![我下一步该做什么](/Areas/CMS/assets/img/blank.gif)
上个月,CMS宣布了一项强制性的捆绑付款 为全国的医院和医师团体提供的项目. 对 在即将到来的总统选举和全球卫生大流行的背景下 放射肿瘤学(RO)模型的宣布是一个前所未有的举动 让供应商措手不及.
现在距离最初的公告已经过去了几周, it’s time for cancer center leaders and 供应商 to roll up their sleeves and figure out how to get ready for this program, 7月1日开始, 2021. (虽然RO模型最初定于1月1日开始, 2021, CMS announced on October 22 that it had received feedback from a number of stakeholders about the challenges of implementing the model by that date. 根据这个反馈,CMS打算将RO模型的开始日期推迟到7月. CMS将通过制定规则来实现这一改变.) This blog post will outline the key considerations and immediate next steps for your organization to ensure you are prepared. 具体来说,我们将帮助您:
- 确定您的组织是否需要参加.
- 了解项目需要实现的新操作流程(计费、报告).
- 参与和教育你的bet8网站备用和员工.
确定您的组织是否需要参加 or if you qualify for any exemptions.
该项目包括医师团体实践(pgp), 医院门诊部, and freestanding radiation oncology centers; ASCs are exempt. 然而, CMS did not make it explicitly clear which specific provider organizations will be mandated to participate (names, ccn, 和/或没有提供tin). 相反,他们发布了一个基于核心统计区域的邮政编码列表. If your organization furnishes radiation therapy services for select cancer types and modalities in one of the listed zip codes,[1] 你将被要求参加.
规则的一个例外是:CMS提供了一个小批量的选择退出. 如果您的提供者组织在2019年CY期间提供了少于20次放射治疗(RT), 你可以选择退出. 如果这适用于您的组织, CMS will contact you directly (likely via the Radiation Oncology Administrative Portal—more on this later) to offer this option. It is important to note that a failure to formally opt out will result in automatic participation in the program. 考虑到数量的潜在波动,选择退出证明必须每年进行一次.e.,您可能有资格在本业绩年度[PY]选择退出,但不包括下一个绩效年度).
The Radiation Oncology Administrative Portal (ROAP) will be integral in exchanging information between CMS and participating organizations, and each provider organization that furnishes RT services in the specified zip codes should register. 即使您计划使用低容量选择退出, 您的组织仍然需要向ROAP注册,以便您可以证明您选择退出. 为了注册ROAP,您将需要您的型号ID和TIN或CCN.[2] Please refer to 心电图’s Decision Tree below for a complete summary of each step in the participation and portal registration process![cms的新放射肿瘤学模型下一步该怎么做](/user_area/uploads/CMSs-New-Radiation-Oncology-Model-What-Should-I-Do-Next-Image-1.png)
了解您的程序将需要实现的新操作流程.
参与该模型将要求您的组织采用新的流程和程序, specifically those related to: (1) billing and revenue cycle processes and (2) clinical informatics and reporting workflows.
计费. The RO model is a prospective bundled payment program and therefore will necessitate new billing requirements that allow a participant provider to denote the start and end of the episode. Your organization will need to work with your billing and revenue cycle 团队 to implement the new provisions, 如下所述. Note that CMS will distribute the prospective payment in two equal parts: 50% at episode initiation and 50% at episode end.
- 启动情节并收到预期付款的前半部分: Participants will need to bill a new “start of episode” (SOE) modifier along with the model- and cancer-specific CPT code for episode initiation. 两个专业提供者(i.e.bet8网站备用、肿瘤学家)和技术提供者(i.e.(RTbet8娱乐的提供者或供应商)将需要提交SOE修改者.
- 在整个情节中: Participants will bill “no pay” encounter codes throughout the episode so that CMS can track utilization. “No pay” codes indicate that a service is occurring but will not be reimbursed in a traditional fee-for-service manner.
- 结束这一集并获得另一半报酬: Participants will bill an “end of episode” (EOE) modifier along with the model-specific CPT code. EOE改进剂可以在任何时候(治疗结束时或90天时)计费, 以提供者负担较轻者为准). 无论如何,在和解时,CMS将考虑所有发作的长度为90天.
信息学与报告. 除了账单, participants will need to quickly ramp up their clinical informatics capabilities and reporting workflows. RO模型需要大量的质量跟踪和报告. 第一个, professional participants must track four quality metrics and manually submit their scores via ROAP every March, 业绩年度结束后. 除了, 参与者需要每六个月提交一次“临床数据元素”, 也通过ROAP, 2021年7月开始.
因此, it is critical to ramp up quickly and begin tracking and measuring quality metrics and clinical data elements as of January 1, 2021. 而不是关注项目人口, CMS要求在你的实践中报告所有患者的指标, 不论付款人是谁. 质量指标包括:
- Oncology: Medical and Radiation: Plan of Care for Pain—NQF #0383; CMS Quality ID #144.
