Hayes' Healthcare Blog

Don Michaels, Ph.D.

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Implementing A New Compensation Plan: 5 Ways to Get Physician Buy-In

Posted by Don Michaels, Ph.D. on April 26, 2017 at 9:00 AM

By Dr. T. Christopher Windham, MD, FACS, Chief of Oncology, Cone Health Cancer Care and Don Michaels, Ph. D, Hayes Management Consulting

The move from fee-for-service to value-based care in the healthcare industry has been gaining momentum and its ultimate adoption is now a foregone conclusion. The question is no longer if the switch will be made, but when it will finally be a reality. The implementation of MACRA is a huge step down the value-based road and organizations are scrambling to meet the requirements of the new law.

Hospitals and physician practices are making major strategic and tactical changes to ensure they can survive in the new environment and increasingly that means determining physician compensation by means other than strict productivity. Healthcare IT vendors are trying to adapt their systems to meet the data collection and reporting needs of the new compensation plans. For both vendors and organizations, meeting these needs remains a challenge.

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Topics: physician compensation, value-based care

The ACA Replacement: How the Views of Trump, Ryan, and Price Tell Us What to Expect

Posted by Don Michaels, Ph.D. on March 1, 2017 at 9:00 AM

“They’re like the dog that caught the bus.” 

That was the comment from Senate Minority Leader Chuck Schumer in a January episode of This Week with George Stephanopoulos referring to the GOP and their pledge to repeal and replace the Affordable Care Act aka Obamacare.

In the more than six years after the passage of ACA, the House of Representatives voted to repeal it 60 times.[1] In December 2015, the Senate used a special budgetary procedure to approve one of the bills with simple majority vote instead of the 60-vote threshold normally needed for major legislation. As expected, President Obama promptly vetoed the bill. But the GOP had finally made a statement.

With the election of President Trump and a majority in both houses of Congress, Republicans can now make policy and do what they have been promising to do since the controversial law was passed in 2009. The GOP has finally caught the bus.

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Topics: value-based care, Healthcare insurance, ACA

3 Things That Most Likely Won’t Be Changing in Healthcare Under the New Administration

Posted by Don Michaels, Ph.D. on January 4, 2017 at 9:00 AM

The election and impending inauguration of Donald Trump combined with continued Republican control of both houses of Congress have sent waves of concern across the healthcare landscape. Predictions are running rampant on what the new administration will do, backed by a Congress itching to make changes – and cuts to existing programs.

The Affordable Care Act (ACA) – aka Obamacare – is clearly in the cross hairs, the target for significant change if not full repeal. There has been talk that the new administration will also address health insurance sales across state lines, health savings accounts, Medicaid payment methods to states and Medicare reform.

Although no one knows for sure what the eventual outcomes will be, there is little doubt changes are coming when it comes to healthcare in the next few years. However, not everything will be changing. Among the sea of uncertainty, there are islands of stability – certain things you can be fairly confident won’t be changing regardless of whatever else may be in store. Here are three foundational concepts we believe will remain as fixtures in the future healthcare environment.

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Topics: Change management, value-based care, MACRA

The MACRA Final Rule: Easing the Pain of Implementation

Posted by Don Michaels, Ph.D. on December 7, 2016 at 9:00 AM

When CMS released the Notice of Proposed Rule (NPRM) for the implementation of the Medicare Access and CHIP Reauthorization Act  - better known as MACRA – in April of this year, howls of protest could be heard throughout the healthcare landscape.  

Critics labeled the proposed rule “too complex, too onerous on small and solo practices, lacking in opportunities for many to participate in alternative payment models, and should be delayed for a full year at least.”[1] Some physicians claimed the rule was an attempt to drive them out of private practice and predictions of mass retirements were rampant.

In the six months after the release of the rule, nearly 4,000 public comments poured into CMS. The agency also collected feedback from over 100,000 physicians at outreach sessions held across the country.

The agency was paying attention. The final rule was released in mid-October and not only offers a series of clarifications, but also significantly softens some of the more aggressive components presented in the original proposed rule.

CMS addressed one of the biggest complaints – that there wasn’t enough time to absorb and comply with the new requirements – by essentially making 2017 a transition year. This gives organizations additional time to figure out what they need to do to implement the mandates of the massive new law.

Here are seven of the key outcomes, changes and clarifications resulting from the release of the final rule.

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Topics: value-based care, MACRA

Amidst the Angst, Value-Based Care Is Working

Posted by Don Michaels, Ph.D. on October 5, 2016 at 9:00 AM

“It’s not the strongest of the healthcare organizations that survive, nor the most intelligent, but the ones most responsive to change.”

–With apologies to Charles Darwin

People – and organizations – tend to fear and therefore avoid change. That often applies to healthcare organizations facing the new reality of value-based care reimbursement models. As a result, many are holding back trying to maintain the status quo against the rising tide of inevitable change.

