MACRA, APMs, MIPS, Oh My!

Taylor HakeBlog

By: Ryan Fox, VP Sales & Marketing and co-written by Taylor Hake, Client Experience Specialist

CMS has been positioning for a shift in reimbursement models from volume to value-based care for a few years now, but with the MACRA final rule being published in October, this vision is finally becoming a reality. So how will health systems prepare for the coming changes, like MIPS, APMs, EPM’s and bundled payments?

2017 will bring about big changes in healthcare that will mark the beginning of what many say, is the future of healthcare.  We will see the first year of the MIPS program (merit-based incentive payment system), which adds another layer of quality based reimbursement measures.  MIPS and APMs build on existing programs like the readmission reduction program (HRRP) and the Physician Quality Reporting System (PQRS). CMS is creating bundled payments, or episode payment models, that will set prices on a per procedure basis. We have already begun to see these bundled payments take shape, as the CJR model is used in approximately 800 acute care hospitals nationwide. This year CMS will be implementing 3 new episode payment models, the AMI, CABG, and SHFFT models, not to mention a Cardiac Rehab incentive payment program. These models will be implemented in 98 healthcare systems beginning on July 1st 2017.  In order for hospitals to thrive under these new reimbursement models, decreasing variability in care will become a critical element to ensuring the highest possible quality while minimizing excess cost.

Early in his training, Dr. John Spertus, a World-Class outcomes researcher recognized the need to incorporate patient preferences into the decision making process – that’s why he created the Seattle Angina Questionnaire and ultimately what led to the creation of ePRISM.  For over a decade, ePRISM has been enabling clinicians to calculate individual patient risk in a prospective manner.  The prospective nature of these risk assessments is absolutely critical in a Bundled Care environment because it allows the clinician to take action while the patient is still in the hospital. By implementing these risk assessments at the point of care, health systems have been able to build treatment pathways based on the individuals predetermined risk, that reduce variability, while maintaining or exceeding quality care expectations.

ePRISM has already been proven successful to improve shared decision making and patient satisfaction rates, reduce complications, improve quality, and decrease cost overall.

Read about how Barnes Jewish Hospital in St. Louis, MO used ePRISM to improve the patients experience in PCI procedures: http://www.cathlabdigest.com/article/Pushing-Limits-Same-Day-Discharge-Value-Proposition-Same-Day-Discharge-Patients-Undergoing

 

Schedule a demo today to see how ePRISM can help prepare you.