Douglas Flora, MD, LSSBB, FACCC

Please help the Association of Healthcare Value Analysis Professionals (AHVAP) in welcoming the newest member, Robin Lundrigan, MS, RN, CVAHP to the Association of Healthcare Value Analysis Professionals (AHVAP) family. Welcome Robin! To learn more about Association of Healthcare Value Analysis Professionals (AHVAP) membership, visit: www.ahvap.org. #AHVAP #membershipmatters #valueanalysis #valuebasedcare

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Now available: Oncology Care Model’s (OCM) final evaluation report: https://lnkd.in/eD5eNTF8 & Patient Perspectives Report: https://lnkd.in/etKN_BBq OCM aimed to improve care coordination, appropriateness of care, and access to care for people undergoing #chemotherapy. Implemented from 2016 to 2022, it also contributed important lessons learned used in the design of the currently recruiting Enhancing Oncology Model: go.cms.gov/eom. The new Oncology Care Model Cancer Care report showcases patient cancer journeys and pinpoints what matters most to people undergoing cancer treatment. It is designed for patients and caregivers to connect and learn about cancer treatment from a patient’s perspective.

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Clinical impact of medication review and deprescribing in older inpatients: A systematic review and meta-analysis. #geriatrics https://lnkd.in/gzzN5Hgf

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How to Use Modifier 25 Questions about modifier 25 have increased since add-on code G2211 was implemented in 2024 to reflect the value primary care physicians provide to patients. Learn how to report modifier 25 correctly so that you can get paid accurately. What is modifier 25? Modifier 25 is a way to identify a “significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service,” according to the CPT 2024 code set. Modifier 25 may only be appended to evaluation and management services. When can it be used? The E/M service must be significant and distinct from the procedure. The E/M must reflect work that is above and beyond the usual work associated with the procedure or other service. Asking the following questions can help determine whether it is appropriate to use modifier 25: ✔️ Did you perform and document the key components of a problem-oriented E/M service for the complaint or problem? ✔️ As documented, could the E/M service stand alone as a billable service? ✔️ Is there a different diagnosis for this portion of the visit? ✔️ If the diagnosis will be the same, did you perform extra physician work that went above and beyond the work of the other service or the typical pre- or postoperative work associated with the procedure? Modifier 25 should not be used when: ❌ The sole purpose of the encounter is for the procedure (e.g., lesion removal), and there is no documented medical necessity for a separate E/M service. The decision to perform a minor procedure is included in the payment for the procedure and should not be reported as a separate E/M service. Example: Visit for lesion removal A patient presents to have a mole assessed and the physician decides to remove it. The decision to remove the mole is included in the procedure code and should not be billed as a separate E/M service. However, in this same scenario, if the mole has a suspicious, potentially malignant appearance that the physician relates to the patient, in a separate identifiable E/M service, and discusses the possible need for a more extensive procedure if the pathology report comes back positive for malignancy, the E/M visit would be reported with a 25 modifier, along with the procedure code for the lesion removal. https://lnkd.in/dgr3MHNT #medicalcoding #modifiers #modifier25 #enm #stayconnected #stayupdated

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In this interview, Lalan Wilfong, M.D., shares insights from the Community Oncology Alliance’s 2024 Community Oncology Conference panel session titled "Defining Value in Oncology: Executing VBC Accurately & Ethically to Account for All Stakeholders." "Whenever we go into a value-based care arrangement, we want to make sure that the true heart of that is improving patient care and making sure that all of the payment models, quality metrics, and everything else goes toward improving that patient’s outcome and quality of life during the time we're under that model," said Dr Wilfong. Check out the full video here: https://lnkd.in/emqpV3wE #JournalOfClinicalPathways #ValueBasedCare #CancerCare #Oncology #EnhancingOncologyModel #COA2024

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The Association of Healthcare Value Analysis Professionals (AHVAP) celebrates Elizabeth Eisenberg, MSN, RN, CVAHP from Scripps Health for commitment to excellence in the specialty of healthcare value analysis! Liz has signified this commitment by signing the official Association of Healthcare Value Analysis Professionals (AHVAP) healthcare value analysis pledge. To learn more about the Association of Healthcare Value Analysis Professionals (AHVAP) Commitment pledge: https://lnkd.in/gqEWPBue. #AHVAP #valuebasedcare #excellenceincare #valueanalysis

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Most viewed in the last 7 days from JAMA Health Forum: This JAMA Forum discusses 3 types of assets (financial, physical, and social) that unlock access to resources and shape population health. https://ja.ma/3UA1Bhi

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Check out this scoping review of shared decision making in rheumatology, led by ISDM member Heba Aref: https://lnkd.in/gmD3Kc3t

