The last Medicare Physician Fee Schedule final rule under the Biden Administration is out now and physicians, trade groups, and those engaged in the Medicare Shared Savings Program and subject to the Quality Payment Program are taking note of the finalized changes.

CMS’ Roadmap for Rural Health addresses access, care delivery, and workforce challenges through Rural Health Hackathons. Participants proposed solutions like telehealth expansion, reduced administrative burdens, and workforce flexibility. CMS plans to scale these ideas and implement rural-specific initiatives to transform healthcare in underserved areas.

CMS finalized a rule to address suspected fraudulent billing for catheter-related DME in 2023, impacting Medicare Shared Savings Program financial calculations. The rule excludes specific catheter claims from ACO performance year and benchmark calculations, with key policy changes affecting ACOs' financial outcomes.

This year’s proposed rule covers a lot of ground—pressing full steam ahead on eCQMs for ACOs, introducing new payment codes for advanced primary care, and seeking more open-ended comment on a higher risk track of MSSP.

Coral Co-Founder, Melissa Cohen, and Senior Advisor, Maria Alexander, attended the CMS Health Equity Conference on May 29-30, 2024. Read more to find out what stood out to us over the two-day conference.

The proposed model holds selected transplant hospitals accountable through upside and downside performance-based payments and includes requirements to address health equity and transparency.

The Centers for Medicare & Medicaid Innovation (CMMI) just announced a new mandatory model via the Hospital Inpatient Prospective Payment System (IPPS) proposed rule, the Transforming Episode Accountability Model or TEAM. 

On January 18, 2024, the Centers for Medicare & Medicaid Services (CMS) unveiled a transformative new model to support Medicaid and Medicare populations with behavioral health needs. The Innovation in Behavioral Health (IBH) Model was designed to enhance mental health and substance use care for individuals grappling with moderate to severe mental health conditions and/or substance use disorders and bridge the gap between behavioral and physical health.

In a bid to reshape maternal healthcare and address alarmingly high rates of poor maternal health outcomes (as compared to other high-income countries), the Centers for Medicare and Medicaid Services (CMS) announced the Transforming Maternal Health (TMaH) Model on December 15, 2023. This bold initiative spans a decade, with the goal of improving outcomes for pregnant and postpartum women, all while tackling disparities in access to care and treatment offered.

When we know something works, we ought to do it. But what if we think we know what works, or that it could work if we did enough of it?

This is the paradox of testing and scaling that has been value-based care for the past decade. Recent reports highlight the growing importance to providers of payer alignment to support implementation of value-based care and population health.

Coral did not create this witty title. Another consulting firm wrote a blog with a similar title when the Quality Payment Program (QPP) first emerged with the concept of Qualifying Participants (QPs) in 2017. The idea behind QPP was to give special status to those entities moving into downside risk and taking accountability for the cost and health outcomes of their patient population. By virtue of being a QP, participants were exempt from the Merit Based Incentive System (MIPs) - a comprehensive quality reporting framework that determined the way all other physicians were paid. This was the plan for continuing to encourage the move away from fee-for-service (FFS) and towards value. And every year, the Physician Fee Schedule (PFS) updates QPP including what it takes to be a QP and the requirements for MIPs.