The shift to value-based care requires a greater focus on cost and quality, but to ensure quality, you need to do more than review and report results annually. Best practice approaches include things like ongoing measurement, continuous course correction and end to end workflow analysis. Multi-Year Quality Strategy Planning keeps you on the path to value-based care by bringing your plan performance into greater focus and enabling you to make faster, smarter decisions with evidence-based insights and simplified processes.
You can more effectively measure, monitor, and improve performance associated with quality reporting with programs like star ratings and HEDIS quality measures, while boosting efficiencies, saving time and resources with services aimed to assist in implementing your practices care management strategies and medical record review validation to support your annual audit process. These are just a few examples of items covered into Edafio’s multiyear quality strategy planning approach.
Edafio can provide a Multi-Year Quality Strategy Planning for your organization’s current state related to your unique setting, payers, and quality programs. Our assessment can also help you identify if you may be eligible for potential additional revenue opportunities.
With Multi-Year Quality Strategy Planning practices can better leverage their resources into areas with the largest positive value-added impact and identified revenue sources, which they may not have sought out in prior performance periods.
It is essential to know who your largest payers are and understand each payer’s requirements to avoid future penalties or negative adjustments based on your participation or non-participation. In many cases, your performance today will impact reimbursements in years to come.
It is vital to know your payers and their quality program to ensure you are making strategic business decisions for your healthcare organization. You also need to know where you stand with each payer by reviewing and planning improvement on past performance that each payer has provided.
If your organization provides care for Medicare patients, make sure you are positioning the organization for success in the Quality Payment Program. You could also be missing revenue opportunities if you do not review new payment updates from your biggest payers.
Payment adjustments for Medicare Quality Payment Programs are cumulative and based on 2019 reporting affect 2021 Medicare fee for service reimbursements. Eligible clinicians that don’t participate in this program can see negative adjustments in the range of +9 % by not participating in 2020. Based on last years’ billed charges to Medicare, ask yourself what that dollar amount will be at your healthcare organization. Patient engagement and satisfaction are also an essential aspect to consider, as well. Start providing “patient-centric” care today. Implement changes that improve the patient experience at the practice with every touchpoint. Even if you are already involved in risk-based or risk-sharing contracts, ensure you get maximum benefit and performance in these payer’s programs.
New payment models are here for many payers. Several in our state focus on the patient-centered medical home model, episodes of care, and reporting quality measures. Edafio Healthcare Consultants recommend reviewing the websites below for additional information on these programs in our state and the Quality Payment Program website. Reporting requirements can be complicated and vary widely by specific payer, but Edafio is here to help you prioritize, strategize, and align the approach wherever possible.
Success in many of the payer’s quality programs demand high utilization of a certified electronic health record and practice management software. Administrative processes such as, scheduling, insurance verification, reception, and coding and billing are all necessary for a healthcare practice to be successful. Today’s practice management systems (PMS) are designed to support medical practices run more efficiently with less manual processes to save time and reduce A/R invoices. For many practices, a practice management system’s main features increase administrative efficiencies and save time and money.
Practice transformation and quality improvement efforts can be sub-optimal if executive and physician leadership are not present. You should have clear roles and responsibilities in place and ensure they communicate with appropriate and responsible office staff within your organization. Team-based care is crucial to the future success of your practice. Each employee will feel valued and empowered with this model of care at the center of your practice.
Align and engage providers in periodic reviews of performance by utilizing Edafio’s Multi-Year Quality Strategy Document to identify gaps in care, increase reimbursement rates, and strengthen your health care organization’s reputation. Many analytics included in your current EMR solution offers a scalable quality management solution that fits your needs, giving you more time to uncover actionable insights that lead to improved outcomes. Having a consultant that can work alongside your organization with routine analysis and planning for improvements can make a difference in your bottom line. Quality Management is part of our value-based performance solution, which also includes population health. Now, are you ready to learn more?
Edafio healthcare consultants can prepare your organization to get on this path and create a Multi-Year Quality Strategy Assessment to move towards a complete value-based health care system. As experts in this field, our consultants have extensive knowledge and experience in value-based healthcare. They will work closely with your healthcare personnel to deliver customized technology solutions to improve your organization’s efficiency. The proven result is high-quality healthcare at the best value to your patients.
Before the Quality Payment Program (QPP), payment increases for Medicare services were set by the Sustainable Growth Rate (SGR) law. This capped spending increases according to the growth in the Medicare population and a modest allowance for inflation. However, as clinicians increased their utilization of services, the reimbursement for each unit of service had to be adjusted downward to hold costs constant. In practice, the SGR would have resulted in significant decreases in the Physician Fee Schedule, which was not sustainable. To avoid these decreases in reimbursement, Congress had to pass a new law (every year) authorizing the current fee schedule and a slight increase for inflation.
With the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), CMS did away with the SGR. Now, we can reward high-value, high-quality Medicare clinicians with payment increases – while at the same time reducing payments to those clinicians who aren’t meeting performance standards.
Clinicians have two tracks to choose from in the Quality Payment Program based on their practice size, specialty, location, or patient population:
Edafio Healthcare consulting team has decades of combined compliance experience in the healthcare industry. Our team has worked with numerous healthcare entities, business associates of covered entities, and other healthcare-related companies supporting their ongoing healthcare practice optimization.
There is no greater support than consultation and guidance. When you talk, we listen, then provide a tailored solution for your business needs. Our certified specialists are standing by to help.