Posts by Hector Cariello

What Eligible Clinicians Need to Know About Proposed Changes to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)

The Medicare Access and CHIP Reauthorization Act of 2015 changed the way Medicare rewards clinicians for providing quality care. CMS released a proposed rule in April 2016 to carry out key provisions of MACRA and implement two payment paths available to “eligible clinicians” (EC) as part of the proposed “Quality Payment Program”: (1) the Merit-Based Incentive Payment System and (2) the Alternative Payment Model Incentive. The proposed “Quality Payment Program” replaces the Sustainable Growth Rate (SGR) formula for paying eligible clinicians based on value and quality of care, which aligns with CMS’s goal to replace Fee-for-Service (FFS) volume-based payment with a value-based system.

Read More

Does Risk-Adjustment for Sociodemographic Status (SDS) Have an Impact on Hospital Performance?

Ongoing research examines the impact of applying sociodemographic status (SDS) risk-adjustment to the Centers for Medicare & Medicaid Services (CMS) quality reporting programs. The main driver for investigation is a community assertion that SDS risk-adjustment is necessary to accurately gauge the quality of care given to patients of diverse backgrounds. Contrary to popular belief, recent research produced evidence that SDS risk-adjustment has little to no impact on hospital performance ratings.

Read More