medicare

Primary Care First is a voluntary five-year payment model that rewards value and quality by offering an innovative payment structure to support advanced primary care delivery. Primary Care First aims to improve quality and access to care for all patients, particularly those with complex chronic conditions. The model also aims to reduce Medicare spending by preventing avoidable inpatient hospital admissions.

Author/s:

Primary Care First

General Provider Telehealth and Telemedicine Tool Kit

John Bayhi — Wed, 25 Mar 2020 19:08:26 +0000

Date Added:

March 25, 2020

Journal/Publication:

Centers for Medicare & Medicaid Services - Current Emergencies Page

Publisher:

U.S. Centers for Medicare & Medicaid Services

Publication Date:

March 20, 2020

URL:

CMS Current Emergencies page

Type:

Practice Management Reviews and Guidelines

Format:

Article

Keywords

medicaid

medicare

public health emergency

telemedicine

telehealth

A summary from CMS on the new policies regarding telehealth visits. James W. Mold, MD, MPH

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No abstract available.

Author/s:

Centers for Medicare & Medicaid Services

Get up to speed with Medicare’s MBI shift

John Bayhi — Sat, 07 Mar 2020 21:45:00 +0000

Date Added:

March 7, 2020

Journal/Publication:

Physicians Practice

Publisher:

MJH Life Sciences

Publication Date:

March 4, 2020

Type:

Practice Management Reviews and Guidelines

Format:

Web Page

Keywords

medicare

medicaid

reimbursement

physician compensation

An alert to the new MBI patient identifiers to be used when billing Medicare. James W. Mold, MD, MPH

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No abstract available

Author/s:

Therriault, R

The Primary Cares Initiative: Value-Based Redesign of Primary Care

John Bayhi — Thu, 16 Jan 2020 16:43:23 +0000

Date Added:

January 16, 2020

Journal/Publication:

The American Journal of Medicine

Publisher:

Elsevier, Inc.

Publication Date:

January 15, 2020

Type:

Practice Management Reviews and Guidelines, Notifications and Opportunities

Format:

Article

DOI (1):

10.1016/j.amjmed.2019.12.010

Keywords

A concise review of CMS’s Primary Cares Initiative, a set of primary care options designed to dramatically affect the way primary care is delivered and reimbursed. Worth reading even if you don’t want to. James W. Mold, MD, MPH

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On April 22, 2019, the Centers for Medicare and Medicaid Services (CMS) rolled out the Primary Cares Initiative, a collection of voluntary payment model options in support of high value primary care.1 The first element of the initiative, Primary Care First, is to engage advanced primary care practice sites via two performance-based payment model options.1 The second element of the initiative, Direct Contracting, aims to involve larger primary care entities via three risk-assuming payment model options.

Author/s:

Bliss, HE, George, P, Adashi, EY

Medicare’s Direct Provider Contracting: To Primary Care And Beyond

Brian Desmarais — Mon, 01 Jul 2019 14:40:44 +0000

Date Added:

July 1, 2019

Journal/Publication:

Health Affairs Blog

Publisher:

Health Affairs

Publication Date:

June 28, 2019

URL:

Medicare’s Direct Provider Contracting: To Primary Care And Beyond

Type:

Notifications and Opportunities

Format:

Web Page

Keywords

MeSH

Centers for Medicare and Medicaid Services (U.S.)

Social Responsibility

Quality of Health Care

Medicare is about to roll out something they are calling Direct Primary Care, which is not at the same thing as the Direct Primary Care concept that evolved as a form of “concierge medicine” in which patients pay a monthly fee for increased access and services from primary care clinicians. This is something with which I believe all primary care clinicians need to become familiar. James W. Mold, MD, MPH

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Direct provider contracting (DPC) is coming to Medicare.

Under a new announcement about reforming health care payment and delivery, the Centers for Medicare and Medicaid Services (CMS) has announced forthcoming DPC models as part of the effort to “deliver value-based transformation in primary care.” In particular, the agency seeks to implement models that enable it to directly contract with providers and suppliers and hold them accountable for the cost and quality of care of defined patient populations. Direct contracting shares and extends some features of existing primary care payment reforms, such as an emphasis on financial accountability over outcomes. However, DPC differs from existing primary care payment models primarily by allowing Medicare to contract with providers for a population of beneficiaries’ entire health care spending via global capitated payments. This incorporates approaches from Medicare Advantage (through which Medicare contracts with health plans for beneficiaries’ entire health care spending), while adding flexibility and emphasis on beneficiary choice.

Author/s:

Liao, J.M., Navathe, A.S.

Patients Over Paperwork

Brian Desmarais — Wed, 12 Jun 2019 19:04:56 +0000

Date Added:

June 12, 2019

Publisher:

Centers for Medicare and Medicaid Services

URL:

Patients Over Paperwork

Type:

Notifications and Opportunities

Format:

Web Page

Keywords

MeSH

Here’s your chance to make suggestions to CMS about how to put patients over paperwork and to see what others have suggested. James W. Mold, MD, MPH

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Patients Over Paperwork

We’re putting patients first by reviewing and streamlining our regulations so we can:

Reduce unnecessary burden
Increase efficiencies
Improve the beneficiary experience

Legal Advocacy To Improve Care For Older Adults With Complex Needs

Brian Desmarais — Mon, 20 May 2019 05:00:00 +0000

Date Added:

May 20, 2019

Journal/Publication:

Health Affairs

Publication Date:

May 17, 2019

URL:

Legal Advocacy To Improve Care For Older Adults With Complex Needs

Type:

Public Health Announcements

Format:

Web Page

Keywords

MeSH

A review of the important underappreciated role of legal advocates in supporting health care-related needs of older adults. James W. Mold, MD, MPH

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Legal advocacy is a recognized strategy to address social factors that influence the health of populations with complex care needs. Such advocacy can improve housing stability, increase access to public benefits that support a host of social needs, assure that medical and financial proxy decision makers are in place, and reduce psychosocial distress.

