当我们继续考虑医疗保险中心的影响时 & 医疗补助云顶集团(CMS)提议改变分割/共享计费的规则, we must examine both the potential impact on professional revenue and inpatient operations and the downstream effect on production-based provider compensation models.
分裂/共享E&M visits occur when both an advanced practice provider (APP) and a physician see a patient, and time studies show it is common for the APP to spend more time and provide most of the standard clinical responsibilities during these visits. 然而, 在现行规则下, these visits can still be billed under the physician as long as they see the patient directly and perform what CMS defines as “a substantive portion” of the encounter.
The proposed rule change aims to eliminate the poorly defined concept of “substantive” and rely instead on the more objective measure of time. 如果APP花更多的时间在病人的访问上, 包括访前准备和访后文件, 规则规定，访问必须在APP下计费, 即使云顶集团40011官网进入病房参与医疗决策.
This change will have material implications on the WRVU distribution among providers on care teams staffing inpatient units, 医院门诊部, 急诊部门, 尽管没有调整日常工作流程.
收入和wrv的预期变化
The two most immediate and broadly applicable impacts of the split/shared billing rule change will be to professional collections and the attribution of WRVUs to physicians and APPs. Both independent physicians who rely heavily on APPs within their practice and hospitals that employ physicians and APPs could see a meaningful decrease in reimbursement, 这将最终影响到付费提供商的可用资金. 另外, 对于受雇云顶集团40011官网, 这一变化可能会导致wrvu从云顶集团40011官网到app的重大转变.
像这样, we recommend conducting a proactive evaluation of current compensation methodologies to assess the potential impact of the policy change.
对医疗集团和云顶集团40011官网的建议
云顶集团40011官网
It is likely that a material amount of WRVUs could shift from physicians to APPs under this new rule, adversely affecting physicians who are paid under production-based compensation plans (within those specialty areas expected to be impacted most by this new rule). Many hospital-based specialties are currently paid materially on time-based plans that recognize expected and incremental shifts worked, 而WRVU归属的改变不会影响它们. But for providers with some or all of their compensation currently tied to WRVU production, these organizations may attempt to mitigate the impact of this change by shifting compensation to further emphasize the time-based component or by either lowering WRVU thresholds or increasing WRVU payment rates under the production-base components.
然而, 使供应商薪酬总额与集团财务业绩保持一致, 避免对单元操作进行大的更改, 并在单位内创造文化凝聚力, organizations should consider increased emphasis on operational or quality performance incentives that recognize contributions from the entire care team and better align with the goal of ensuring all providers work at the top of their licensure while also promoting the effectiveness of the care delivered. These incentives could prompt more meaningful funding tied to specialty-specific quality measures or broader inpatient quality measures like hospital-acquired infection rates, 停留时间, 以及潜在的可预防的再入院率.
除了, APP supervision stipends—which have gradually been phased out under extender care models as organizations recognize the net benefit to physicians who work with APPs—may come back in a meaningful way to recognize the time physicians still dedicate to these shared visits. This change could spur organizations to rethink their patient care teams and utilize higher APP-to-physician ratios as the role of physicians explicitly shifts to a more supervisory one.
最后, clinical compensation for impacted physicians will likely plateau in the specialties impacted by the new rule, 甚至可能略有下降, as medical groups look to align overall compensation with the reduced professional collections stemming from this new reimbursement model.
为应用程序
甚至在规则改变之前, we have witnessed more incentive-based compensation plans for APPs due to the industry’s shift away from static salary structures and toward the use of more meaningful production incentives. 从历史上看, APPs under team-based coverage models that offer no incentive to work autonomously generate few personally performed WRVUs and are therefore not considered for production incentives—this attribution gap is part of the impetus for change. The updated rule would create a more accurate accounting of APPs’ clinical efforts and should prompt organizations to develop meaningful ways to recognize production across all providers, 我们知道哪个是提供者满意度和参与度的主要驱动因素.
心电图正积极与组织合作，以应对这一拟议变化的细微差别, 尤其是在它仍然可以解释的地方. CMS has afforded medical groups and health systems a longer transition period to allow for a smoother conversion. Organizations should be proactive in using this additional time to not only ensure compliance with the new rule but also to evaluate the advancement of care delivery via increasingly collaborative and interdisciplinary teams, effectively utilizing scarce clinician resources to meet progressively complex inpatient care needs.
心电图’s experts can provide strategies to help your organization proactively address and prepare for these forthcoming regulatory changes.
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编辑: 马特杂粮面包
