Neurolutions’ Post

TEAM  (Transforming Episode Accountability Model) a new alternative payment model is set to be tested in Jan 2026 for select CBSAs. Mandatory, episodic-based, CMS bundled payment model coming in 2026 for selected areas in Alabama CBSA’s- specifically Huntsville and Alexander City. ·     The new payment model will essentially help address fragmented care and improve patients’ transition of post-operative care for select surgical procedures. ·     The surgical procedures (inpatient and/or outpatient) included in the model will be lower extremity joint replacement, surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedures. ·     Essentially the participating hospitals will bill for Medicare FFS but be provided with a target price (risk-adjusted) which CMS deems should be the cost of care for a 30-day period. If total costs are below the target price and quality measures are met, then the hospital may earn additional payment from CMS. ·     The participants will be required to refer patients to a primary care service for continuity of care. This will be challenging since we are already facing a shortage of primary care physicians. ·     Overall, good for patient care and aligns incentives for participating hospitals. The question here is whether the financial incentives are enough to sustain the financial risk hospitals are taking.  Time and appropriate data will be key to parsing this out. ·     Healthcare has always been a TEAM (no pun intended) endeavor.  We shall see if this helps or complicates the landscape in our ability to deliver positive outcomes for the great people of Alabama. https://lnkd.in/e6y4nMtj

Early research we conducted as a member of Center Surgical Outcomes and Quality and an American College of Surgeons-sponsored RWJ Clinical Scholar nearly 15 years ago was focused on understanding the causes of hospital readmissions. Fast-forward, we at HubMD now address one of the factors thought to contribute to readmissions- discontinuity of care, especially specialty care follow-up- through our Virtual Post-Discharge Clinical Transitions program. Focusing initially on patients who have needs for mental health and substance use disorder services, we have learned many important lessons: 1. Connecting with patients takes time and trust. (And often many failed attempts!) 2. Stakeholder engagement with hospital leadership and emergency department physicians is crucial 3. A comprehensive care team matters as patients barriers to post discharge specialty care access vary (e.g., confirming insurance status, appointment making, arranging transportation, clinical assessments, information gathering in abscence of HIEs, etc.) 4. Sharing data and simplifying tech use is key. As we expand to addressing the post-discharge transitional care needs for other at-risk specialties and conditons, we believe we are on a path addressing yet another gap. Patients who have seen a surgeon or cardiologist shouldn't have to go back to their pcp after being told by a hospital-based specialist that additional specialty care follow up and intervention is needed. Yet, for many medicaid patients, that's exactly what happens. It needs to change. And it can. William Jih, M.D., M.B.A. and his team working with HubMD is making that change happen in the Inland Empire.

📣 The Centers for Medicare & Medicaid Services Innovation Center recently announced a new proposed model, the Transforming Episode Accountability Model (TEAM), advancing on prior episode-based payment models Bundled Payments for Care Improvement Advanced (BPCIA) and Comprehensive Care for Joint Replacement (CJR). TEAM is designed to hold hospitals responsible for coordinating care for Medicare patients.  If launched, TEAM will run from January 1, 2026, and run for five years. TEAM aims to enhance care quality for Medicare patients during specific surgeries, decreasing rehospitalization and recovery time. This also aims to cut Medicare spending and promote fair outcomes. TEAM members will be responsible for episode quality and cost, ensuring patient referrals to primary care services. This supports CMS's goal of all Medicare patients having a care relationship with cost and quality accountability by 2030. Major episodes of focus include:  🔹Lower extremity joint replacement (470) 🔹Surgical hip femur fracture treatment (481) 🔹Spinal fusion (460) 🔹Coronary artery bypass graft (235) 🔹Major bowel procedure (330) Performance will be measured on quality metrics, including hospital-wide all cause readmissions, patient safety and adverse events composite measure, and patient-reported outcomes.  Interested in learning how HDAI can help you with this and other value-based programs and quality improvement initiatives? Let's chat!  #cms #innovation #valuebasedcare #qualityimprovement #dataanalytics #primarycare #readmissionreduction #aco #healthcare https://lnkd.in/eKy9eKGT

🔔 This is a great article by the former CMS Chief Medical Officer Dr. Fleisher. I take one exception to his point in this article: “Looking forward, establishing more standardized and predictable communication between agencies can significantly bolster their capacity to evaluate evidentiary standards for novel surrogate endpoints to ensure the right drugs and devices get to the right patients.” 💭 To me, Dr. Fleisher presupposes robust competition in the healthcare space exists in order to facilitate CMS & FDA moving the healthcare needle forward. A limited healthcare system may never ensure that right devices, drugs or services will get to the right patients if it is cost prohibitive. 💡 The problem with this is as healthcare market leaders consolidate, competition becomes limited which narrows choice and access to health services which then makes healthcare market leaders too powerful which then makes them complacent. 💣 Complacency is the graveyard for innovations. 🤯 A Jan 16, 2023, Forbes article by Dr Robert Pearl says it best: “De facto monopolies abound in almost every healthcare sector: Hospitals and health systems, drug and device manufacturers, and doctors backed by private equity. The result is that the U.S. healthcare has become a conglomerate of monopolies.” 📰 Curious to hear your counter points to mine #cms #fda #federalcontracting #healthcare

