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ICYMI: Notes from the field for June 2020

DATE: July 1, 2020

As states begin to open up and our understanding of the coronavirus improves, the end of the pandemic is nowhere in sight. The effects of the crisis on the healthcare industry and ongoing changes in payment and practice policy continue to generate news.

The continuing COVID-19 crisis

  • CMS announced preliminary data on COVID-19, through May 16, based on Medicare claims from more than 325,000 beneficiaries diagnosed with the disease.
  • Hospitals that have suffered financial losses during the pandemic will continue to weigh the risks of their participation in Medicare value-based purchasing programs. DataGen’s Business Intelligence Analytics Manager John Kalamaras weighs in on providers’ post-COVID-19 future as part of this article.
  • Although there is still much to learn about the coronavirus, it is clear that COVID-19 will permanently alter the delivery of healthcare in many ways, with long-term implications for both providers and patients.

Value-based care updates

  • A recent Center for Medicare and Medicaid Innovation study of providers taking part in the Bundled Payments for Care Improvement-Advanced model is broken down in this Modern Healthcare article. Some industry experts question the effectiveness of CMS pilots in achieving significant cost savings.
  • Our recent webinar, Taking the leap: A panel discussion on what’s next for value-based care, offered five thought leaders from a range of healthcare organizations. They examined the current state and challenges with value-based care. You can watch it here.
  • What does risk mean in healthcare? Institutions that have made commitments to value-based approaches have fared better during the pandemic than healthcare systems that rely on fee-for-service models, according to this Forbes article.
  • A survey by the Community Oncology Alliance examined the experience of oncology practices with the Oncology Care Model. See how oncologists are faring in the shift from fee-for-service to value-based care.
  • Check out this episode of Managed Healthcare Executive’s Tuning into the C-Suite podcast featuring DataGen’s John Kalamaras, to hear their discussion of the changes to bundled-care programs like BPCI-A.
  • The Comprehensive Care for Joint Replacement program may have two new hip-related diagnostic groups added as part of the Medicare inpatient rule change proposed by CMS.
  • According to an article in Fierce Healthcare, a glaring lack of authoritative data amid the COVID-19 pandemic is a reminder of the big long-term challenge hospitals face in improving efficiency and making the value-based care model work.
  • Another perspective from the same publication paints a sunnier version of the future, stating that there will be a positive impact on healthcare delivery if shifts in clinical practice remain after COVID-19 runs its course. These changes include the increased use of telemedicine, focused emergency care and streamlined services for those with chronic conditions.

Other news

  • To help healthcare executives stay on top of adjustments being made by CMS, DataGen introduced free interactive tools to evaluate expenses and get a better view of the total participants, episodes and changes in BPCI-A. You can choose clinical episode categories and easily compare data from model years 1 and 2 with model year 3.
  • CMS has proposed new Medicare Prospective Payment System rules for FFY 2021 that healthcare providers should understand. Here is DataGen’s analysis on the estimated impact on providers, What to know about five proposed rules from CMS.