Author/s:

Hooper, Sarah, Parekh, Ami, Fabiny, Anne, Teitelbaum, Joel

Lung Cancer Screening: A Clinician’s Checklist

Jeffrey Wilson — Mon, 22 Oct 2018 16:17:09 +0000

Date Added:

October 22, 2018

Publisher:

Agency for Healthcare Research and Quality

Publication Date:

March 1, 2016

Issue:

URL:

Lung Cancer Screening: A Clinician’s Checklist

Type:

Clinical Decision Aids

Format:

Web Page

Keywords

MeSH

This is a checklist for use when helping smokers decide whether to be screened for lung cancer with low-dose CT.

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This checklist was developed to help clinicians meet the Centers for Medicare & Medicaid Services (CMS) criteria for a lung cancer screening counseling and shared decisionmaking visit. All of the criteria listed below must be met for the screening to be covered as a preventive service benefit under Medicare.

Lung cancer screening with low-dose computed tomography (LDCT) reduces mortality from lung cancer. There are also potential harms associated with lung cancer screening, including a high-false positive rate and the associated need for diagnostic followup, known and unknown risks of additional testing associated with incidental findings, cumulative radiation exposure, and overdiagnosis. Shared decisionmaking is a collaborative patient-centered process in which patients and clinicians make decisions together, within the context of the best evidence and recommendations and based on the patient’s values and preferences.

Medical-Legal Partnership

Tracy Ashby — Thu, 11 Oct 2018 05:00:00 +0000

Date Added:

October 11, 2018

Type:

Notifications and Opportunities

Keywords

MeSH

delivery of health care

poverty

This is an opportunity to collaborate with Legal Aid of OK to connect patients to legal services when appropriate

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In Oklahoma, 1 in 5 people live in poverty and also have at least one health-harming civil legal need. Creating a system to screen for these legal needs will allow us to address problems not otherwise attended to, reducing patient stressors and saving health care partner’s money in terms of reducing illness, increasing
adjustment rate payments and reimbursement potential. The Medical-Legal Partnership (MLP) model integrates civil legal aid attorneys in health care teams to address health-harming legal needs for low-income populations.

Author/s:

Legal Aid Services of Oklahoma, Inc.

Short- and Long-Term Outcomes after Bariatric Surgery in the Medicare Population

Jeffrey Wilson — Mon, 10 Sep 2018 13:05:36 +0000

Date Added:

September 26, 2018

Journal/Publication:

Technology Assessment Program

Publisher:

Agency for Healthcare Research and Quality

Publication Date:

January 7, 2018

Issue:

OBST0816

URL:

Short- and Long-Term Outcomes after Bariatric Surgery in the Medicare Population

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

Keywords

MeSH

technology assessment, biomedical

bariatric surgery

In Medicare-eligible patients, bariatric surgery overall leads to improvements in weight loss outcomes beyond one year after surgery. Roux-en-Y gastric bypass performs better compared to sleeve gastrectomy or adjustable gastric banding for weight loss, metabolic, cardiovascular outcomes, renal function outcomes and postoperative complications.

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Introduction. We conducted a technology assessment to summarize and appraise the current evidence regarding the effectiveness and safety of bariatric surgery in the Medicare-eligible population.

Data Sources. We searched six bibliographic databases and the reference lists of published clinical practice guidelines, relevant narrative and systematic reviews, and scientific information packages from manufacturers and other stakeholders on the outcomes and prediction models of different bariatric procedures studied in the Medicare-eligible population.

Results. Of 126 eligible studies, 83 described outcomes after bariatric therapy and 43 described predictors of body weight loss or absolute body weight after bariatric therapy. We did not identify any randomized clinical trials in the Medicare-eligible population. Studies examined surgical modalities. There were no studies on endoscopically-performed bariatric procedures. Only 15 studies had a design and/or analytical approach that allowed inferences for causal treatment effects on weight loss outcomes, adverse events/complications, or other non-weightloss outcomes. Bariatric surgery in the Medicare-eligible population leads to improvements in weight loss and non-weight-loss outcomes, particularly mortality, metabolic, cardiovascular, respiratory, and musculoskeletal outcomes, and polypharmacy but the strength of evidence is low to moderate. There is moderate evidence that Roux-en-Y gastric bypass performs better compared to sleeve gastrectomy or adjustable gastric banding for metabolic, cardiovascular, and renal function outcomes and for postoperative complications. Finally, no models to predict weight loss have undergone internal or external validation.

Conclusions. Relatively few nonrandomized studies examine the comparative effectiveness and safety of bariatric therapies in the Medicare population. Large gaps remain in regard to comparisons of individual bariatric surgical procedures to each other, and very limited evidence exists in regard to patient-centered outcomes such as quality of life after surgery.

Author/s:

Orestis, A. Panagiotou, Markozannes, Georgios, Kowalski, Rishi, Di, Mengyang, Bond, Dale S., Ryder, Beth A., Adam, Gaelen P., Trikalinos, Thomas A.