- Preventive Care and Screening: Screening for Depression and Follow-Up Plan—NQF #0418; CMS Quality ID #134.
- Advance Care Plan: NQF #0326; CMS Quality ID #047.
- 治疗总结交流:放射肿瘤学.
It is CMS的 intention that clinical data elements will be “seamlessly” extracted from your EHR; however, 我们预计组织将不得不对电子病历进行调整,以跟踪和报告这些数据. Clinical data elements are data not tracked in claims or quality metrics and will only apply to RO participants for five specified cancer types.[3] CMS将在PY1开始时公布所需的临床数据元素.
此外,CMS将于2021年4月开始启动CAHPS癌症护理调查. CMS将通过承包商进行调查,因此承担其费用. 虽然调查是在PY1开始, 在PY3之前,该结果将不用于参与者的整体质量得分. Providers should focus the next two years on improving patient experience measures that affect the results of the CAHPS score to maximize success in PYs 1, 2, 和3.
最后, participants will have the option to request data reports from CMS to track their performance at any point during the program. Via ROAP, participants may request claims data at the beneficiary, episode, and/or participant level. 要想成功, your organization should develop a process and plan for requesting and analyzing data: at what frequency will you request data? 你将如何分析数据? 它将与谁共享? 根据调查结果,你会采取什么行动?
在接下来的几个月, 为账单和质量跟踪制定一个操作计划是至关重要的. RO模型给提供者带来了许多管理负担, 心电图可以帮助你的组织在水中航行. 我们已经帮助供应商成功实施了其他CMS项目, 包括MSSP, 《哥伦比亚, 和BPCI高级, 我们了解确保您的项目取得成功所需的流程.
参与并教育你的bet8网站备用.
之前的RO模型开始日期为1月1日, 2021, 让你的bet8网站备用参与是很重要的, 供应商, 和其他相关人员,以确保您的程序有效运行. 尤其是课程的专业部分, bet8网站备用会对组织的绩效产生直接影响. It is important that they are highly engaged and well informed of the program and its impacts prior to the start date.
- 教育你的bet8网站备用: 尽快向你的bet8网站备用提供有关该计划的教育和信息. Convey how their role may impact performance and the importance of their engagement throughout the program.
- 确定医师冠军: 任命一位高度敬业的肿瘤学家作为“医师冠军”.” This person will advocate for the physicians in the program and be a source of knowledge for physicians who may have questions or concerns. 他们还将帮助bet8网站备用适应任何新的流程或工作流程.
- 启用护理流程更改: Physician engagement will be critical in evaluating and updating care processes and other workflows, 根据需要, 为RO模型. 授权你的bet8网站备用推动变革,并致力于建立基于证据的协议.
![cms的新放射肿瘤学模型我现在该怎么做](/user_area/uploads/CMSs-New-Raditation-Oncology-Model-What-Should-I-do-Now-Image-2.png)
完成这些行动项目将确保你的 1月1日,计划实施成功,组织成立, 2021. 这些都是可操作的、有形的项目,只要有合适的团队,就可以 立即执行.
展望未来
The RO model marks a significant departure from CMS的 historical fee-for-service payment approach and solidifies its shift toward value-based care. We believe that CMS will continue to accelerate these initiatives and launch more mandatory bundled payment programs in the future. 像这样, organizations should start evaluating their current competencies and capabilities and preparing for a future with more alternative payment models (APMs). 心电图的基于价值的准备评估是您入门的指南. 我们可以帮助您在RO模式和任何其他apm方面取得成功.
![cms的新放射肿瘤学模型下一步该怎么做](/user_area/uploads/CMSs-New-Radiation-Oncology-Model-What-Should-I-Do-Next-Image-3-resized.png)
您对CMS新的放射肿瘤学模型有什么疑问吗? bet8娱乐的 团队 如有任何问题,请bet8娱乐.
bet8娱乐脚注
- 1.
癌症类型包括:肛门癌, 膀胱, 骨转移, 脑转移, 乳房, 颈, 中枢神经系统肿瘤, 结直肠, 头部和颈部, 肝, 肺, 淋巴瘤, 胰腺, 前列腺癌, 上消化道, 和子宫. 模式包括三维适形RT, 强度调制RT, 立体定向放射治疗, 立体定向体RT, 质子束治疗, 影像引导放射治疗, 和近距离放射疗法.
- 2.
要获得您的型号ID,请致电CMS帮助台844-711-2664,选项5. 准备好提供您的TIN或CCN号码.
- 3.
参与者将报告临床数据要素 以下癌症类型:前列腺癌、乳腺癌、肺癌、骨转移癌和脑转移癌.
2020年10月2日发布