MBMS, LLC’s Post

I'm not sure how Centers for Medicare & Medicaid Services or US Congress can justify this approach to cancer prevention. - new Medicare proposal will result in Medicare payments reduced by >7% over last 4 years - when adjusted for inflation, Medicare payments have declined by 30% in the last 20 years - from 2007 to 2022, reimbursements for colonoscopies and biopsies decreased 38% - an average colonoscopy costs $1600-2400. Of that, the physician fee is about 10%. Yes, you read that correctly. We are all aware of increasing costs especially since COVID. Reducing reimbursement while costs go up will profoundly affect delivery of care, if it hasn't already. If you're outside a metro area, can you find a GI doc? If so, what's the waitlist for a screening colonoscopy? It's only a matter of time until physician offices limit the number of Medicare patients/month, or stop seeing them altogether. #healthcare #colonoscopy #medicare #reimbursement Michael Bass, M.D.

How to comply with CMS's CT #radiation #dose measure or the simple answer: contact me to find out more about NovaDose aka Dose Monitor. via AuntMinnie.com Centers for Medicare & Medicaid Services #patientsafety

"You can walk with wolves but don’t howl like one." This phrase captures the essence of Value-Based Care today. While we’ve embraced the vision of a healthcare system that promises improved patient outcomes and cost containment, we need to avoid being swept up in idealism without addressing the real flaws. #VBC, especially in managing kidney disease, dialysis, and transplantation, hasn’t fully delivered on its promise VBC’s intention is clear: better patient care at lower costs. But with #CKD and #ESRD, this model has struggled. Centers for Medicare & Medicaid Services has tried bundling payments to contain costs, but the reality is more complicated. #Dialysis and organ #transplantation are areas where cost management has been particularly challenging In dialysis, for instance, care is often reactive. The bundled payment model aims to reduce costs but can lead to unintended consequences. Providers may cut corners to save money in the short term, overlooking essential, comprehensive care that could prevent complications and reduce long-term costs. This approach, focusing on keeping today’s expenses down, leads to higher costs down the road when complications inevitably arise When it comes to kidney transplantation, the issues run even deeper. VBC’s promise of integrating care to improve health outcomes fails to consider the complexities of long-term transplant care. Transplant patients require lifelong monitoring to prevent organ rejection, manage immunosuppressive medications, and handle potential complications. However, VBC models often miss these long-term needs, focusing instead on short-term outcomes. This oversight leads to higher hospital readmissions, post-surgical complications, and eventually, escalated costs. The system, by prioritizing immediate cost savings, ends up spending more in the long run The main flaw with VBC models today is their reliance on short-term metrics. These metrics may look good on paper, but they fail to capture the real patient experience, especially for those living with CKD. Patients are treated as if they all follow the same path, but chronic conditions like kidney disease require personalized care. Current VBC models overlook these complexities, leading to gaps in care The U.S. Department of Health and Human Services (HHS), U.S. Department of Health and Human Services (HHS) and CMS need to pay attention to these signals. The #VBC model, in its current form, may look like a utopian system, but the data show a different reality. Cost containment and patient outcomes are often at odds, especially in kidney care. If we don’t confront these flaws, the system will collapse under its own contradictions To make VBC successful, particularly in dialysis and transplantation, we must shift our approach. Instead of focusing on short-term cost-cutting, we need to look at long-term patient outcomes. Charles Bearden PA-CPTC Tim Fitzpatrick Mark Masson

10 years ago, I had the honor of being a part of a small team charged with reimagining how a community hospital could be resurrected to serve the South LA population long known to be under-served and under-resourced with respect to its healthcare needs Since then, much progress has been made. And in many ways due to its success, much is still left undone. Primary care access, while underfunded and inaccessible in many communities like South LA, specialty care is equally unpredictable, inaccessible and under-resourced- if not moreso. What results? As a urologist who staffs two of the busiest hospital EDs in the country, we routinely see patients whose presentation is merely to "see a specialist." 60% of patients referred to a specialist never see one! The implications: we have grown so untrustworthy as a healthcare system when servicing medicaid populations that patients and clinicians alike resign to leveraging the ED for routine primary and almost all of their specialty care needs. This has to change. The elderly man with newly diagnosed prostate cancer, the recently discharged young women with a painful, untreated kidney stone, or construction worker who required an emergent bladder repair of a complication of surgery all of who could not "find a urologist" or whose primary care doctor resorts to "sending them to the ED" for tests they struggle to obtain through the patient's medicaid plan are clearly not being served well by our current system. Hence is why we started over 5 years ago HubMD (hubmd.org) and Afya (afyaglobal.com) to begin creating a better way- a responsive and intentional approach to caring for the least among us through ambulatory triage with eConsults, expanding access with virtual visits and coordinating patients care through transitions be it from clinic, hospital, ED, urgent care, psychiatric or correctional facility. We now conduct >6,000 eConsults per month and coordinate care for a growing number of patients specialty care needs. 10 years from now, I hope to not have the type of ED consults I see today. It will take persistent, collective, and strategic effort to create the change we need.

