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A Quick Lesson on Bundled Payments

by John Nelson, MD, MHM
By: John Nelson, MD, MHM The Centers for Medicare & Medicaid Services (CMS) has too many new payment models for a practicing doctor to keep up with them all. But there are three that I think are most important for hospitalists to know something about: hospital value-based purchasing, MACRA-related models, and bundled payments. Here, I’ll focus on the latter, which unlike the first two, influences payment to both hospitals and physicians (as well as other providers). Bundles for Different Diagnoses Bundled payment programs are the most visible of CMS’s episode payment models (EPMs). There are currently voluntary bundle models (called Bundled Payments for Care Improvement, or BPCI) across many different diagnoses. And in some locales, there is a mandatory bundle program for hip and knee replacements that began in March 2016 (called Comprehensive Care for Joint Replacement, or CCJR or just CJR). These programs are set to expand significantly in the next few years.…
John Nelson, MD, MHM has been a practicing hospitalist since 1988. He is co-founder and past president of SHM, and principal in Nelson Flores Hospital Medicine Consultants. He is co-director for SHM’s “Best Practices in Managing a Hospital Medicine Program” course. Write to him at [email protected]

The ABIM Has New Plans for MOC and Wants Your Opinion. Give It to ‘Em!

  We have more details on what the ABIM is considering regarding changes to the Maintenance of Certification (MOC) process since they last announced some very high-level ideas in the spring. The ABIM is now requesting feedback through a member survey on some proposed options to update its controversial MOC process. Specifically, they are outlining two main alternatives to the current 10-year high-stakes, high-prep, high-anxiety MOC exam: a 5-year pathway and a 2-year pathway. The chart below from the ABIM blog hits the key points. The email to the membership with the survey link attached goes into more depth about what each proposal could entail but also adds some things not shown in the table, the most key of which is that both of these options would be “low stakes”. Specifically, they call out the fact that “if you don’t do well on one assessment, you will not lose your certification”. This, if…

VIP Syndrome

I was reading a nice piece eulogizing David Bowie.  If you are a fan of his you know what a towering figure he was in the music world.  Given he died of cancer, I was also thinking about the docs involved in his care and their absolute pledge to him to guard his celebrity.  HIPPA aside, if you know the man or like his music, you must be in awe and most certainly, aimed to satisfy his expectations. If you work in a big town, you have probably seen your share of VIPs come and go into your facilities as well.  And you have also witnessed or partaken in the privileges accorded to them by request from above or out of your reverence. By VIPs, of course, I mean starting quarterbacks, lead singers, chairs of the board, and local luminaries and donors with deep pockets. I was curious about the…

Serious Upgrade for SHM’s 2016 State of Hospital Medicine Report

Great news! The long-anticipated 2016 State of Hospital Medicine (SoHM) Report was released last week to rave reviews. Pre-orders of the report blew away previous records, and that’s on top of the almost 600 hospital medicine groups (HMGs) that received free versions of the report as a result of participating in the survey. Again this year, the SoHM Report breaks down the latest statistics for a number of salary and workload benchmarks and a wide variety of HMG structural and operational characteristics that inform those two areas. I was privileged to be on a web conference last week in which SHM staffer extraordinaire Patrick Vulgamore, the primary writer/editor of the report, walked us through the enhanced online version. And I have to say it’s a massive upgrade to previous digital versions. Two extra-cool things about the new digital version: It is searchable. It can be accessed via a mobile app.…

MACRA, ABX, Post-Discharge Responsibility Make HM News

SHM & Hospital Medicine in the News: September 29 – October 13, 2016 Check out the latest hospital medicine and SHM-related stories in mainstream and healthcare-centric news. For the full stories, click on the links below: Some physicians fear that the upcoming MACRA rule, which will soon be released, will be too narrow and complex to achieve its goal of boosting value over volume. diff remains a challenge at top hospitals nationwide, despite efforts to promote more judicious antibiotic prescribing practices. Former Journal of Hospital Medicine research was cited in a recent story discussing the similarities between hospitalists and residents in their perception of post-discharge responsibility. Hospitals are feeling the pinch of increased drug prices that often have no correlation with improving patient health, according to a new report. A blog post from Brigham and Women’s Hospital highlights the recent implementation of SHM’s RADEO toolkit to guide them in safer…
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