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 Six
Reasons Your Risk Scores are Inaccurate
As we enter the third quarter of 2020, healthcare organizations have
been struggling for months to balance priorities and resources while
navigating new technologies and processes to keep employees and
patients safe during the coronavirus.
The AAFP and MGMA both recently reported, “Medical group practices of
all sizes and specialties have felt the direct and indirect financial
impact... On average, patient volumes have dropped 60% nationally since
the start of the pandemic attributing to a 55% decrease in
fee-for-service revenues.
Medical practices are not alone, hospital revenue is dropping by an
average of $1.4 billion per day as COVID-19 continues to impact patient
volumes, according to Crowe RCA Benchmarking analysis.
Risk Scores and
Value-Based Payments
As more and more healthcare organizations are moving away from
traditional fee-for-service payment models, how will this decrease in
utilization impact risk scores and value-based payments in the future?
According to Avalere, the deferral of care has resulted in fewer claims
and diagnoses among Medicare Advantage (MA) enrollees, which will
likely lead to a 3%–7% reduction in 2021 risk scores and lower plan
payments.
To read the full
article click here
CMS proposes telehealth changes under Trump executive order
The Centers for
Medicare and Medicaid Services has started implementing the proposed
rules needed to fulfill President Trump's executive order on Monday to
make temporary telehealth services permanent, especially for rural
areas.
As directed by Trump's order "Improving Rural and Telehealth Access,"
CMS said it is taking steps to extend the availability of certain
telemedicine services after the public health emergency ends.
Trump on Monday outlined 135 telehealth services to become permanent
that CMS added on a temporary basis during the emergency.
These include initial inpatient and nursing facility visits, physical
therapy, home visits, mental health counseling, substance abuse
treatment and discharge day management services that can be paid when
delivered by telehealth.
To read the full
article click here
Wearable
Sensors for COVID-19: A Call to Action to Harness Our Digital
Infrastructure
The COVID-19
pandemic has brought into sharp focus the need to harness and leverage
our digital infrastructure for remote patient monitoring. As current
viral tests and vaccines are slow to emerge, we see a need for more
robust disease detection and monitoring of individual and population
health, which could be aided by wearable sensors. While the utility of
this technology has been used to correlate physiological metrics to
daily living and human performance, the translation of such technology
toward predicting the incidence of COVID-19 remains a necessity. When
used in conjunction with predictive platforms, users of wearable
devices could be alerted when changes in their metrics match those
associated with COVID-19. Anonymous data localized to regions such as
neighborhoods or zip codes could provide public health officials and
researchers a valuable tool to track and mitigate the spread of the
virus, particularly during a second wave. Identifiable data, for
example remote monitoring of cohorts (family, businesses, and
facilities) associated with individuals diagnosed with COVID-19, can
provide valuable data such as acceleration of transmission and symptom
onset. This manuscript describes clinically relevant physiological
metrics which can be measured from commercial devices today and
highlights their role in tracking the health, stability, and recovery
of COVID-19+ individuals and front-line workers. Our goal disseminating
from this paper is to initiate a call to action among front-line
workers and engineers toward developing digital health platforms for
monitoring and managing this pandemic.
To read the full
article click
here
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Are
you prepared to make the switch to Value-Based Reimbursement?
Transforming to
a valued-based reimbursement model has changed the way providers
regularly bill for care. It is now imperative that instead of billing
for the quantity of services provided, that providers bill for the
quality of care they deliver. Providers and health systems risk
financial penalties and lower reimbursements if they do not
successfully participate in this switch.
What
are the benefits of switching to a model focused on Value?
1.
Improvements in quality, fostered from a patient centered approach to
care
2. Promote proactive care rather than reactive care
3. Drives improvements in care at a reduced cost
4. Financial incentives; increasing the number of ways
providers can get paid for the care they deliver
5. Improve patient experience with quality and satisfaction
6. Enhanced population health by focusing on health
outcomes, morbidity rates, and disparities in care
How can I
successfully switch to a model focused on Value?
1. Meet
quality standards while cutting cost
2. Create a team-based approach to care
3. Continuously monitor data using population health
management tools and resources
4. Ongoing education and training on population
health, quality measures, and valued-based reimbursement programs
5. Coordinated Care that is evidenced based to ensure
efficient and effective care across all health care systems
6. Implement and monitor quality improvement plans
How can we help?
FocusMD Inc is
dedicated to supporting medical providers and regional
hospitals as they strive to deliver quality and cost-effective care to
their patients.
Our team offers Population Health Management (PHM) consulting along
with implementing various quality care initiatives.
Our team also provides services to manage and maximize reimbursements
from value-based reimbursement programs.
To receive more information about the services we offer and the many
ways we can help your organization, please reach out to us at
412-428-7700, option 1
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