule Rule

LaHood, DelBene Legislation Receives Broad Support to Incentivize Value-Based Health Care

All-Payer Value-Based Contracting in Organizations with Medicare ACOs

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