Dobson|DaVanzo

Dobson|DaVanzo’s Data Analytics for Medicare Episode-Based Payment Models

Tuesday, March 30, 2021 | by Randy Haught

Tags: Alternative Payment Models, CMS Innovation Award Data, CMS Mandatory Payment Model, Data Analytics, Medicare data, Medicare Episode-Based Payment Model, Radiation Oncology, Value Based Payment

Using CMS Innovation Award Data, Dobson|DaVanzo is helping physicians and physician group practices “deep dive” into the complex world of MIPS VBP cost efficiency measures by dissecting risk-adjusted Medicare spending during episodes of care for 18 medical conditions/surgical procedures by clinical theme, type of service, and episode period (pre-, intra-, and post-trigger periods) compared to peer-group benchmarks. This allows providers to easily identify areas for improvement. Our monthly and quarterly data updates provide timely information that allows providers to continually monitor their performance trend overtime.

How Much of the Herd Has Some Immunity?

Friday, February 26, 2021 | by Alex Hartzman

Tags: COVID-19, HerdImmunity, pandemic, PHE, Public Health Emergency

COVID-19 cases are currently on the decline in the U.S. and effective vaccines have been developed, approved and are being distributed at record pace – all cause for celebration. However, new variants and societal fatigue are continuing dangers to the health and well-being of Americans as the government and healthcare industry race to vaccinate and protect people from the novel pathogen. As we complete our first full year living in the COVID-19 public health emergency, this blog explores two questions worth asking:

  1. How far are we into this pandemic (in terms of herd immunity); and
  2. What are our policy options to take advantage of this recent decline in cases and steadily increasing availability of vaccines?

Dobson | DaVanzo Can Help Assess Performance and Areas for Potential Savings Under the New Radiation Oncology Bundled Payment Model

Friday, October 30, 2020 | by Randy Haught

Tags: Bundled Payment, Radiation Oncology

On September 18, 2020, The Centers for Medicare and Medicaid Services (CMS) finalized the Radiation Oncology Bundled Payment Model and delayed implementation to July 2021. Through our access to Medicare claims data, Dobson | DaVanzo will be developing national and regional benchmarks to help providers assess their current performance and identify areas for potential savings under the new bundled payment model. We can help providers make use of their own CMS provided data by constructing episodes of care and dissecting their historical Medicare payments for various components of radiation therapy episodes as well as the utilization and costs of different treatment modalities.

COVID-19 Modeling Update: May 15, 2020

Friday, May 15, 2020 | by Alex Hartzman, Al Dobson, Joan DaVanzo

Tags: COVID-19

Federal guidance has shifted to reopening and states are just beginning to lift restrictions. With no vaccine in the foreseeable future and testing still inadequate (both for active disease and presence of antibodies), many models indicate that the U.S. is poised for major resurgences in infections in the coming months.

COVID-19 Modeling Update: Dobson | DaVanzo Modeling Corner

Friday, April 24, 2020 | by Alex Hartzman

Tags: Hospitals, modelling, COVID-19, Hospital Finance

Alex Hartzman dicusses the changing nature of the COVID-19 forecast models. What does it all mean?

Dobson | DaVanzo Provides Analytical Support for COVID-19 Planning and Response Activities

Tuesday, April 14, 2020 | by Alex Hartzman

Tags: COVID-19

Dobson | DaVanzo works with clients to find the best possible data in their state, examine the differential spread of COVID-19 by county, and include information about health system capacity to build an actionable model that helps planning and response activities. We are also working to extend our modeling to post-acute care and other services as it relates to the risk of providers, their patients and the recovery of those infected by COVID-19. Send us an email at info@dobsondavanzo.com if you would like to discuss how we can assist in the modeling for your medical demand or surge planning over the immediate or longer-term future.

Radiation Oncology Models of Care: Savings for Providers

Wednesday, October 30, 2019 | by Randy Haught

Tags: Radiation Oncology, CMS Mandatory Payment Model, Medicare

On July 18, 2019, the Centers for Medicare and Medicaid Services (CMS) proposed a payment model that would make prospective episode-based payment for a list of specified professional and technical radiation therapy (RT) services furnished during a 90-day episode to Medicare fee-for-service (FFS) beneficiaries diagnosed with one of 17 cancer types. This issue brief - the third in our series of "Radiation Oncology Episodes of Care"- shows that the newly proposed CMS payment model may present savings opportunities for radiation therapy providers. 

