Effects of Health Care Payment Models on Physician Practice in the United States: Follow-Up Study

Abstract

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The complex case of EHRs: examining the factors impacting the EHR user experience

“…There are also concerns about the perceived misalignment between data entered into an EHR for the purposes of patient care, and data entered for quality reporting and meeting MIPS and QPP requirements 1 , 25 , 26 . The increasing demands that the EHR be used as a tool for documenting mandatory payment data and quality reporting, paired with the possibility that EHR functionality may not be sufficient to support all of these demands, affect EHR usability 27 .…”

“…The increasing demands that the EHR be used as a tool for documenting mandatory payment data and quality reporting, paired with the possibility that EHR functionality may not be sufficient to support all of these demands, affect EHR usability 27 . Modifying EHRs to collect data needed to succeed in alternative payment models also continues to be a challenge for physicians and their practices 26 …”

Savings or Selection? Initial Spending Reductions in the Medicare Shared Savings Program and Considerations for Reform

“…The ability to alter the attributed patient population by changing the TIN under which clinicians bill does create some opportunities for risk selection, and there is some anecdotal evidence of ACOs exploiting this mechanism. 11 In particular, one strategy relates to the inclusion of encounters in postacute or long-term nursing facilities among the qualifying services used by CMS to assign patients to ACOs. Consider an internist or geriatrician who sees patients in the office and on rounds with patients in a skilled nursing facility (SNF), billing both types of services under the same TIN.…”

“…An ACO also could terminate clinicians’ employment or move them to a different practice, though these behaviors seem implausible and might provoke legal action. The ability to alter the attributed patient population by changing the TIN under which clinicians bill does create some opportunities for risk selection, and there is some anecdotal evidence of ACOs exploiting this mechanism 11 …”

Spending Reductions in the Medicare Shared Savings Program: Selection or Savings?

“…The ability to alter the attributed patient population by changing the TIN under which clinicians bill does create some opportunities for risk selection, and there is some anecdotal evidence of ACOs exploiting this mechanism. 11 In particular, one strategy relates to the inclusion of encounters in post-acute or long-term nursing facilities among the qualifying services used by CMS to assign patients to ACOs. Consider an internist or geriatrician who sees patients in the office and rounds on patients in a skilled nursing facility (SNF), billing both types of services under the same TIN.…”