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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.

POSTS BY TAG | 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 BPCI Advanced 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.

pMD Helps Practices Participating in Alternative Payments Models


Not only does pMD, a MIPS registry, 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.

Image: New York Times/Craig Frazier

Here's The Latest in Health Care:


•  Vitamin D deficiency is likely being over tested and over treated, according to a recent study in Maine. Vitamin D popularity began back in 2000 when medical journals began publishing studies of illnesses believed to be linked to vitamin D deficiency. As a consequence, healthy people who believe they have a deficiency are taking dangerous levels of supplemental doses.  Read More

•  A study published in JAMA this week found that value-based programs yield lower hospital readmission rates and significant cost savings. Researchers examined 2,837 U.S. hospitals between 2008 and 2015 and found that participation in 1 or more of Medicare’s value-based programs, including Meaningful Use, Accountable Care Organization, and the Bundled Payment for Care Initiative, was associated with greater reductions in 30-day readmission rates.  Read More

•  It’s now easier for physicians to get licensed in multiple states thanks to the new Interstate Medical Licensure compact, which launched last week. Qualified physicians can apply for licensing in 18 participating states. This agreement will ease the administrative burden for physicians who practice medicine in multiple states, including locum tenens doctors, doctors in metropolitan areas that include more than one state, and doctors who provide telemedicine services.  Read More

•  New analysis by the Pennsylvania Patient Safety Authority shows a rising number of medication errors that were attributed in some part to electronic health records and other technologies used to monitor and record patients’ treatment. Researches attributed the errors to system problems and/or user mistakes.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture software.
As a software engineer at pMD, I get to straddle the cutting edges of two very different industries: health care and technology. I’m familiar with how quickly the technology world moves -- developers jumping on a new front-end technology every other day, “sprinting” through “agile” hoops at the speed of light. But I’ve been surprised to learn how thoroughly the health care environment is also evolving. I’ve learned that over the next few years, physicians will be facing fundamental changes in the way they see and treat patients. It has been one of the most interesting parts of my job to not only learn about these changes, but to help providers transition to the health care environment as it transforms around them.

With value-based health care on the horizon, providers will need to bring the patient into the center of their care. For the more than 100 million Americans with chronic illnesses, for example, the occasional face-to-face encounter with a provider might not be enough. Obviously, for those types of patients, providers must think beyond the 30 minute annual checkup; with constant management of medication, treatment, and services. In today’s day and age, providers often have difficulty bridging communication gaps, leading to inconsistent data, increased expenses, and poorer outcomes for their chronically ill patients.

We are trying to solve that problem at pMD, and to help providers proactively coordinate their patients’ care. Every new feature we are working on supports providers as they take on this new paradigm shift. One of the simplest ways we help providers is by showing them how they can get reimbursed for adapting to this new, patient-centric health care model. For example, since 2015, Medicare has reimbursed providers who offer at least 20 minutes a month of non-face-to-face medical care to patients with two or more chronic diagnoses. For our providers -- who have been using pMD's charge capture tool to record services outside of face-to-face encounters like medication reconciliation review and care coordination, and may soon start to use pMD for patient education -- this could prove to be a fruitful change that helps them transition to tomorrow’s health care system.