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Oculus Health and MACRA: Effortless Performance-Based Incentives


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Advanced APMs for 2017


The following is a list of Advanced APMs for 2017 and an explanation of that APM so that you can consider which, if any, might be worth working towards joining.  One thing to note is that CMS is actively trying to grow this list each year to continue making it more easy for small and rural practices to participate in APMs and achieve incentives. 

1.          Comprehensive End-Stage Renal Disease (ESRD) Care Model

The Comprehensive ESRD Care (CEC) Model is designed to identify, test and evaluate new ways to improve care for Medicare beneficiaries with End-Stage Renal Disease (ESRD). Through the CEC Model, CMS will partner with health care providers and suppliers to test the effectiveness of a new payment and service delivery model in providing beneficiaries with person-centered, high-quality care. The Model builds on Accountable Care Organization experience from the Pioneer ACO Model Next Generation ACO Model, and the Medicare Shared Savings Program to test Accountable Care Organization for ESRD beneficiaries. There are 37 ESRD Seamless Care Organizations (ESCOs) participating in the Comprehensive ESRD Care Model.  You can find that list here:  See ESCOs List.

 2.          Comprehensive Primary Care Plus

Comprehensive Primary Care Plus (CPC+) is a national advanced primary care medical home model that aims to strengthen primary care through regionally-based multi-payer payment reform and care delivery transformation. CPC+ includes two primary care practice tracks with incrementally advanced care delivery requirements and payment options to meet the diverse needs of primary care practices in the United States.  There are 2,993 primary care practices participating in Comprehensive Primary Care Plus.  You can see that list here: See CPC+ List.

 3.          Next Generation ACO Model

Building upon experience from the Pioneer ACO Model and the Medicare Shared Savings Program, the Next Generation ACO Model offers a new opportunity in accountable care – one that sets predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality standards of care. There are 45 ACOs participating in the Next Generation ACO Model.  You can see that list here:  See ACO List.

 4.          The Medicare Shared Savings Program Track 2 and Track 3

The Medicare Shared Savings Program (Shared Savings Program) was established by section 3022 of the Affordable Care Act. The Shared Savings Program is a key component of the Medicare delivery system reform initiatives included in the Affordable Care Act and is a new approach to the delivery of health care. Congress created the Shared Savings Program to facilitate coordination and cooperation among providers to improve the quality of care for Medicare Fee-For-Services (FFS) beneficiaries and reduce unnecessary costs. Eligible providers, hospitals, and suppliers may participate in the Shared Savings Program by creating or participating in an Accountable Care Organization (ACO). You can see all shared savings program ACOs here:  See Shared Savings ACOs.

 5.          Oncology Care Model

The Center for Medicare & Medicaid Innovation (CMS Innovation Center) is developing new payment and delivery models designed to improve the effectiveness and efficiency of specialty care. Among those specialty models, is the Oncology Care Model, which aims to provide higher quality, more highly coordinated oncology care at the same or lower cost to Medicare. Under the Oncology Care Model (OCM), physician practices have entered into payment arrangements that include financial and performance accountability for episodes of car surrounding chemotherapy administration to cancer patients.  The Centers for Medicare and Medicaid Services (CMS) is also partnering with commercial payers in the model. The practices participating in OCM have committed to providing enhanced services to Medicare Beneficiaries such as care coordination, navigation, and national treatment guidelines for care. There are 190 practices and 6 payers participating in the Oncology Care Model. You can see the list of practices and payers here: See Oncology Care Model List.


6.          Comprehensive Care for Joint Replacement Model

The Comprehensive Care for Joint Replacement (CJR) model aims to support better and more efficient care for beneficiaries undergoing the most common inpatient surgeries for Medicare beneficiaries: hip and knee replacements (also called lower extremity joint replacements or LEJR). This model tests bundled payment and quality measurement for an episode of care associated with hip and knee replacements to encourage hospitals, physicians, and post-acute care providers to work together to improve the quality and coordination of care from the initial hospitalization through recovery.

 7.          Vermont Medicare ACO Initiative (as part of the Vermont All-Payer ACO Model)

The Vermont All-Payer Accountable Care Organization (ACO) Model is the Centers for Medicare & Medicaid Services’ (CMS) new test of an alternative payment model in which the most significant payers  throughout the entire state – Medicare, Medicaid, and commercial health care payers – incentivize health care value and quality, with a focus on health outcomes, under the same payment structure for the majority of providers throughout the state’s care delivery system and transform health care for the entire state and its population.

 Hopefully, you now have a better understanding of the Advanced APMs that are available to you. As mentioned in the beginning of this article, CMS will be working hard to grow the list of APMs to make it easier for small and rural practices to participate.

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3 Things Every Healthcare Provider Should Know About Telehealth

How to Get (and Give) the Most Out of Telehealth Delivery.

So far, the 21st Century has seen some phenomenal improvements in modern healthcare, with both quality of care and access to services improving by leaps and bounds. As one of the most remarkable new advances, telehealth is primed to set a new standard for healthcare. As our industry universally moves towards a streamlined, tech-integrated approach, here’s what you need to know:

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3 Major Pitfalls of Chronic Care Management

The need for chronic care management cannot be understated. The American population has seen an increase in its number of citizens over the age of 65. Figures from 2012 note that people over the age of 65 make up 13.7 percent of our population, or roughly 43 million people. Medicare CPT code 99490 now allows for reimbursement for primary care providers for remote chronic care management. This creates solutions for the following three chronic care pitfalls.

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Do Medicare Advantage Plans Pay For CCM Services?


CMS addressed whether physicians could bill for chronic care management (CCM) services provided to Medicare Advantage plan members using the CCM code implemented on Jan. 1 2015.

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on Care Coordination