Quality Assurance Programs

The new Fee-For-Value programs no longer reimburse doctors for volume of care. It’s all about quality now.

Practices of moderate size typically leave large sums of money “on the table”, like half a million dollars in quality services. If this sounds to financial to you, think a little more about it.

Studies have shown time & again that Medicare’s quality measures & services save dollars to Medicare. A single hospitalization for diabetes typically costs $50,000 to $150,000.

Preventing just one hospitalization out of dozens of patients will pay for a lot of increased primary care. Once you understand this, you understand the key concepts underlying Fee-For-Value, Medicare Advantage, & all the other major population health/prevention programs.

The goal is to increase primary care services in order to prevent disease states requiring hospitalization & tertiary care services.

We coordinate both quality of care and quality of services. Oversight and critical intervention are important components, to ensure patient satisfaction, compliance and the best final results.

5 Star Program

Your 5-STAR ratings are critical to your ability to thrive in the new world of healthcare. Typical fee-for-value programs provide escalating bonuses for 4 & 5-STAR programs, while 1 & 2 -STAR programs are penalized.

HEDIS

HEDIS stands for Healthcare Effectiveness Data and Information Set. It was developed by the National Committee for Quality Assurance (NCQA) in the 1980s.
CMS uses it now to measure the quality of the work you do.

CAHPS

CAHPS Stands for Consumer Assessment of Healthcare Providers & Systems. It was developed by AHRQ (the Agency for Healthcare Research & Quality) in 1995 for payors & consumers to understand the patient/consumer experience.

HOS

HOS stands for Health Outcomes Survey (HOS). This is the first patient-reported outcomes measure used in Medicare Coordinated Care. HOS objective is to gather valid, reliable and meaningful health status data from the Medicare Advantage (MA) program.

Risk Management

When doctors, hospitals, and other healthcare providers are being negatively compared to other providers by cost, the most common reaction is, "That is not fair. My patients are sicker." Fee-for-value now considers that.

If you're a physician, NP, or other provider, think about the Fee-For-Value, or Preventive Medicine Revolution. It's not coming - It's Here.

Ready to find out more?

Call us at 859-721-1414 or email us. Your patients deserve it. Your family deserves it. You deserve it!

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