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The HHS Agenda: Smart Spending, Better Care
By Sally Eggleston, MBA, BSRT (T)

Better, smarter, healthier: what everyone wants to be. But can we be 30 percent better, smarter and healthier by 2016? Or 50 percent by 2018?

The answer rests on how and what we’re attempting to do better, smarter and healthier. In our world, we mean improved wholeness of care balanced with wiser spending. The Department of Health and Human Services has set goals for implementing alternative payment models and value-based payments. Do you think your practice or hospital can get better and smarter—and your patients healthier—to meet them?

In a New England Journal of Medicine online article, "Setting Value-Based Payment Goals — HHS Efforts to Improve U.S. Health Care," Sylvia Burwell writes:

    The Department of Health and Human Services (HHS) now intends to focus its energies on augmenting reform in three important and interdependent ways: using incentives to motivate higher-value care, by increasingly tying payment to value through alternative payment models; changing the way care is delivered through greater teamwork and integration, more effective coordination of providers across settings, and greater attention by providers to population health; and harnessing the power of information to improve care for patients.

    Read the full article here.

Currently, providers could be seeing as much as a 7 percent decrease on 2017 Medicare payments based on what they're performing and reporting today, in 2015. Just this month, many providers are seeing changes on their Medicare payments: a 2 percent sequestration reduction, a 2 percent PQRS reduction and a 3 percent EHR reduction. What can be frustrating is the fact that a private practice physician working in a hospital outpatient department may have absolutely no control over EHR utilization, yet can be penalized if he doesn’t file for a hardship. Even more frustrating is the fact that if you do control the EHR utilization and decide to not attest until the deadline of March 20, 2015, you’re being penalized anyway and after attestation will have to fight to get those monies back. The Value Based Modifier is also coming into play and while there’s opportunity for incentives, there’s always the risk of penalties.

Gone are the days, too, when a solo physician practicing in a hospital setting could get by with outsourcing his billing and just having an accountant on staff. Now, it’s likely that having a practice manager on staff will be essential in ensuring all quality measures are not only documented but reported. The idea that these shifts in payment policies aren’t going to reach oncology is no longer substantiated. Fee for service really is being replaced, and the focus will be on some form of bundled, value-based alternative payment methodology.

In "Medicare Moves Toward Value-Based Oncology Payments" on modernhealthcare.com, Sabriya Rice writes:

    The CMS Innovation Center plans to test a new oncology payment model intended to address the spiraling costs of cancer care and improve quality for beneficiaries.

    As part of a broader federal push to reward hospitals and doctors for value rather than the volume of services they provide, the CMS is inviting oncology practices and solo practitioners to join a five-year test set to begin in the spring of 2016.

    Under the new model, the CMS will deliver episode- and performance-based payments designed to reward quality and care coordination. Participants will receive, for example, a monthly $160 care-management payment for each Medicare fee-for-service beneficiary during care episodes. Those episodes start during the beneficiary’s initial chemotherapy treatment and terminate six months later.

    The substantial economic burden of cancer in the U.S. is expected to grow. If recent trends in incidence, survival, and costs continue, the cost of cancer care would increase to $172.8 billion dollars in 2020, a 39% increase from 2010, according to a 2011 study from the National Cancer Institute.

    Read the full article here.

Changes in the health care delivery system and payment models mean it’s more important than ever for your staff and facility to be efficient and up-to-date. Rather than trying to sift through mountains of ever-emerging reports, releases, and fact sheets, rely on Revenue Cycle Billing to serve as your centralized information center. Our consultants can cull through it all, streamlining updates of what you need to know and guiding you through implementation. To find out how we can help, please contact us at info@rcbilling.com or call 512.583.2000.

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