The pMD Blog

Welcome to the
pMD Blog...

where we cover interesting and relevant news, insights, events, and more related to the health care industry and pMD. Most importantly, this blog is a fun, engaging way to learn about developments in an ever-changing field that is heavily influenced by technology.

THE FUTURE OF HEALTH CARE IN VALUE-BASED CARE
Increasing medical practice revenue


As health care organizations in the U.S. move towards electronic systems to manage their patient records, data collection and analysis on health care information has become easier for entities like the Centers for Medicare and Medicaid Services (CMS). As a result of this, trends in patient outcomes and patient health history can provide useful information. This has given way to a new format of hospital reimbursement in health care, which is called value-based care.

VALUE-BASED CARE AND ALTERNATIVE PAYMENT MODELS


Value-based care is a broad term for a reimbursement model for health care organizations (HCOs) in which CMS or other insurance institutions will reimburse based on the quality of care provided and the quality of patient outcomes. This means that providing efficient and quality care to a patient will result in a higher reimbursement for the HCO, while inefficient care will result in a lower reimbursement to the organization. This differs from the traditional fee-for-service model, where providers are reimbursed based on the service provided to a patient, regardless of quality of care or outcome.

One way that CMS has begun to implement value-based care models in the U.S. is by offering certain HCOs the opportunity to participate in Alternative Payment Models (APMs), which is their version of value-based care. There are nearly 100 APMs offered by CMS that organizations can participate in, each of which has different participation requirements and different quality measures by which patient outcomes are measured. The Bundled Payment for Care Improvement (BPCI) Advanced model is a great example of an APM.

BUNDLED PAYMENT FOR CARE IMPROVEMENT (BPCI) ADVANCED MODEL


The BPCI Advanced model is just one example of a value-based payment model, and it’s one that pMD can largely accommodate today. The quality measures tracked by this payment model are: 

1. Unexpected hospital readmission for the patient in question within 30 days of discharge
2. Existence of an Advanced Care Plan
3. Quality of care based on a list of 26 CMS-defined Patient Safety Indicators  

How are these quality measures reported and tracked? With HCOs' profits on the line, most would not want to participate in a reimbursement model that could lose them money if they’re unprepared. Fortunately, with the BPCI Advanced model, and many of the other models offered by CMS, these quality measures can be completely tracked through electronic means, providing a more streamlined way to submit that information to CMS. The additional work required here, however, would be the time it takes to complete some advanced care planning with your patients, a practice that may not have been standard but has been shown in data to have a positive impact on patient outcomes in health care.

Not only does pMD have the capability to accurately submit claims electronically but we also provide the tools to help organizations better navigate patient care. Our comprehensive platform offers customizations to accommodate the growing needs of practices participating in alternative payments models. pMD’s functionality is constantly evolving to support customers looking to participate in value-based care payment models, improve patient outcomes, and maximize reimbursement.

 

To find out more about pMD's suite of products, which includes our charge capture and MIPS registrybilling servicestelehealthsecure messagingclinical communication, and care navigation software and services, please contact pMD.
5G ACA Account Management accurate coding ACI adoption Advancing Care Information Advice AHCA AHRQ AI Alternative Payment Model Amazon S3 Android API Apple appointment reminders Artificial Intelligence arts Audit Award Bay Area BCRA Benefits Best Place to Work Best Practices Big Data Billing Billing & Collections Billing Service Billing Services bootcamp BPCI BPTW Bundled Payment Model Bundled Payments Business relationships Care Communities care coordination Care Navigation Care Team Career Fair CDC Charge Capture Charge Capture App Charge Capture Software Charge Capture Solution Charge Capture Statistics Charge codes Charge Lag Charge Reconciliation CHIP CIO Claims Clinical Communication clinical data Clinical Data Registry Clinically integrated network Cloud CMS cms regulations Coding Collaboration Communication Company Culture Conferences Connected Health Record contact practice Coronavirus COVID COVID-19 COVID19 Cross-functional culture custom reports Customer Interaction customer relations customer service customer success customer support Customers Cyber Security cybersecurity Developer DHHS Diagnosis codes Dialysis discharge instructions Doctor EHR elderly Electronic Charge Capture Eligibility EMR Encryption End-to-End Platform epidemic Expansion FDA FHIR Flu fundamentals Gen Z GI GI Outlook Goals group messaging Health Care Health Care Technology Health Care Web Health Care. Health Care IT health data Health Information Exchange Health Record Healthcare Healthcare Data healthcare interface healthcare interface integration healthcare software HIE HIPAA HIPAA Compliance hipaa compliant communication hipaa compliant communication platform HIPAA-Compliant Hiring HL7 Holidays Home dialysis Home Health Hospital Census Hospital Communication humanity IA ICD-10 ICD-11 Immunizations Implementation Improvement Activities in-app calling inclusive software incorrect billing increase revenue injury rehabilitation innacurate coding Instant capture Integration interface interoperability iOS iOS 8 iOS7 iPad iPhone iPhone 6 IT Lead Generation length of stay LGBTQIA Long Term Care LTC Machine learning MACRA Medaxiom Medical Billers Medical Billing Medical Billing & Collections medical billing denials and solutions Medical claims Medical Coding medical coding accuracy medical coding quality Medical Errors medical practice revenue Medical Record Medical Software Medicare Mental Health Mentorship Messaging Messaging with Patients MGMA MIPS MIPS Registry mobile Mobile App Mobile Charge Capture Mobile EHR Mobile Health Mobile Messaging Mobile Payments Mobile security Mobile Software Mobile Technology Mobile telehealth Modern Healthcare Native App natural language processing Network new feature new features news NIH nlp OCM onboarding Oncology Care Model operations opioid crisis Pandemic Parenting Partnership partnerships Patient Patient access Patient Adherence Patient App Patient Care Patient Chat Patient chat routers Patient Communication patient data Patient Engagement patient experience patient experience cycle Patient Generated Health Data Patient Handoff Software Patient Information Patient Messaging Patient payments patient portal Patient Record Patient Safety Patient satisfaction Patient Simulators patient support Patient Visits Patient-Centric PCP Performance bonus PHI Phishing Scams Physician Physician burnout pmd pMD Pro pMD Team population health Population Health Management Post-COVID PQRS Practice Management Pregnancy Press Release Product Development Productivity products Promoting Interoperability Protected Health Information QCDR QPP Quality Data quality reporting Quality Scoring Ransomware RCM Recruiting Recruitment Reimbursement remote jobs Remote Work Reporting reports Residents Responsibility revenue cycle management ROI Rural communities Ryuk Sales Secure Communication Secure Data Secure Messaging Secure Messaging Video Secure Text Messaging Secure Video Secure Video Chat Security Audit self care seniors sexual orientation and gender identity SF Biz Times SMB SNF SNOMED-CT SOC 2 software vendor SOGI Spear Phishing Specialty Care success support TCM TDM Team Team culture Teamwork technology telehealth telehealth reporting Telemedicine telemedicine in long term care Telemedicine skilled nursing facilities Teletherapy Text Messaging texting Thanksgiving Therapeutic Drug Monitoring time-based billing training transgender Travel Upgrades UX Design VA vaccination records vaccinations Vaccine Value-based care Video Calling Video chat video communication video conferencing Virtual Care Virtual Visit voice calling voice memos WannaCry Wearable Device wearing many hats Web App wellness wfh Wireless Work From Home Work Life Balance Workflow optimization Workplace Culture