On the other hand, some organizations have embraced and committed fully to the change. They have implemented various versions of value-based care programs, been patient and as a result, are starting to reap rewards. They are proving the truth of Darwin’s “repurposed” statement above, and have the best chance to survive – and thrive – because they have been the most responsive to change.

The changes these organizations are going through are not only succeeding in strictly financial terms. They are also increasingly meeting the other major goal of value-based care – better patient outcomes.

Here are three examples of the kinds of positive change possible in the new value-based care environment.

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Topics: value-based care

The Two Sides of MACRA: Examining the Pros and Cons

Posted by Don Michaels, Ph.D. on August 10, 2016 at 9:00 AM

The shock and awe of the April release of the 962-page Notice of Proposed Rulemaking (NPRM) for the Medicare Access and CHIP Reauthorization Act (MACRA) has started to wear off as the healthcare industry continues to dig into the details. Slogging through the NPRM is an intimidating but necessary chore as healthcare organizations try to determine how it affects them.

MACRA represents change – significant change – in the way Medicare providers conduct business so it’s not surprising that much of the feedback has been negative. People dislike and fear change regardless of the reasons for it or the potential positive outcomes. Adding to the resistance is the fact that in recent years, changes in the healthcare industry have been aimed at providers like water from a fire hose and “change fatigue” is starting to set in. Lastly, providers know that most governmental changes to reimbursement have meant fewer collections for their practice. At best, they have been trained to hope that these types of changes are revenue neutral.

Despite the negative reviews, MACRA and the NPRM that puts it into action is not all bad. In fact there are several positives to be taken from the new law. Here is a look at the major pros and cons of MACRA.

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Topics: cms, Fee-for-service, value-based care, MACRA

MACRA 101: 9 Things You Need To Know

Posted by Don Michaels, Ph.D. on June 29, 2016 at 9:00 AM

Congressional passage of the Medicare Access and CHIP Reauthorization Act (MACRA) last year was only the beginning of a major upheaval in Medicare reimbursements. This past April the other shoe fell – all 962 pages of it. The Centers for Medicare & Medicaid Services (CMS) released the Notice of Proposed Rulemaking (NPRM) providing the details on the plan to transition healthcare providers from a payment system based on volume to one that rewards value. MACRA is the next step in driving healthcare organizations from a fee-for-service to a value-based care reimbursement model.

The massive NPRM document will be dissected and discussed (and maybe even read) for many months to come, but the implications for clinicians providing care under Medicare Part B are real and far-reaching. The major consequence for those of you who are Medicare providers is that you will soon have to choose to operate under a merit-based incentive program or transition to an Alternative Payment Model. Other than leaving the practice of medicine, there is no third choice.

Here are nine things you need to know to help you begin digesting this next significant change in the healthcare industry.

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Topics: cms, meaningful use, value-based care, MACRA

Fee-For-Service to Value-Based Care: The Future is Now

Posted by Don Michaels, Ph.D. on March 9, 2016 at 9:00 AM

The U.S. Department of Health and Human Services (HHS) has a stated goal of shifting 85% of Medicare fee-for-service reimbursement into value-based models by 2016. Private payers will no doubt follow close behind. Meeting this aggressive goal is causing angst among healthcare providers with much conjecture about what it means for their organizations going forward.

The future, however, isn’t as bleak as it may seem. Several forward-looking organizations have leapt into the breach and embraced the change. Although there have been bumps along the way, a few have successfully made the transition and offer both a preview into life in the new reimbursement model world and examples of what you need to do as a provider organization to be successful.

Here are three examples.

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Topics: ACOs, Fee-for-service, value-based care

Is Becoming an ACO the Right Choice for You? 5 Questions to Ask

Posted by Don Michaels, Ph.D. on January 6, 2016 at 9:00 AM

One of the key concepts to rise out of the turbulent past decade in the healthcare industry is the Accountable Care Organization (ACO). In the ACO model, private and government payers offer the opportunity for financial incentives to groups of providers to encourage them to come together voluntarily to deliver high quality while keeping costs down. The theory is that rewarding providers for outcomes rather than just the number of services provided will ensure more efficient and effective patient care. The initiative makes sense, but putting it into practice has proven to be challenging.

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Topics: strategic planning, Accountable Care Organization

Healthcare Leaders Blog: 5 Steps to Prepare Your Organization for Value-Based Care, Don Michaels, Ph.D.

Posted by Don Michaels, Ph.D. on November 11, 2015 at 9:00 AM

The shift from fee-for-service to value-based care may be moving slowly, but there’s little doubt that the change is inevitable. According to a recent survey by PwC, alternative incentive based payment models like bundles and capitation currently make up a small percentage of payments. The report indicated that at the end of 2014, only 20% of Medicare payments to hospitals are tied to alternative payment methods. On the physician side, more than half of physician revenue is still based on a fee-for-service model.

Clearly change is on the way. How will you prepare your organization for value-based care?

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Topics: Change management, payment models, Fee-for-service, Hayes Thought Leadership Blog Series

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