The release of the 2024 Darzi review made difficult reading for those that care passionately both about healthcare provision in England and the overarching principles of the NHS. Darzi identifies the key challenges patients are facing, particularly long waiting times for essential services like surgery, A&E, mental health, and cancer treatment. The report highlights that inefficiencies in hospital care and underinvestment in infrastructure are significant barriers to improving patient outcomes. With about 7.6 million people on waiting lists and delays in cancer care, patient experience has been severely impacted. Social care’s challenges have compounded these issues, as hospital beds are often occupied by patients awaiting support outside hospitals. This strains the system, negatively affecting staff morale and productivity. For NPC, the report offers future optimism and opportunity. Specifically to work with and on behalf of Practices in our Alliance to influence or hopefully lead some of the changes required, specially with the report emphasising the need to shift care from hospitals to communities and primary care aligning it closely with NPC's mission. Overall these opportunities highlight the need for a long-awaited shift towards prevention and care closer to home, potentially offering an invigorated and transforming role for Primary Care as a whole over the next decade. James Leeming Richard Parker Wayne Bolt Simon George Emma Smith Rachel Arkieson

SonarMD acknowledges the increasing demand for high-value specialty care amidst challenges of declining reimbursement rates, emphasizing the critical importance of payer/specialty network collaboration. As diagnoses in various specialties rise there's a pressing need for accessible and sustainable healthcare solutions. While recent policy shifts like expanded coverage and adjusted screening ages are steps in the right direction, the ongoing disparity between demand and reimbursement poses significant obstacles for specialty care providers. SonarMD supports collaborative efforts among policymakers, payers, and clinicians to address these reimbursement disparities and ensure equitable access to high-value specialty care. By providing the necessary tools and resources, SonarMD aims to empower GI specialists to navigate these challenges effectively, ultimately advancing the goal of improved patient outcomes and healthcare delivery for complex, high needs patients. https://lnkd.in/gD4fGTGQ #chroniccare #specialistcare #valuebasedcare #vbc #complexcare  

Great news! Four out of the seven Medicare Administrative Contractors (MACs) have expanded their medical policy to allow plaque analysis coverage, including Elucid PlaqueIQ, for eligible patients with coronary artery disease beginning November 24, 2024. With broader coverage and reimbursement for artificial intelligence-enabled plaque analysis, more physicians can incorporate this technology into everyday clinical practice, improving outcomes for a growing number of heart disease patients. The coverage of plaque analysis extends to Medicare beneficiaries with acute or stable chest pain and less than 70% stenosis found on CCTA. The remaining MACs will continue to review coverage for plaque analysis on a case-by-case basis, potentially expanding access even further. We at Elucid are thrilled to see continued growth in the field and increased support for physicians and patients! Read more: https://lnkd.in/g8GPQ669 #YesCCT #PlaqueAnalysis #PlaqueIQ

TEAM  (Transforming Episode Accountability Model) a new alternative payment model is set to be tested in Jan 2026 for select CBSAs. Mandatory, episodic-based, CMS bundled payment model coming in 2026 for selected areas in Alabama CBSA’s- specifically Huntsville and Alexander City. ·     The new payment model will essentially help address fragmented care and improve patients’ transition of post-operative care for select surgical procedures. ·     The surgical procedures (inpatient and/or outpatient) included in the model will be lower extremity joint replacement, surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedures. ·     Essentially the participating hospitals will bill for Medicare FFS but be provided with a target price (risk-adjusted) which CMS deems should be the cost of care for a 30-day period. If total costs are below the target price and quality measures are met, then the hospital may earn additional payment from CMS. ·     The participants will be required to refer patients to a primary care service for continuity of care. This will be challenging since we are already facing a shortage of primary care physicians. ·     Overall, good for patient care and aligns incentives for participating hospitals. The question here is whether the financial incentives are enough to sustain the financial risk hospitals are taking.  Time and appropriate data will be key to parsing this out. ·     Healthcare has always been a TEAM (no pun intended) endeavor.  We shall see if this helps or complicates the landscape in our ability to deliver positive outcomes for the great people of Alabama. https://lnkd.in/e6y4nMtj

🔔 This is a great article by the former CMS Chief Medical Officer Dr. Fleisher. I take one exception to his point in this article: “Looking forward, establishing more standardized and predictable communication between agencies can significantly bolster their capacity to evaluate evidentiary standards for novel surrogate endpoints to ensure the right drugs and devices get to the right patients.” 💭 To me, Dr. Fleisher presupposes robust competition in the healthcare space exists in order to facilitate CMS & FDA moving the healthcare needle forward. A limited healthcare system may never ensure that right devices, drugs or services will get to the right patients if it is cost prohibitive. 💡 The problem with this is as healthcare market leaders consolidate, competition becomes limited which narrows choice and access to health services which then makes healthcare market leaders too powerful which then makes them complacent. 💣 Complacency is the graveyard for innovations. 🤯 A Jan 16, 2023, Forbes article by Dr Robert Pearl says it best: “De facto monopolies abound in almost every healthcare sector: Hospitals and health systems, drug and device manufacturers, and doctors backed by private equity. The result is that the U.S. healthcare has become a conglomerate of monopolies.” 📰 Curious to hear your counter points to mine #cms #fda #federalcontracting #healthcare

Medicare is looking to transition from traditional fee-for-service (#FFS) to value-based reimbursement (#VBC) models by #2030. Business of cardiology sessions at ACC.24, the American College of Cardiology's recent annual meeting in Atlanta, offered insights into the impending transition. As #CMS moves entirely toward value-based payment models, cardiologists must adapt to these evolving frameworks, wherein payments are contingent upon achieving predetermined cost and quality targets. #vbc, #vbaforvbc, #vba , #valuebasedcare, #alternativepayments, #wholepersoncare, #contractbuilder, #valuebasedinfrastructure, #dataengineering, #datascience, #interoperability, #fhir , #hl7 , #edi , #unstructureddata Rahul Sharma, Lynn Carroll, Deepti Sharma ,CPC CMHP, Mohan Badkundri, Karthik Kanakaraj, Kimberly Shepard, Eric D. Young, John Layne, Carl King, Amol Bapat, MD, FACC, Michael Roach https://lnkd.in/gKUrJJ9J