CareHarmony’s Post

Value-based care, anyone? If shared quality and outcomes are the foundation of VBC networks, MSSPs, and ACOs, why are hospital-owned physicians and groups still compensated based on volume (relative value units)? This RVU-based compensation system can only last until legislation appears on the horizon. Quantity will never equal quality. #ValueBasedCare #HealthcareReform

Are they unfair? Let us help you analyze that data. CostFlex can allocate physician practices and professional services costs (Direct Variable, Direct Fixed, and Indirect) by RVUs to show profitability and contribution margin by Physician Group, Specialty, or Physician by Physician. #decisionsupport, #healthcare, #healthcareleadership, #hospitals, #hospitalmanagement, #costaccounting, #ruralhealthcare, #ruralhospitals, #ruralhealth, #costflex, #revenuecycle, #contractmanagement

From Larry Benz's Substack . . . in the latest draft of the 2025 CMS Physician Fee Schedule, the proposed rate reduction sent to all providers is 2.93%. Like most things from CMS coiffers, don’t believe the fine print. The reality for physical therapists is that significant cuts to NMS re-education (4.7%) and therapeutic exercise (5.4%) will weigh their overall cut much greater because there is generally a higher use of these more advanced clinical competencies. This proposed cut demonstrates CMS is trying to eliminate PT’s as both a profession and a service as it will make seeing medicare patients an ethical balance of wanting to treat patients that need us most but at rates that are likely less than cost. By the way, in Medicare logic the explanation for the reduction in those two codes is simply their growing and increased use. Yes, reimbursement (along with research) drives practice-in this case not something CMS receives well. What should be applauded for the use of these advanced competency codes is thus punished and the skills of PT further marginalized. Expect to see medicare patients given the worst appointment times, extended wait lists, and handouts for recommendations to other centers willing to take patients at below cost. By 2025, the total impact on physical therapists, considering both the cumulative conversion factor cuts and inflation, will be approximately 13.93% (10.33% cumulative conversion factor cut + 3.6% inflation increase). This significant reduction in real terms is compounded by the unprecedented inflation rates we’ve seen over the past few years: 7% in 2021, 6.5% in 2022, 3.4% in 2023, and roughly 3% year-to-date in 2024. . . . and that does not factor in the PTA differential . . .but hey they might get rid of the POC requirements and let PTAs see Medicare patients in OP environments . . .for less money Happy Wednesday

The 2024 “Medscape Physicians and RVUs Report” from March 1 – May 26 reported that more than half of physicians find the RVUs unfair and not accurate and current. Some physicians cited increased pressure to increase patient counts and to use higher billing codes. #CostFlex #hospitaldecisionsupport #costaccounting #healthcareleadership We can help you look at not only your costs and service lines but compare different physicians as well. https://lnkd.in/gzpS79ab https://lnkd.in/gDv_6fDm

Adjusted for inflation, Medicare physician reimbursement has declined roughly 30% since 2001. That makes it challenging for independent physicians to compete with hospitals, whose reimbursement rates have outpaced inflation in that time period. This unlevel playing field drives healthcare market consolidation and leads to increased patient costs. AIMPA supports a permanent, inflation-based fix to Medicare physician reimbursement so that independent docs can compete -- and care can stay local and affordable. Learn more about our work: www.aimpa.us #AIMPA #HealthcareConsolidation #IndependentPhysicians

Clear, simple and helpful article for physicians in navigating the complex world of revenue cycle. Well done Steven Huddleston! https://lnkd.in/gFXwdXba

#1 rule of new technology in medicine for the US = What’s the payment model? = Most traditional and reliable payment model is still fee for service codes. It appears we’ll get new codes from the American Medical Association that could mean more #RemotePatientMonitoring reimbursement by 2025 - If the American Medical Association approves new changes and Medicare and private payers follow suit, providers that expand their remote patient monitoring programs to fit the new codes will gain the most benefits for their patients and clinics https://lnkd.in/eCcCnG8S #DigitalHealth #TransformingCare

I read this article when it came out, but wanted to fully think through its content. I've gone from agreement with the findings to ANGRY on behalf of patients and providers. The impact on patients noted in the article, "Ninety-four percent of respondents reported prior authorizations create delays in care", please know this Prior Auth delay is AFTER the delay in getting an appointment. Clinicians are working harder than ever and are more frustrated than ever. "The average practice completes 43 prior authorizations per physician, per week. Physicians and staff also report spending about 12 hours per week completing such paperwork. Thirty-five percent of physicians said they have staff who exclusively work on prior authorizations," per the article. You're likely asking the same question I am: Why, in highly capable, technology-enable society, should healthcare providers be required to hire fleets of people to get "permission" to treat our loved ones? These are the kinds of statistic-driven, clearly articulate problems that drive Spesana's team. We built the Spesana Platform to serve ALL healthcare participants, simplifying (or crushing) hurdles to access healthcare for all people. The most elegant solution is often the simplest. Spesana's Authorize is an automated prior authorization returning prior auth numbers in HOURS not days. Our team cares deeply about solving our nation's healthcare problems, especially delays in care and financial hardships around prior auth. We will PROVE there is a better way for clinical sites and revenue cycle companies to do prior auths. Reach out to me as I'm no longer angry about the state of healthcare, but ENERGIZED and ready to serve you a solution. Carla@Spesana.com

The American Medical Association Physician Practice Information (PPI) Survey is nearing completion (June 30), and we urgently need all selected physicians to actively engage in this effort. #ASEAdvocacy The intent of the survey, which has been endorsed by over 170 medical societies and other healthcare associations, is to collect updated and accurate data on practice costs which are key element of physician payment. These data have not been updated since last collected over 15 years ago. It is critically important to update these data to ensure accurate payment.

Good Tuesday Afternoon, MABillers! CMS to address unusual catheter billing affecting ACOs. Premier and 10 health care organizations sent a letter to CMS urging the agency to remove catheter spending claims from all accountable care organization financial calculations due to unusual "Medicare spending outside their control." Atypical billing caused spending for two catheter codes to surge from $153 million in 2021 to $3.1 billion last year, the groups wrote, adding that "[five percent] of ACOs would see an impact ranging from $166 per patient per year to well over $1,000 per patient per year" if the agency will not alter the calculations. https://lnkd.in/eYn9F87k #MAB #CMBS #CPSP #MARA #MedicalBilling #Medical #Billing #Reimbursement #Credentials #Training #RemoteWork #Remote