Merit-based Incentive Payment System Measures for #Cardiologists #MIPS #Coding   1.     What is MIPS? ·       The Merit-based Incentive Payment System (MIPS) is one of the two tracks of the Quality. Payment Program, which implements provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). · ·       Visit QPP.CMS.GOV to understand program basics, including submission timelines.   2.     What are the Measures that provider Must Submit to Successfully Participate in MIPS? ·        If you are participating in the Quality Payment Program through MIPS, you will be able to pick your pace the first year through three participation options—test, partial, and full. Your Medicare payment adjustment will be based on submitting data and your performance for the following MIPS categories: Ø Quality Performance Category - Assess the value of care to ensure patients get the right care at the right time. Quality has 60% weightage. Ø Improvement Activities Performance Category - It includes Support care coordination, patient engagement, patient safety, population management, and health equity. This has 15% weightage. Ø Advancing Care Information Performance Category – This includes Support the secure exchange of health information and the use of certified electronic health record technology (CEHRT). This has 25% weightage. Ø Cost Performance Category – It helps to create efficiencies in Medicare spending. This has 0% weightage.   Source - https://lnkd.in/g7C3zn5H        

The recently released 2022 RPM CMS data showed a 41% increase in billing CPT Code 99454, driven by Internal Medicine, Cardiology, and Family Practice.  Cardiology had one of the biggest increases with a 66% increase in billing, demonstrating the growing utility of RPM to monitor blood pressure and heart health. CPT 99454 Code Volumes by Specialty Internal Medicine - 377,197 Cardiology - 288,103 Family Practice - 217,515 Nurse Practitioner - 80,524 Nephrology - 52,303 Interventional Cardiology - 47,306 Pulmonary Disease - 32,494 Clinical Cardiac Electrophysiology - 27,841 Geriatric Medicine - 23,673 Endocrinology - 17,984 #rpm #remotepatientmonitoring #cms #cptcodes #devices #healthcare

Merit-based Incentive Payment System Measures for #Cardiologists #MIPS #coding   1.     What is MIPS? ·       The Merit-based Incentive Payment System (MIPS) is one of the two tracks of the Quality. Payment Program, which implements provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). ·       Visit QPP.CMS.GOV to understand program basics, including submission timelines.   2.     What are the Measures that provider Must Submit to Successfully Participate in MIPS? ·        If you are participating in the Quality Payment Program through MIPS, you will be able to pick your pace the first year through three participation options - test, partial, and full. Your Medicare payment adjustment will be based on submitting data and your performance for the following MIPS categories: Ø Quality Performance Category - Assess the value of care to ensure patients get the right care at the right time. Quality has 60% weightage. Ø Improvement Activities Performance Category - It includes Support care coordination, patient engagement, patient safety, population management, and health equity. This has 15% weightage. Ø Advancing Care Information Performance Category – This includes Support the secure exchange of health information and the use of certified electronic health record technology (CEHRT). This has 25% weightage. Ø Cost Performance Category – It helps to create efficiencies in Medicare spending. This has 0% weightage.   Source - https://lnkd.in/gHt-VRr5        

CMS's upcoming Transforming Episode Accountability Model (TEAM), launching on January 1, 2026, marks a significant advancement in episode-based alternative payment models. TEAM builds on the successes and lessons learned from previous models, with a strong focus on improving patient outcomes through coordinated care. This mandatory model will require hospitals in selected geographic regions to be accountable for the cost and quality of care from surgery through 30 days post-discharge, incentivizing more coordinated care transitions and reducing avoidable readmissions. TEAM also incorporates measures to prioritize health equity and address climate change impact on healthcare.  The launch of this model represents a significant step forward in transforming the healthcare landscape and enhancing value-based care for Medicare beneficiaries. https://lnkd.in/eKy9eKGT

MDMA recently responded to the Centers for Medicare & Medicaid Services (#CMS) request for comment on information collection related to its planned #ASC #priorauthorization demonstration. MDMA wholeheartedly supports #CMS efforts to investigate fraud and steward precious healthcare resources; however, we have serious concerns over the agency’s expanding #priorauthorization efforts, which impose burdensome requirements on #providers and deny #beneficiaries timely access to #innovative medical technologies. Our recent letter also reiterated our strong concerns over the creation and expansion of the #priorauthorization for certain hospital outpatient (#OPD) services program, which extends to medically necessary, non-cosmetic services. MDMA’s concerns are shared by Members of #Congress and over 40 healthcare stakeholder organizations. Congress and #CMS we must ensure all #beneficiaries maintain appropriate and timely access to care in all healthcare delivery settings. We look forward to working with #CMS on our shared commitment to improving access, for all #beneficiaries, to the best and most innovative technologies the #medtech industry has to offer. #CMS #Priorauthorization #MedTech #Patientaccess 

I'm not sure how Centers for Medicare & Medicaid Services or US Congress can justify this approach to cancer prevention. - new Medicare proposal will result in Medicare payments reduced by >7% over last 4 years - when adjusted for inflation, Medicare payments have declined by 30% in the last 20 years - from 2007 to 2022, reimbursements for colonoscopies and biopsies decreased 38% - an average colonoscopy costs $1600-2400. Of that, the physician fee is about 10%. Yes, you read that correctly. We are all aware of increasing costs especially since COVID. Reducing reimbursement while costs go up will profoundly affect delivery of care, if it hasn't already. If you're outside a metro area, can you find a GI doc? If so, what's the waitlist for a screening colonoscopy? It's only a matter of time until physician offices limit the number of Medicare patients/month, or stop seeing them altogether. #healthcare #colonoscopy #medicare #reimbursement Michael Bass, M.D.