Vigilance Health’s Post

CMS Needs to Do a Better Job With Value-Based Care, Experts Tell House Panel — The program has "gotten off track and needs a thorough reevaluation and reformulation," doc says Value-based care -- in which medical practices are paid based on the value of their care, not on volume -- is a good idea but the Centers for Medicare & Medicaid Services (CMS) need to improve its implementation, doctors and a healthcare executive told members of the House Ways & Means Health Subcommittee. https://lnkd.in/er4PN6Hi

Dr. Mehmet Oz's recent nomination as the Administrator of #CMS has ignited widespread discussion across the healthcare community. In our latest blog, we dive into the potential ripple effects of this appointment on the future of #MedicareAdvantage and #Medicaid. Key topics covered include: ➡️ Anticipated policy shifts under his leadership ➡️ The future of value-based care initiatives ➡️ Implications for health plans, providers, and patient care Read more: https://shorturl.at/0oGIm

Long-term care facilities are governed by regulations set by the Centers for Medicare & Medicaid Services (CMS) and State Health Departments. CMS enforces federal standards and conducts compliance surveys, while state agencies oversee licensure and state-specific rules. Qsource supports facilities in navigating these regulations with expert guidance on quality assurance, root cause analysis, and the development of corrective action plans. Learn More: https://hubs.la/Q02_NB2r0 #NursingHomes

Thanks to the Centers for Medicare & Medicaid Services's decision to include the Patient Activation Measure in MIPS and specialty measure sets, the #patientvoice is being incorporated more widely across healthcare settings. The PAM’s impact is tangible. Over 800 studies back its effectiveness in improving outcomes and lowering costs.   My colleague Kristen Ballantine recently wrote about how PAM can be used by providers to tailor care to fit individual needs, which is particularly helpful in specialty care settings where certain conditions may require advance support.   What’s next? Phreesia is advocating for even wider adoption across specialties with the goal of creating a future where it is the norm for all patients to receive the personalized care they deserve. https://lnkd.in/enfPS-r2

We see it again. "Flawed approaches to quality measurement and interoperability" is what the real world is challenged with. On the policy side, we continue to be in an echo chamber of "how great things are going and digital quality measure fed by interoperable data flows." No one in those positions of policy power and thought leadership are knocking on my door to hire me, that is what scares me the most about the likelihood of a positive change in quality measurement. Sure, we will always have client work to slog through the quagmire to report measure results and find the small incremental opportunities to improve measure performance. If there were a political appointment in the next administration to address this, I would take it in a heartbeat regardless of political affiliation. I see both sides.

Attention wound care providers! 📢 The Centers for Medicare & Medicaid Services (CMS) has announced changes for Medicare payments under the Physician Fee Schedule, effective Jan 1, 2025. Notably, there’s a 2.93% reduction in payment rates. Stay informed on what these updates mean for your practice and patient care. 👉 Dive deeper into the details here: https://lnkd.in/dMFrz8Bf #WoundReference #MedicareUpdates #WoundCareProfessionals #Healthcare #News #WoundCare

🚨 Medicare Advantage Prior Authorization Reform Stuck in Congress 🚨 The Improving Seniors’ Timely Access to Care Act of 2024, a bipartisan bill aimed at increasing transparency and expediting prior authorization in Medicare Advantage, has broad support from lawmakers and healthcare leaders—but its future remains uncertain. With 228 sponsors in the House and 59 in the Senate, this popular measure has the numbers to pass. However, it faces tough competition in a crowded legislative agenda, with Congress focusing on expiring healthcare programs like telehealth extensions and physician pay adjustments. What’s at stake? Patients and Providers: Streamlined prior authorization could reduce delays and administrative burdens, ensuring timely care for seniors. Efficiency Gains: Mandating faster decisions (72 hours for urgent cases, 7 days for non-urgent). While the Centers for Medicare and Medicaid Services (CMS) has introduced similar rules for 2026, this legislation could codify these protections sooner, addressing ongoing frustrations in healthcare delivery. 🩺✨ #MedicareAdvantage #PriorAuthorization

In NAACOS' response to the 2025 #Medicare Physician Fee Schedule proposed rule, we acknowledge and appreciate that many of the #physicianpayment and MSSP policies in the proposed rule will enable providers to deliver comprehensive care management and provide enhanced beneficiary care services, including policies to create payment for advanced #primarycare, receive shared savings payments in advance, and provide a health equity benchmark adjustment in MSSP. While we support these changes, we are concerned that the Centers for Medicare & Medicaid Services (CMS) has not addressed two key policy issues that, if left unaddressed, will significantly hamper participation in MSSP and impede CMS' goal to have all beneficiaries in accountable care models by 2030. We urge CMS to address: 1. Flawed approaches to quality measurement and interoperability 2. Financial benchmarks and long-term viability Read more in our comments: https://lnkd.in/e9vaf84y

Big News for New York's Healthcare Landscape!  The Medicaid Section 1115 Demonstration just got a significant upgrade with a groundbreaking amendment announced on January 9, 2024.  This approval from the Centers for Medicare and Medicaid Services (CMS) reflects a significant stride in New York's pursuit of an inclusive healthcare system, backed by a substantial $7.5 billion investment over the next three years. The journey to health equity is underway, and New York's initiative is poised to leave a lasting impact on the national healthcare landscape. Key Components of the 1115 Waiver Amendment:  The waiver amendment focuses on integrating primary care providers and community-based organizations (CBOs) and Social Care Networks (SCNs) to address health-related social needs (HRSN). The creation of the Health Equity Regional Organization (HERO) to reduce health disparities and advance health equity. The amendment authorizes up to $2.2 billion for the Medicaid Hospital Global Budget Initiative, supporting financially distressed safety net hospitals in transitioning to a global budget alternative payment model. #NY1115Waiver #1115Waiver #CMS #Healthcare #Interoperability https://lnkd.in/gUheDetn

PBJ reporting is incredibly important for the healthcare industry. One main reason is to ensure that your facility meets the required staffing levels. The Centers for Medicare & Medicaid Services (CMS) requires medical facilities to compile and submit PBJ reports that provide data on staffing levels regularly. We’re thrilled that Fingercheck now offers this on the platform! 🎉 Check out the article below to learn more ⬇️ #PBJReporting #Healthcare #CMSCompliance