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By focusing on asthma management, physicians not only improve patient outcomes and reduce healthcare spending, they also earn more money. Asthma is a condition targeted under the Medicare Access and [...]

By focusing on asthma management, physicians not only improve patient outcomes and reduce healthcare spending, they also earn more money. Asthma is a condition targeted under the Medicare Access and [...]

HIGHLIGHTS * Interoperability issues are raising the question as to whether doctors can access the information they need for value-based care reporting. * The best approach for interoperability may be [...]

New guidelines from the American Heart Association and the American College of Cardiology mean 30 million more U.S. adults could now be classified as having high blood pressure. The updated [...]

What a difference a year makes. Twelve months ago physicians were preoccupied with Medicare payment reform, which was just taking effect, and wondering how--or whether--to gather and submit the data [...]

Many physicians are relieved to see 2017 come to an end. From day one of his administration, President Donald J. Trump has pledged to repeal and replace the Affordable Care [...]

the price of prescription drugs used to be largely a medical concern: Patients wouldn't get better if they couldn't afford to fill their prescriptions. But with Medicare's growing emphasis on [...]

IF DOCTORS WANT to continue providing the best care for their patients, they will need to fight through the challenges of data reporting and government mandates accompanying the transition to [...]

HIGHLIGHTS Always ask patients to identify what's most difficult for them in terms of managing their diabetes. To improve medication adherence, help patients identify the times of the day when [...]

MANY INDEPENDENT primary care physicians already work hard to coordinate care effectively; but, are they ready to further strengthen these efforts and work even more collaboratively with hospitals to improve [...]

SINCE 2015, when Congress passed significant Medicare payment reform legislation, primary care physicians have treated the measure as something to deal with sometime in the future. That future arrived January [...]

1. Surviving reimbursement changes 13.3% (especially under MACRA) PAGE 27 2. Time/energy required for prior authorizations PAGE 29 9.9% 3. Lack of negotiating power with prayers PAGE 47 8.5% 4. [...]

INTERNIST MICHAEL Soppet, MD, part of an eight-physician internal medicine practice in Dothan, Alabama, achieved recognition as a patient-centered medical home (PCMH) in 2011. Recently, however, he and his partners [...]

HEALTHCARE'S TRANSITION to value based payments is ratcheting up the pressure on independent medical practices battling for survival, and data is the ammunition they need to have any chance of [...]

JUST WHEN PHYSICIANS thought they had electronic health records (EHRs) under control, they must now learn how to use other health IT applications that support the shift to a new [...]

QUALITY METRICS are assuming an ever-greater role in healthcare delivery, and many physicians are angry about it. They cite the vast increase in the number of metrics they must track, [...]

HIGHLIGHTS * The keys to improving adherence are establishing trust and good communication: involving the patient in development of the plan, making sure the patient understands all the elements of [...]

WITH SO MANY changes taking place in healthcare reimbursement, including the transition to value-based payments, payer consolidation, the growing popularity of high-deductible insurance policies, and the expansion of telehealth, the [...]

Introduction: The Renal or Ureteral Stone Surgical Treatment Episode-based Measure in the Quality Payment Program evaluates clinicians' cost to Medicare for beneficiaries who receive surgical treatment for stones. The measure score is calculated from Medicare claims according to a complex methodology. This paper seeks to describe the stone treatment patterns of urologists and establish benchmarks for 2 surrogate measures-preoperative stenting and postoperative infection-which may predict clinician performance on the episode cost-based measure., Methods: The study data were drawn from the adjudicated claims of 960 providers who performed at least 30 surgical stone treatments between January 1, 2020, and June 30, 2022. To allow for the correlation of procedures performed by the same providers, generalized estimating equations logistic regression models were used to evaluate the rate of preoperative stenting and postoperative infection., Results: A total of 185,076 surgical episodes (113,799 [61.5%] ureteroscopy, 63,931 [34.5%] extracorporeal shock wave lithotripsy, and 7,346 [4.0%] percutaneous nephrolithotripsy) were identified over the study period. Preoperative stenting was performed in 35,550 episodes (19.2%) and postoperative infection was documented in 13,114 episodes (7.1%). Preoperative stenting and postoperative infection were significantly more common in patients who were female (adjusted OR 1.42, 1.38), in those undergoing ureteroscopy vs extracorporeal shock wave lithotripsy (adjusted OR 3.24, 1.66), and in patients on Medicare vs commercial insurance (adjusted OR 1.19, 1.17)., Conclusions: This large study of surgical stone treatments documents rates of events and associated attributes of patients that may increase episode cost and be relevant to urologists participating in the Quality Payment Program.

SCREENING PATIENTS for hepatitis C and discussing treatment options are both important from a clinical standpoint. These tasks can also help physicians score highly in the Medicare payment reform program [...]

THE MEDICARE PAYMENT reform law Congress passed in 2015 intended to reward doctors for value and good outcomes rather than the number of services they provide, but it may have [...]

THE PATH to the new Medicare physician payment system known as the Quality Payment Program (QPP), which began on January 1, is strewn with pitfalls for doctors. Among those are [...]