Healthcare Snapshot - November 2024

Earlier this month, CMS issued the final rule for changes under the Physician Fee Schedule that will be effective January 1, 2025. PSW coordinated with multiple associations to comment on key policies that will impact our ACOs and our provider partners.

Key policies that were finalized include:

• Finalized proposals to mitigate the impact of Significant, Anomalous, and Highly Suspect (SAHS) billing activity.
• A decrease in the conversion factor by 2.83%.
• The release of new Advanced Primary Care Management (APCM) billing codes.
• Established flat benchmarks for Medicare CQM measures in their first 2 measurement years.
• Expanded the APP Measure set to include new measures over the next several years.
• Created a prepaid shared savings option for eligible ACOs.

There are several positive changes in the final rule that directly support areas that PSW has advocated for. However, there are still important policies that CMS has not yet addressed. PSW will continue its advocacy efforts in support of the needs of our networks.

Read the CMS Fact Sheet here.

When one of our patients was referred to care management services, she was struggling with frequent emergency department visits due to unmanaged anxiety and depression. Living alone, she found it challenging to complete daily tasks and connect with others socially. Her anxiety about potential allergic reactions had also led her to stop taking her prescribed medications.

After meeting with her nurse care manager, she received compassionate guidance and education about her medications, including how to monitor for side effects and when to seek help. Together, they coordinated with her pharmacist and primary care physician, easing her concerns and empowering her to take her medications as prescribed. The nurse care manager also connected her with behavioral health resources and helped her start counseling sessions, which she has been attending consistently.

As their partnership grew, the nurse care manager encouraged her to explore activities that could improve her mood and physical health. She began walking daily and visiting her local senior center, where she discovered a love for crafting and made new social connections.

Today, she reports feeling happier and healthier. She is taking her medications as directed without side effects, enjoying her senior center activities, and no longer needing frequent visits to the emergency department. Her brighter outlook is a testament to the power of care management in transforming lives.