Update on MACRA Rule 2022 – Part 2

This episode, an excerpt from the recent Medical Leadership Series webcast, continues the discussion of the final MACRA Rule for 2022, focusing on challenges providers now face as MACRA progresses into next year and the serious consideration providers should give to joining an Alternative Payment Model (APM). Also part of the discussion are MIPS Value Pathways (MVPs) and Advanced Alternative Payment Models (aAPMs).
 
Guest speakers:
Valinda Rutledge, MBA, MSN
Senior Advisor, Sg2
Vizient
 
Madeleine McDowell, MD
Principal and Medical Director, Sg2
Vizient
 
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Principal
Clinical Operations and Quality
Vizient
 
Show Notes:
[00:27] Uncontrollable circumstance exemption for COVID-19
[02:22] Changes to the final score
[03:36] “The juice ain’t worth the squeeze anymore”
[03:56] The only way to do well
[04:33] The heavy lift: the reporting burden
[05:46] MIPS Value Pathways (MVPs)
[07:41] Advanced Alternative Payment Models (aAPMs)
 
Links | Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Maddie McDowell’s contact email: madeleine.mcdowell@vizientinc.com
Valinda Rutledge’s contact email? valinda.rutledge@vizientinc.com
Program handout from December 8, 2021 Vizient Medical Leadership Series webcast: Click here
Link to December 8 webcast: Click here
 
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Update on MACRA Rule 2022 – Part 1

For physician and clinician leaders, this episode provides the latest information on the final MACRA Rule for 2022, including regulatory activities impacting reimbursement. We will discuss the Merit-based Incentive Payment System (MIPS), Alternative Payment Models (APMs), telehealth reimbursement, split visit payment rules and other information crucial to physicians and clinicians.
 
Guest speakers:
Valinda Rutledge, MBA, MSN
Senior Advisor, Sg2
Vizient
 
Madeleine McDowell, MD
Principal and Medical Director, Sg2
Vizient
 
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Principal
Clinical Operations and Quality
Vizient
 
Show Notes:
[01:58] Concerning changes to payments
[04:31] Split visits
[07:56] Telehealth coverage
[09:10] MACRA—details and ramifications
 
Links | Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Maddie McDowell’s contact email: madeleine.mcdowell@vizientinc.com
Valinda Rutledge’s contact email? valinda.rutledge@vizientinc.com
Program handout from December 8, 2021 Vizient Medical Leadership Series webcast: Click here
Link to December 8 webcast: Click here
 
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Patient Safety Indicators

Patient Safety Indicators, or PSIs, provide insight into safety events that occur during care delivery. Health care organizations can use PSIs to assess potential complications and events to improve their care. Today, we define PSIs and their importance. We also discuss how health care organizations can use Present on Admission data to alleviate being unfairly compared to other organizations regarding care outcomes.
 
Guest speaker:
Terry Golde, MBA, RN, CCDS
Consulting Director
Vizient
 
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Principal
Clinical Operations and Quality
Vizient
 
Show Notes:
[00:53] Definition
[01:14] Importance of PSIs
[01:44] What PSIs measure
[03:07] Development of PSIs
[03:36] What lower PSI rates mean for hospital performance
[04:14] How PSI data is collected
[07:10] Hospital Rate in PSIs
[08:07] Calculating PSI rates
[09:13] Adjust for patient characteristics – so hospitals will compare fairly
[10:01] Using Present on Admission (POA) data
[11:08] Effect of PSIs on reimbursement and performance ranking
[11:49] PSIs as a useful measure
 
Links | Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Terry Golde’s contact email: teresa.golde@vizientinc.com
Patient Safety Indicators (AHRQ) Click here
 
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Clinical validation and denials

When a clinical diagnosis or procedure is not validated in the medical record, resulting in a claim denial, the health care organization loses reimbursement, the physician or clinician involved may come under scrutiny and the reputations of both clinician and hospital may suffer. Errors in documentation needlessly contribute to this problem. On this episode, we discuss what clinicians and organizations can do to avoid claim denials.
 
Guest speaker:
Erica Braun, MS, RN, CCDS
Consulting Director
Vizient
 
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Principal
Clinical Operations and Quality
Vizient
 
Show Notes:
[01:11] Clinical validation denial
[01:31] Implications for denials: downgraded DRGs and lower reimbursement
[02:31] Avoiding denials
[03:25] When diagnoses are at high risk for denial
[03:59] Examples of disputed diagnoses
[04:30] Establishing criteria for diagnoses
[05:15] What physicians can do to help improve documentation
[06:17] What to do when a denial occurs
[07:29] Negotiating and coordinating with payers
 
Links | Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Erica Braun’s contact email: erica.braun@vizientinc.com
Fact sheet on Vizient’s clinical documentation improvement services: Click here
Clinical Validation: The Next Big Challenge in Inpatient Coding (American Academy of Professional Coders, AAPC): Click here
 
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Accreditation services – Part 2

A strategy to achieve regulatory and accreditation compliance is important more than ever, especially in the wake of COVID-19 when regulatory agencies ramp up their efforts again. On this episode, we’ll discuss how health care organizations can face the challenges they face in achieving compliance.
 
Guest speaker:
Diana Scott, MHA, RN, CPHQ
Associate Vice President
Accreditation and Regulatory Services
Vizient
 
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Principal
Clinical Operations and Quality
Vizient
 
Show Notes:
[00:37] Challenges are not new, with infection prevention at the forefront
[02:48]  Cleanliness of ice machines
[03:25] Dialysis: orders, water management, disinfecting equipment
[04:23] Behavioral health: suicide risk
[05:31] Medication management
[06:26] Perinatal standards
[07:27] New requirements/developments
[09:24] Vizient resources
 
Links | Resources:
To contact Modern Practice: modernpracticepodcast@vizientinc.com
Diana Scott’s contact email: diana.scott@vizientinc.com
Vizient Accreditation Services: Click here
The Joint Commission: www.jointcommission.org
 
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