Hayes' Healthcare Blog

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

5 Benefits of Increased Patient Engagement You May Not Know

Posted by Susan Cruz on October 26, 2016 at 9:00 AM

In today’s disruptive healthcare environment, we’re hearing of all sorts of new initiatives that aim to provide the best and most
affordable healthcare to patients.  Everything from MACRA, to Meaningful Use, to interoperability.  A common theme among these is the active foundation of improving health and realizing increased patient engagement.  With the shift from fee-for-service to fee-for-value, patients and consumers are becoming less passive and more proactive and engaged.  With this idea on the tip of everyone’s tongue, one might ask questions like, how do I create the best environment for my providers and their patients? What is the best way to educate patients on what exactly is going into their healthcare? How do I increase my patient engagement?

Not unlike using the age-old sentiment that history repeats itself, you can begin to answer these questions by going back to examples of how people have been engaged in their education in the past.  When you talk about education, you intuitively think of school. Active learning is a methodology utilized in the classroom to move the students from the role of passive receivers of information to that of active participants responsible for their own learning.  Techniques used in active learning include discussion, self-assessment, projects, group learning, self-defined goals, and more.  These techniques have proven to be far more effective than the traditional learning environment in which students sit passively and listen to lectures from a seemingly autocratic authority.

Similarly, the provider-patient role in many healthcare institutions has evolved throughout history into an authority and passive recipient relationship.  But as we noted earlier, this is clearly starting to shift within the healthcare industry today.  With the implementations of value-based care, we are seeing the provider-patient relationship shifting to organically place more ownership of the patients’ own health onto their plates to become more like the traditional consumer of any good or service, and less like a passive student within a lecture-style environment. 

While the healthcare industry is abuzz with all sorts of opinions about these initiatives and the shift value-based care, one perspective you can take is to see the win-win benefits of such an evolution of healthcare, especially for providers.

Here are five benefits that you may not have realized since the industry has started to steer patients into becoming active learning healthcare consumers.

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Topics: Fee-for-service, value-based care, provider education, patient engagement

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 21st Century Revenue Cycle Leader: 3 Key Factors for Success in the Evolving Healthcare Environment

Posted by Steven M. Wagner, PH.D., M.P.A, on August 17, 2016 at 9:00 AM

By Steven M. Wagner, PH.D., M.P.A, Executive Director Medical Practice Income Plan; Clinical Instructor in Health Policy, Finance and Administration, Department of Medical Education, Texas Tech Health Sciences Center El Paso at the Paul L. Foster School of Medicine, faculty instructor for Independence University, and Research Fellow at the Centers for Healthcare Research in the School of Advance Studies for the University of Phoenix.

Healthcare leaders need to look at the bigger picture of healthcare reform rather than narrowly focusing on its separate components. Fragmented legislation and grants led us to where the healthcare industry stands today, and only integrating networks of components in healthcare can lead us to successful reform. Success means that healthcare becomes accessible and affordable with or without insurance to all payors, quality outcomes take into account the functional and holistic health of the patient, and patients are satisfied and feeling well.

The hard reality is that in the end, everyone in the industry will be dealing with less revenue because the over-arching goal for the US government is cost containment. Only when leaders take all the changes into account will we, as an industry, be able to facilitate truly beneficial change. To make that happen, revenue cycle leaders need to be able to integrate cost, quality, and access into our routine processes of patient care, frequently analyze outcomes including the patients’ self-perceived health statuses, and develop actionable solutions.

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Topics: revenue cycle management, value-based care, Hayes Thought Leadership Blog Series

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

Looking to Embrace Population Health? Focus On Your People, Process, and Technology

Posted by Don Livsey on July 20, 2016 at 9:00 AM

By Don Livsey, former Vice President and CIO, UCSF Benioff Children’s Oakland, Founder DZL Solutions

Big data, informatics, business intelligence, and data mining have all been floated as “silver bullets” to solve the riddle of healthcare reform. One that will likely have the biggest impact, however, is population health. HealthcareIT News recently reported that population health and data analytics are the top two topics of interest for 2016. Everyone wants it, but few can clearly define what it is, and we don’t know what it will cost.

David Kindig of the Department of Population Health Sciences at the University of Wisconsin and Greg Stoddart from the Department of Clinical Epidemiology and Biostatistics at McMaster University in Ontario, are credited with this first attempt at a definition of population health in 2003:

“The health outcomes of a group of individuals, including the distribution of such outcomes within the group. These groups are often geographic populations such as nations or communities, but can also be other groups such as employees, ethnic groups, disabled persons, prisoners, or any other defined group.”[1]

A 2015 survey of 100 healthcare leaders conducted by Milken Institute School of Public Health noted that the definition was accurate but focused strictly on measurement and didn’t explain or acknowledge the “role that healthcare providers must take to impact those outcomes.”[2]

What isn’t in dispute is the fact that population health will be a significant focus of the healthcare industry going forward. A recent industry 2015 report identified three key trends involving population health:

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Topics: value-based care, Hayes Thought Leadership Blog Series, population health

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

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