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ambulatory specialty model
Started by mille125
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I believe that we will get dinged for all muscle relaxants in the 65 plus crowd.
Unknown
Yes..more points are better
The scoring system is posted on the CMS site including the one that Doctor Jay posted here.
Up to 50 points for quality (measures listed by Doctor Jay earlier)
Up to 50 points on cost (nothing to report.musing there own undisclosed measures)
Up to minus 20 on collaborating with a PCP
Up to minus 10 on using your EMR
Up to 10 points on having complex patients ( no info on how that is determined)
10 bonus points if small practice
Q5 bonus points if solo practice
It was my understanding that pretty much all pain docs stay away from that.
My understanding is that it uses a combination of TIN/NPI, so not just NPI…
I switched practices middle of 2025. I’m on the list but no one else in my current group is. They still have me listed under my old TIN so looking into this now. Will updated if I find anything out
ironically, last i checked methocarbamol (as a combination medication) was available OTC in canada.
Tizanidine in my experience is the most sedating/side effect inducing second to Flexeril, and Robaxin is the least sedating and I have people using it BID/TID without issue.
Furthermore, if your patient has heart failure or a cardiac Hx, avoid tizanidine. You will ultimately put someone in the hospital for bradycardia and hypotension, I have done this twice. It is an alpha 2 agonist, and this is CMS right? You want to give old people a very sedating alpha 2 agonist but not Robaxin?
WTF does it mean to collaborate with the PCP? Send records? Phone calls? I am going to call every single Medicare pt's PCP and tell them what I'm doing? On this phone call will I be asking why they are prescribing absurd amounts of opiates to these same patients but they're not part of this program are they?
Furthermore, if your patient has heart failure or a cardiac Hx, avoid tizanidine. You will ultimately put someone in the hospital for bradycardia and hypotension, I have done this twice. It is an alpha 2 agonist, and this is CMS right? You want to give old people a very sedating alpha 2 agonist but not Robaxin?
WTF does it mean to collaborate with the PCP? Send records? Phone calls? I am going to call every single Medicare pt's PCP and tell them what I'm doing? On this phone call will I be asking why they are prescribing absurd amounts of opiates to these same patients but they're not part of this program are they?
Did anyone get an email or anything from cms about this? Were we just supposed to guess whether or not we are on the list? I understand there’s a website but if someone wasn’t on sdn, how would they even know. My group was totally oblivious to this until I brought it up
I thought robaxin was one of the safest muscle relaxants after skelaxin. Stupid
Me too! My problem is I can’t determine a safe number, 7, 8, 9 or 10 mil? What you think
I think paid off houses/cars and 5 million is enough. I don't have kids. My cars are paid off. Need to finish paying off house or putting that much into market.
Many people die with more money in their brockerage account than they had when they first retired.
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It is for future payment. “Performance” in 2027 is calculated and used to determine your payment for 2028. How you perform in 2028 subsequently used to calculate payment for 2029. High performers theoretically could get up to a 9% payment increase, paid for by low performers getting up to a 9% cut. But the reality is, this is all bull**** and everybody is getting cut to some extent.
Isn't it all relative so someone has to get that -9 to +9% right?
What kind of reckless “provider” are you? Nortriptyline? Do you not have methadone, a more safer medication?
Theoretically. But I’m not holding my breath.
Last I checked nortriptyline was first line for PHN and it does "cure it" a good portion of the time.
Most of the people that come to me for treatment of PHN because they have failed another doctor's regimen which includes pregabalin and/or gabapentin are "cured" by nortriptyline. The few that still fail are usually "cured" by scrambler.
Yes....it is a zero sum game. If you are "better" by their criteria than all of your colleagues you get 9 percent bonus. The "worst" gives a 9 percent penalty. Everyone else is on the curve somewhere.
That is why I made this post. There is still very little fanfare about this rather big issue even now that we are at 90 days away.
Im pretty sure my hopd is going to use me as a guinea pig and just see what happens because im the only one in my group on the list. The funny thing is that everyone thinks it’s not their problem until it is as the participant list is rolling and people can just get added next year. I told admin about it and they basically said nothing..
Should be a good opportunity for participants who are aware then. If a lot of people don’t report then those who do will automatically have more potential upside.
you shouldnt have said anything
I’m surprised your admin isn’t motivated to get things squared away. Mine is proactively working to make sure they/we are in compliance. Because ultimately if you’re hospital employed under the usual RVU setup, you’re not the one potentially getting paid less as your RVU isn’t changing, but the hospital would get less payment. Assuming they don’t try to add language into your contract about adjusting your RVU conversion factor dependent on your ASM performance, which would be a non-starter.
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they wont even know about it until years later, meanwhile, you just keep collecting the RVUs. at least that is how it would work for me....
When they get the notice in 2027 that their 2029 payments are getting decreased, I would think that would get their attention and get a meeting in the boardroom.....but what do I know.
They don’t care . They should, but they don’t bc facility fees >>> pro fees. It isn’t run well and there is no transparency bc of multiple levels of beaurocracy
Drusso would lose his sh$t if he knew how inefficiently things run in HOPD. I have the procedure room running like a well oiled machine but the $$$ and staffing and billing and collections is like flushing money down the drain.
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I believe that.
At least the HOPD that I go to occasionally can get 20 patient done from 1230-400. They are efficient with patient volume but a lot of the rest is puzzling.
For instance a c-arm was down for 6 weeks. I gave them a contact to rent one for a reasonable price. Instead they said that we can use one. Well podiatry and ortho were on the same day. Both need a c-arm. They ended around 9pm instead of 3pm.
My office manager found that quite a few of the ASM quality measures are already in MIPS and we have been using some of them. We are already doing Depression screening, high risk meds, and health related social needs. She also found some low back functional status forms.
I don't know for sure but I think that most of us will likely score well on this part. The other 50% for cost is what will likely cause separation.
I have always said that I think this whole thing is a ruse to show that outcomes are the same in office vs HOPD/ASC in order to cut services in the more expensive places.
Hopefully I am wrong.
I don't know for sure but I think that most of us will likely score well on this part. The other 50% for cost is what will likely cause separation.
I have always said that I think this whole thing is a ruse to show that outcomes are the same in office vs HOPD/ASC in order to cut services in the more expensive places.
Hopefully I am wrong.
Just a reminder to those who do their own billing, it's not enough just to do the screening. You have to put in the ICD-10 and whatever other type of codes to signal that you completed it, CMS is not reading through your notes to figure out if you're hitting the measures.
