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Reimbursement Radar: How 2019 rule changes from CMS will affect cardiologists

Posted on: 12.13.18

On November 23, 2018, the Centers for Medicare & Medicaid Services (CMS) published the final rule changes for the 2019 calendar year. How will they affect nuclear medicine and your practice in particular? After all the noise in 2018, the changes were minimal. It seems that 2019 will be following suit:

Hospital procedure rates remain nearly static

On the hospital side, CMS has continued to evaluate and adjust the cost of procedures that are either under- or overvalued. The majority of nuclear medicine procedures will see a minimal increase of between 0.5% and 2.2%. The slightly more significant but far from dramatic adjustments will be made to codes for administering radiopharmaceutical therapies, which will see a decrease of 3.3%.

Fewer measurements

One notable change was made in direct response to the administrative burden that meaningful use measures and quality reporting placed on providers. In 2019, not only will no new meaningful use and quality measures be implemented, but CMS will look to reduce the current policy. The reduction is aimed at allowing providers the ability to focus on the measures that are most meaningful and impactful on their patient care.

Site neutrality payment cuts

More interesting, however, was CMS’ decision to neutralize payment variances between the Hospital Outpatient Prospective Payment System and the Ambulatory Surgical Center Payment System. By implementing a Physician Fee Schedule (PFS)-equivalent payment rate for an off-campus provider-based department (PBD) clinic visit that is paid under the OPPS, patients will benefit from high-quality care and lower copayments.

In order to further evaluate the unnecessary increases they’ve seen in services rendered at PBDs, however, CMS will establish a moratorium on the addition of any new off-campus PBDs. Existing locations will continue with business as usual, and CMS will monitor the total amount of payments made under the current arrangements. Any follow up to this issue will likely be addressed in the 2020 or 2021 ruling.

Physician fee schedule sees positive change

Overall, current projections are seeing a negligible increase, barely 1%, in nuclear medicine. Procedure rates are slated to remain largely the same, based on the national unadjusted average.

An additional year for AUC preparation

One of the biggest reliefs in the final ruling has to do with the effective date for adherence to authorized use criteria (AUC), which has been postponed numerous times and last slated to take effect on July 1, 2019. Many of the medical societies voiced their concern about the preparedness of providers and their ability to implement a new system by mid-year. CMS responded by designating 2019 as an education year with a revised effective date of January 2020.

How practices are making the shift to Value-Based care

Posted on: 04.19.18

When you think about positioning your practice for success and overall sustainability, the transition to value-based care should be one of the first things that comes to mind. The shift from the fee-for-service model is no longer a trend, but a critical necessity in today’s healthcare environment. The value-based approach is the future of patient care and resisting–or even hesitating–will cost your practice the loss of potential revenue and overall viability.

The central idea behind value-based care is to create a system that is not measured solely by services rendered. Its objective is rooted in redefining quality care by enhancing both patient outcomes and experiences, and improving the health of the patient population, while ultimately reducing the increasingly high costs of healthcare.

Transitioning to this new school of thought will include modifications to organizational workflow and a move away from episodic care. Here are a few practical steps you can take as you prepare your practice for value-based success.

Know your patient population

Under the value-based reimbursement model, patient analytics is a critical factor in population health management. Patients with the highest risk of hospitalization, such as chronic or complex conditions, typically incur the highest health care costs. They’re also the ones who suffer most from fragmented care. Identifying this population will help you isolate areas for improvement.

Analytics also use trends to reveal gaps in care by identifying individual patients who may be accessing health care outside of the traditional channels. For example, when and why do patients visit an urgent care facility or emergency room? Is it after hours or on the weekend? Had they been recently discharged from the hospital? Implement a solution that drives utilization toward a high-quality, lower-cost alternative. Ultimately, patients must feel their needs are being met without going outside the box. In some instances, enrolling patients in a care transition program might be the answer.

Analytic software can also help you identify other unnecessary costs. Compare costs for imaging services used by your practice or the cost of supplies. Your findings may reveal that an imaging center used by your practice is more expensive than another comparable one in your area. That’s an easy way to reduce expenses.

Invest in the right technology

With value-based care reimbursement, it’s critical to employ the technologies that support your overall goal. Clinical decision support tools provide the knowledge and patient-specific information that enhances decision-making in the clinical workflow and ultimately improves care. By providing a playbook of protocols, these tools eliminate waste by minimizing unnecessary tests. They also improve patient safety by giving providers access to a patient’s complete medical records, a comprehensive view of their overall health, and a method of easily and quickly sharing patient data with other health systems as needed.

Improve patient engagement

Engaging patients in their health and care is a critical component of value-based care. Patients who are engaged have greater knowledge, ability, skills, and willingness to successfully manage their health and are more compliant with doctors’ orders and recommendations. Investing in engagement leads to better outcomes and lower costs, which are both critical in value-based care.

Patient portals are an ideal method of improving engagement because you effectively give patients access to your practice and a level of control that empowers them. Enrollment, visit summaries, online appointment booking, collecting family health history, and email communication are just some examples of the value and efficiency it can offer your practice and your patients.

Couple that with the creation of care teams who follow patients through their care cycle and beyond, you allow for a more longitudinal care approach. This approach can bring about sustainable change in your patient relationships and how they view their care.

Each step on the way to value-based care should be viewed as a learning experience. As these experiences provide you with more knowledge and understanding about what works best, you can make the changes that will better meet your patient needs.

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