Archives: Quality

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Proving the Financial Impact of Chronic Care Management Services

Over the last four years, the Centers for Medicare & Medicaid Services (CMS) has expanded Medicare reimbursement for chronic care management (CCM) services based on the agency’s belief these services can lower the total cost of care.  While the clinical case for care management is compelling, the evidence supporting CMS’ conclusion has been limited to … Continue Reading

2018 Medicare Physician Fee Schedule Final Rule: Care Management

On November 15, the Centers for Medicare & Medicaid Services (CMS) published its almost 400-page 2018 Medicare Physician Fee Schedule Final Rule.  Buried among those hundreds of pages, as has been the case for the last five years, the Final Rule again refines and expands Medicare reimbursement for care management services. Ambulatory Care Management Having … Continue Reading

Taking a Closer Look at the MIPS Improvement Activities Component

While the Quality and Advancing Care Information components account for more significant percentages of a provider’s overall Merit-Based Incentive Payment Systems (MIPS) score (60% and 25%, respectively), one also needs to focus on the work required under the Clinical Practice Improvement Activities component, which comprises 15% of the MIPS score. The Centers for Medicare & … Continue Reading

Am I Included in MIPS? New On-Line Lookup Tool

The lookup tool is available on the Quality Payment Program website.  To use it, an individual provider need only enter his or her 10-digit NPI.  The lookup tool then generates a personalized report for the provider, stating whether he or she is excluded from MIPS under the low-volume threshold. Specifically, the report lists each TIN … Continue Reading

Physician Compare: Changing How Healthcare Decisions Are Made

Our decisions to buy a certain product or service often are based on opinions expressed by prior purchasers.  In addition to soliciting advice from friends and family, we have at our fingertips hundreds of websites by which to access others’ opinions (and express our own opinions as well). While other users’ subjective opinions can be … Continue Reading

Good answer – but to the wrong question?

With the reality of value-based purchasing settling in, over the past several months I’ve had the same conversation with a number of healthcare executives related to H-CAHPS performance. In describing their efforts, they explain, “We’ve set specific goals; we’ve clearly identified standards on checklists for each H-CAHPS dimension; and we’re rounding with purpose more often … Continue Reading

Nurses must play central role on the frontline of reform

In an introspective conversation last week, a close friend who is a hospital CEO shared a story that reflects the real struggles most healthcare leaders experience today as they balance the significant – and often competing – demands of reducing cost, increasing quality and improving patient experience. As he was leaving the hospital on a … Continue Reading

Stable performance? Then you’re losing ground in Value-Based Purchasing

  “Even if you’re on the right track, you’ll get run over if you just sit there.” – Will Rogers Though the witty philosopher-of-the-people Will Rogers spoke these words decades ago, the advice could easily have been meant for healthcare providers today. By design, the Centers for Medicare & Medicaid Services will reward approximately half of … Continue Reading

Making the grade under the spotlight of transparency

Although it might not make the popular “What’s trending now?” lists, healthcare followers on Twitter have seen a common theme emerge over the last several days. “Our hospital received an ‘A’ in patient safety” has been proclaimed by numerous institutions that performed well on The Leapfrog Group’s Hospital Safety Score website report card released last … Continue Reading

Strong leaders – and cultures – start with self-awareness

During a session on great leadership at the Becker’s Hospital Review Annual Meeting in Chicago last Friday, four prominent healthcare executives talked about the characteristics of contemporary leaders and how they contribute to a multidisciplinary, team-based culture that is essential for success. Especially notable were insights from Pamela Stoyanoff, executive vice president and COO of … Continue Reading

The dangers of pursuing the “silver bullet”

In her remarks at the ninth annual World Congress on Health Care, Shari M. Ling, MD, deputy chief medical officer of the Centers for Medicare and Medicaid Services wisely pointed out that there is “no silver bullet” to achieve better value. As reported by Fierce Healthcare associate editor Alicia Caramenico, Dr. Ling emphasized, “When we start to talk … Continue Reading

The Ultimate Compliment

It was almost nine o’clock in the evening when I finally arrived at my hotel from a long day of meetings and travel in preparation for the full-day workshop I would lead the next day. I was tired, but I was also hungry. I asked the front-desk clerk as I checked in if there was … Continue Reading

Think Small?

I frequently joke with those that I work with that my dream job is to be the “Vice President of Big Thinking.”  It would be great to have the time to take all of the complex issues we are facing in healthcare, sit in a room and come up with big ideas and big solutions.  … Continue Reading

The price of being human

Several months ago, I committed the mistake that strikes fear in the heart of every businessperson who is a frequent flyer:  I missed a flight. No bad weather. No huge traffic jams on the way to the airport. I simply had in my mind that the flight left one hour later than it actually did.  … Continue Reading

Teaching to the Test

This past weekend, I got to do something I truly enjoy. My tried and true 2007 Avalon was groaning and moaning a bit more than in days past, so I decided it was time to take the dive and go buy a new car.  Unlike many people, I actually enjoy the car buying process. I … Continue Reading

Here’s Lookin’ at You

As a consultant, I spend a lot of time in the friendly skies.  On a recent flight, while once again waiting on the tarmac for air traffic control to decide my destiny, I peered into the cockpit.  As expected, the pilot and first officer were busy going through their pre-flight routine, but they were not … Continue Reading

Comfortably Numb

2,080. 40 times per week. That’s the number of wrong site surgeries still happening annually in hospitals and clinics across the US, according to a recently released study from The Joint Commission. I read the article with great interest yesterday morning as I was making my way through several airports traveling to a client site. As I … Continue Reading

Elevators and Amusement Rides

Yesterday was no different than many other days in my life as a consultant.  Two clients, three cities, and finally arriving late evening at the hotel. It had been a long day of travel and I was looking forward to getting into my room and off of my feet. As I got onto the elevator, … Continue Reading

Draft Day

  As I was getting my daily fix of ESPN this morning, something a bit different than the routine scores and highlights came across my TV. Two very talented men, both potentially bound for NFL stardom, were showcasing their talents for scouts, coaches, recruiters, and reporters – a panel of judges if you will. Although these … Continue Reading

For a Few Dollars More

Over the last several days I have been pouring myself into the latest information from CMS on what lies ahead in the world of quality – that being the proposed rule on Value Based Purchasing as published in the Federal Register. As with most things that the government produces, I prefer to read the original text, … Continue Reading

The Slippery Slope of Value

  This morning United Health Care announced its new Cancer Care Payment Pilot. According to UHC, this pilot is designed to “advance a new cancer payment model that focuses on best treatment practices and better health outcomes.” As a matter of fact, most agree that the cost of treating cancer under the current model is unsustainable. As evidence … Continue Reading

Certifying Quality

As we continue to move further down the path of healthcare reform, finding ways to focus on and measure the quality of clinicians is generating more and more discussion. An article published this week in the Columbus Dispatch highlighted the value of board certification as a proxy for quality. The article even went so far as … Continue Reading

Meaningful Quality

This past week, Nevada’s state board of health found itself in the middle of an all too familiar debate – just how much information should hospitals be required to share directly with the public.  The debate arose over a new regulation that would require Nevada hospitals to report hospital acquired infections to the CDC’s infection … Continue Reading

Blurring the Line

This past week, CMS announced a public comment period on several newly released quality metrics focused on stroke outcomes – 30-day all cause mortality and 30-day readmission rates. As I spend most of my day working on healthcare reform and quality, I spent the weekend diving into these metrics, wanting to be sure exactly which clinical … Continue Reading