The Journal of medical practice management : MPM最新文献

This is the first in a three-part series of articles intended to guide medical practice managers through the maze of the innovative,'yet complex regulations that will affect the amounts paid to healthcare providers by Medicare for at least the next three years. The goal of this series is to provide information to help practices optimize their payment potential from Medicare in 2019 based on their actions toward compliance for some portion of 2017 and to prepare to expand these behaviors as required in future years. Although there-are two pathways for participation in these new pay-for-performance programs, the series focuses more on actions required in the Merit-Based Incentive Payment System (MIPS). Approximately 85% of clinicians submitting Medicare Part B claims will participate in MIPS. The remaining 15% could assume risk in return for larger incentives while carrying out improvement activities similar to the MIPS requirements in frameworks known as Alternative Payment Models.

With CMS establishing preliminary definitions for fully qualifying Advanced Alternative Payment Models (APMs) in May of 2016, it has become crucial to many care providers accepting Medicare and Medicaid payments to understand the nature of these entities if they wish to eventually participate in one of the current or future payment models. Changes under the Medicare Access and CHIP Reauthorization Act of 2015 specifically identify subsets of APMs that allow providers to avoid possible negative adjustments for poor relative performance compared with their respective peer groups through the Merit-Based Incentive Payment System beginning in 2017. This article reviews the nature of one of the fully qualifying Advanced APMs, the Next Generation Accountable Care Organization (ACO) Model, and its risk-benefit sharing principles based on prior experience with the Medicare Shared Savings Program and other previous ACO models. This model represents a more sophisticated option for organizations with significant ACO experience seeking an Advanced APM for the 2018 reporting reriod and beyond.

By now most healthcare providers have heard about the transition from volume, based to value-based reimbursement, but it can be challenging to keep up with the latest initiatives and to understand the implications for providers. In fact, as of the writing of this article, lawmakers are continuing the debate on healthcare legislation. This article reviews the basics of the transition from volume-based to value-based reimbursement, summarizes the latest government healthcare programs under the Affordable Care Act, and explores what providers need to know to navigate the transition successfully.

The seven deadly sins, also known as the capital vices or cardinal sins, is a list of vices of Christian origin. They are hubris, greed, lust, malicious envy, gluttony, anger, and sloth. Likewise, there are deadly sins (mistakes) that have a negative impact on the medical practice. This article discusses the deadly sins of a medical practice and what each physician and each practice manager can do to combat those sins or mistakes.

With the 2016 election now in the past, everyone is wondering and predicting what will happen next. I have heard everything from fearful Democrats saying the new President will abolish Obamacare and throw 20 million people out in the cold and return them to the ranks of the uninsured to optimistic Republicans making statements that President Trump is going to fix everything in the first 100 days and healthcare will be affordable again. To be honest, both are probably equally wrong. Although we do not know what the new administration will do, we can be assured of this: healthcare is a complex problem that will not be solved easily or overnight.

This article addresses the importance of relationships between physicians and the administrative leader. The article points out that the administrative leader has been hired to manage or run a family business; these organizations are owned by physicians, and they are not only their businesses, but also their life. It discusses the meaning of good concise communications, with a strict no surprises policy, as well as how being willing to adapt rather than adopting solutions will better ensure success. The board of directors should never be seen as people you dread being around. If you do view them in such a manner, it will only be a matter of time until they begin to act in accordance with your worst fears. The goal should be to develop a relationship based on trust, competence, and mutual respect.

As the demand for healthcare increases in the United States, nonphysician practitioners such as nurse practitioners (NPs) and physician assistants (PAs) are being called upon to provide more services in a greater variety of settings. State laws have been amended to broaden the scopes of practice of NPs and PAs. New Medicare programs such as Chronic Care Management and Transitional Care Management are well suited for NPs and PAs. This article discusses these developments, their impact on healthcare delivery and reimbursement, and how medical offices, clinics, and health systems can utilize NPs and PAs to provide excellent healthcare in an efficient manner.

You think you are an employer at will. Think again! This article discusses how employers too often create binding contracts of which they are completely unaware-until the employee or former employee seeks to enforce the "contract" and collect on the liabilities the organization did not know it had. Such lack of awareness may lead to the creation of full-blown contracts of employment, or a variety of mini-contracts that can be enforced for smaller, specific issues, or huge liability for wages and commissions. It may even eliminate the ability to enforce the organization's work rules and discipline. This article focuses on the contract area.

It turns out that taking care of worker health and well-being is the most effective way to increase engagement and performance. Putting yourself and your health first isn't selfish; it's exactly what we all need to do to make our businesses thrive. It is a minimum requirement for doing your job well, and the perfect New Year's reso.lution. This article offers a comprehensive list of the "don'ts," with suggestions on what to do instead, including strategies that increase movement and exercise, improve sleep and eating habits, reduce stress, improve air quality, and reduce chronic and infectious disease in medical offices. Healthy workers are more productive. The most obvious benefits to the bottom line are the avoidance of healthcare costs, but companies that make investments in employee health and wellbeing also are seeing increases in creativity, engagement, and productivity, and, as a result, business growth.

The shift from fee-for-service to value-based reimbursement models represents one of the biggest billing transitions and greatest financial opportunities for physician practices. On the heels of ICD-10 adoption and against the backdrop of new digital infrastructure and workflows, practices face a new journey toward the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the Quality Payment Program. Knowledge of how to traverse the path, navigate the intersections, and optimize the opportunities of healthcare payment reform is essential. This article offers an overview of the new Medicare reimbursement landscape and specific steps that practices can take to protect revenue streams today and ensure they thrive tomorrow.