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Today the Centers for Medicare & Medicaid Services (CMS) published the request for applications (RFA) for the ACO Primary Care Flex (PC Flex) Model, which will test #primarycare hybrid payments within MSSP beginning January 1, 2025. (https://lnkd.in/epgeV9ie) The application portal is open now (https://lnkd.in/erZPbmGq). To apply, ACOs must submit an MSSP application (as an initial, re-entering, or renewing/early renewing applicant) and a supplemental PC Flex application questionnaire. The MSSP application is open now through June 17 at 12:00pm (noon) ET. The PC Flex supplemental application must be submitted by August 1, 2024. CMS will host a model applications webinar on June 6 at 2-3:30pm ET. (https://lnkd.in/eVJJKrrP) Considerations for applying to PC Flex were discussed during NAACOS' MSSP 2025 Application Insights webinar yesterday, the slides and recording will be available on-demand shortly (https://lnkd.in/ejizaatZ). Stay tuned for additional NAACOS resources on the PC Flex model. Key model details: > The model will run January 1, 2025 – December 31, 2029. > Eligible participants are low revenue ACOs using prospective assignment that begin a new MSSP agreement starting Jan. 1, 2025; ACOs cannot simultaneously participate in Advance Investment Payments (AIP). > Participation is at the ACO level and all ACO participants and their primary care providers will be required to participate; fee reductions will be applied at the TIN/NPI level. > In addition to the MSSP application and PC Flex questionnaire, applicants must submit a spend plan, roster of non-physician practitioner data, and assurance of ability to repay; applicants may withdraw the PC Flex application at any time prior to signing the Participation Agreement (December 6 – 12, 2024), and may withdraw the PC Flex application without impacting the MSSP application. > Participants will be required to submit a health equity plan, collect and report health equity data, and secure a repayment mechanism (separate from MSSP repayment mechanism for 2-sided tracks). > ACOs will distribute the Prospective Primary Care Payment (PPCP) to their participant primary care providers, FQHCs and RHCs. CMS will require ACOs to publicly report information on the distribution of the PPCP. #valuebasedcare #accountablecare #healthcareinnovation

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Most viewed in the last 7 days from JAMA Health Forum: This JAMA Forum discusses 3 types of assets (financial, physical, and social) that unlock access to resources and shape population health. https://ja.ma/3yaXEYV

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2022 Dobbs decision overruled 50 yrs. of reproductive autonomy with major implications for clinical research including scientific integrity and health disparities; clear guidance from funding agencies to safeguard data and participant protection is needed. https://ja.ma/4baMTE4

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Check out the latest issue of the Journal of Clinical Pathways! https://lnkd.in/egTcUy4H Featured stories include: Andrew Pecora, MD, et al provides insights and perspective from each constituent involved in shaping health care payment and delivery throughout the US. Sabree C. Burbage, PharmD, et al details their study regarding prostate-specific antigen (PSA) outcomes and clinical surveillance patterns among patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) receiving next-generation androgen receptor inhibitors (ARIs) with or without in-office dispensing (IOD) services using electronic medical record (EMR) data from community-based urology practices in the US. Randy Vogenberg, PhD, FASHP, et al discusses how there is a stakeholder disconnect in precision medicine, leaving employers and other commercial plans or administrators seeking solutions as they face emerging risks from precision therapies. Lee Blansett, MBA, summarizes the third part of a study by HMP Market Access Insights , which examined the influence and impact pathways have on oncologists’ treatment decisions. #JournalOfClinicalPathways #ValueBasedCare #CancerCare #TransformativeEmployerTrends #DecisionMaking #HealthCareRisks #PrecisionMedicine #HMPMarketAccessInsights #MAI #nmCRPC

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Check out the most recent issue of the Journal of Clinical Pathways, which includes an article from OMI CEO Dr. Andrew Pecora discussing the future of healthcare payment and delivery in the US. #JournalOfClinicalPathways #ValueBasedCare #healthcarepayment #healthcare #decisionmaking https://lnkd.in/eiWuKegG

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Excellent overview by Akiko Chiba, MD, FACS on how social media may impact health outcomes - Jennifer Plichta https://lnkd.in/gg3YvznG #oncodaily #oncology #socialmedia #healthoutcomes #physicianeducation #patienteducation #publichealth #misinformation #healthcommunication #medicalresearch #healthcareinformatics #ASBRS24

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Be there this September 20-22 for CSRO's flagship Advocacy Conference!   Our curated program will feature sessions highlighting current issues impacting patients and practices like copay assistance, 340B, the Inflation Reduction Act, and more - don't miss out. Visit our website to learn more and register: https://lnkd.in/gmcJeQgv #Advocacy #AdvocacyConference #Rheumatology #Rheumatologists #Networking

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How to improve healthcare by marrying value analysis with clinical outcomes to elevate patient care. Dr. Hudson Garrett, FACHDM, FAHVAP, FACHE, FSHEA, FNAP, FIDSA, Karen Niven and Anne Marie Orlando explore this intersection in there insightful upcoming article coming next week! #HealthDataManagement #ValueAnalysis #ClinicalOutcomes #EvidenceBased #HealthcareExcellence. 

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The Association of Healthcare Value Analysis Professionals (AHVAP) appreciates our ongoing collaboration with Health Data Management and Mitchell Josephson, FACHDM as we advance safety across the healthcare continuum. Check out our next article highlighting the utilization of evidence-based medicine in the evaluation of new products and technologies as part of the clinical value analysis process. #AHVAP #HDM #valueanalysis #clinicaloutcomes #valuebasedcare #EBM #EBP #evidencebasedcare

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