DENVER MEDICAL BULLETIN
Official Publication of The Denver Medical Society

A new multi-state report by the RAND Corporation places Colorado 20^th out of 25 states for highest relative commercial health care prices compared to Medicare. The analysis indicates that across the 25 states participating, prices paid to hospitals by private insurers in 2017 averaged 241% of what Medicare would have paid. Colorado is on the high-end of the spectrum with relative prices across both inpatient and outpatient services paid at 269% of Medicare. Outpatient services average 350% of Medicare in Colorado while inpatient services average 220% of Medicare.

The analysis includes claims for more than four million people and over 1,500 hospitals, 77 of which are Colorado hospitals. Information for the study came from two state all payer claims databases, including the Colorado All Payer Claims Database (CO APCD), self-insured employers, and records from health insurance plans who participated voluntarily. The breadth of hospital pricing makes the study unique and shines new light on ways to contain health care costs. This is the first broad-based study that reports prices paid by private health plans to hospitals identified by name and to groups of hospitals under joint ownership (hospital systems) identified by name.

According to the RAND study authors, “If employers and health plans participating in the study had paid hospitals using Medicare’s payment formulas, total payments over the 2015-2017 period would have been reduced by $7 billion — a decline of more than 50%.”

Large price discrepancies exist between what private health plans pay for hospital services and what Medicare pays. RAND Corporation researchers used data from three sources — self-insured employers, state-based all-payer claims databases, and health plans — to assess $13 billion in hospital spending in terms of hospital price levels, variation, and trends from 2015 through 2017 in 25 states. In this report, prices reflect the negotiated allowed amount paid per service, including amounts from both the health plan and the patient, with adjustments for the intensity of services provided. These negotiated prices are then compared with Medicare reimbursement rates for the same procedures and facilities to determine relative prices.

Read the whole article here.

Monday, July 15th - 7:00am to 2:00pm

7:00 am- Registration/ Breakfast

8:00 am - Shot Gun Start

12:30 pm Luncheon and Award Ceremony

The Veterans Choice Program and other Department of Veterans Affairs (VA) initiatives that give veterans who meet certain eligibility criteria the option to see community-based physicians and other health care professionals has been supported by medicine and the AMA has worked on the national level to encourage program changes that support patients and community physicians. The recent passage of the MISSION Act built on these efforts by consolidating all of the VA's purchased care authorities into the Community Care Program beginning June 6. Unlike the Choice Program, the Community Care Program signifies a long-term commitment by the VA to partner with private practitioners, hospitals and other community-based providers to deliver care to veterans. There will be one contracting process, one set of rules, one set of eligibility criteria, a new claims processing system that should reduce payment delays and, significantly, there is no sunset date for the Community Care Program. 

In the Community Care Program Proposed Rule, the VA specifically acknowledged that many community-based providers will be small businesses and that the impact on such entities will be considered in subsequent rulemaking.

The Community Care Network administrators have yet to be finalized in most regions and the VA has yet to publish rules on claims processing and payments, so the program will be rolled out with some unanswered questions. The Triwest provider network will be a critical bridge during this transitional period and payment rates will be carried over from the Veterans Choice Program until the VA issues rulemaking that is expected to align VA payment rates with Medicare. The ability of the VA to coordinate care with community-based physicians is the biggest question mark, given the reliance on untested information technology that allows community-based physicians to interface with the VA.

QPP Resources for Colorado Practices

TMF Health Quality Institute Upcoming Offerings

TMF QPP-SURS Events – July 2019

• Let's Talk QPP Special Office Hours: Use of Registries for Specialty Clinicians  – Wednesday, July 3 at noon CT Register Here

• In this roundtable discussion, representatives from specialty registries will be present to discuss opportunities to improve Merit-based Incentive Payment System (MIPS) reporting and quality improvement using a specialty registry. In addition to the vendors, a practice that is successfully using a specialty registry will join the discussion.

• Let's Talk QPP: Understanding Implications of Special Status Designation  – Wednesday, July 17 at noon CT Register Here

• There are a number of Special Status designations for clinicians in MIPS. They relate to the size of the practice, location of the physical practice and where the clinician provides services the majority of time. Learn how CMS calculates these Special Status designations.

• Let's Talk QPP: The Medicare Annual Wellness Visit and Its Potential MIPS Impact  – Wednesday, July 31 at noon CT Register Here

• The Medicare Annual Wellness Visit (AWV) is done by providers as a routine service to Medicare beneficiaries. Did you know it could potentially impact up to 25 Quality measures? In addition, Improvement Activities that impact the AWV may be used to meet the Improvement Activities and Promoting Interoperability categories. TMF consultants will discuss how you can utilize the AWV to improve your overall Merit-based Incentive Payment System (MIPS) final score.

 Promoting Interoperability Workshop 

Join the Promoting Interoperability (PI) Workshop to prepare for this category of the Merit-based Incentive Payment System (MIPS). This interactive workshop will include an implementation guide and action items, live workshop sessions and individual support as needed.
For more information, click here.

for the Promoting Interoperability Workshop 

Sign up now for the Workshop. After signing up, look for more information by email, and you can register for the individual online sessions listed above.