Radiation Oncology Model Episodes of Care: Cost Differences Across Treatment Modalities

Monday, October 14, 2019 | by Randy Haught

Tags: CMS Mandatory Payment Model, Radiation Oncology

CMS proposed a prospective payment model that would pay participating hospital outpatient departments (HOPD) providers and freestanding radiation therapy centers for radiation therapy (RT) episode-based payment for a list of specified professional and technical RT services furnished during a 90-day episode to Medicare fee-for-service (FFS) beneficiaries diagnosed with one of 17 cancer types. Providers will be paid a single rate for each specific cancer type regardless of the treatment modality (i.e., stereotactic radiosurgery, intensity-modulated radiotherapy, conventional external beam, intraoperative radiotherapy, proton beam therapy, or brachytherapy) selected for the patient. Technical component providers that will be subjected to the Radiation Oncology (RO) payment model will need to determine how to achieve a 5-percent savings, which is CMS discount from average historical spending. One option will be to assess the clinical appropriateness and cost effectiveness of the treatment modality used during the episode. This blog is the second in the multi-series of blogs titled "Radiation Oncology Episodes of Care" and examines the cost differences across the various treatment modality options and their impact on episode spending.

Radiation Oncology Model Episodes of Care: Analyzing Medicare Spending

Monday, September 30, 2019 | by Randy Haught

Tags: CMS Mandatory Payment Model, Radiation Oncology

On July 18, 2019, the Centers for Medicare and Medicaid Services (CMS) proposed a payment model that would make prospective episode payments to hospital outpatient departments (HOPD) and freestanding radiation therapy centers for radiation therapy (RT) episodes of care. The model will be mandatory for a sample of RT providers and suppliers and is specific to core-based statistical area (CBSAs), which have not yet been determined. Medicare would pay participating providers and suppliers a site-neutral, episode-based payment for a list of specified professional and technical RT services furnished during a 90-day episode to Medicare fee-for-service (FFS) beneficiaries diagnosed with one of 17 cancer types. This blog is the first in the multi-series of blogs titled "Radiation Oncology Episodes of Care" and takes a look the historical Medicare payments for radiation therapy.

Challenges for Rural Healthcare

Friday, August 30, 2019 | by Steven Heath

The Center for Medicare and Medicaid Services (CMS) recently proposed changes in the way Medicare payments for inpatient hospital visits are made through changing wage index calculations. In the proposed 2019 notice of public rulemaking (NPRM), CMS proposes two solutions to address th Medicare national standardized payments to account for differences in market area labor costs across the country. This blog discusses the implications of the NPRM for hospitals in rural areas.

BPCI Advanced Participation Decisions in March 2019

Monday, March 25, 2019 | by Randy Haught

Tags: Hospitals, BPCI Advanced, Bundled Payment

Last August CMS provided a one-time retroactive opportunity to withdraw in total from the BPCI Advanced program or withdraw selected clinical episodes by March 1, 2019. This grace period allowed participants to “test the waters” between October 2018 and February 2019 before making a final decision. Participants that retroactively withdraw in total or for select clinical episodes are not held accountable for those episodes, meaning that any losses incurred relative to the established target prices will not be charged to the bundler.

Pathways to Success Implementation Offers ACOs Greater Risks and Rewards

Wednesday, February 27, 2019 | by Alex Hartzman

Tags: Hospitals, Medicare, MSSP, Accountable Care Organizations, ACOs

The Medicare Shared Savings Program (MSSP) is undergoing a major overhaul under the Pathways to Success regulation, finalized December 31, 2018. This regulation replaces the existing program participation tracks with an emphasis on increasing downside risk, as well as updates a variety of other program rules. This rule went into effect on January 1, 2019, with most aspects to be implemented fully starting July 1, 2019.

Is It Time for a Mid-Course Correction for Medicaid DSH?

Wednesday, February 27, 2019 | by Joan DaVanzo

Tags: Hospitals, Medicaid, Uninsured, ACA, DSH

The Patient Protection and Affordable Care Act (P.L. 111-148 as amended) required significant reductions to Medicaid payments to hospitals that serve a disproportionate share (DSH) of low-income and vulnerable patients starting in 2014. However, the start of Medicaid DSH payment cuts was delayed several times by policymakers. In 2013, Congress postponed the beginning of payment reductions to 2018, and budget bills in later years continued to postpone the cuts.

BPCI Advanced Grace Period is Coming to a Close

Monday, February 25, 2019 | by Randy Haught

Tags: BPCI Advanced, Bundled Payment

Last August the Centers for Medicare and Medicaid Services (CMS) provided a one-time retroactive opportunity to withdraw in total from the BPCI Advanced program or withdraw selected clinical episodes by March 1, 2019. This grace period allowed participants to “test the waters” between October 2018 and February 2019 before making a final decision. Participants that retroactively withdraw in total or for select clinical episodes will not be held accountable for those episodes. Meaning that any losses incurred relative to the established target prices will not be charged to the bundler.

The Importance of Medicaid DSH Payments

Friday, November 2, 2018 | by Steven Heath, MPA

Tags: Medicaid, DME, DSH

Medicaid DSH provider payments are an important public policy issue as we move through “repeal and replace.” Let me tell you why.