Pinnacle's Blog & Publications

  • Responsible AI in Healthcare: Ethical Considerations While Navigating the Moral Maze

    Posted On: January 17, 2024

    Introduction

    In the labyrinthine world of healthcare, Artificial Intelligence (AI) is the Minotaur that promises both mighty solutions and moral conundrums. But before tackling these head-on, let’s take a page—or several—from Eric Topol’s insightful book, Deep Medicine. Topol offers a profound narrative on how AI can deepen and humanize the patient-provider relationship, not by replacing the clinician but by freeing them to operate at their empathetic best. The book delves into the potential of AI to transform healthcare through personalization, efficiency, and a renaissance of the care in healthcare, all while navigating the complexities ...

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  • Social Determinants of Health (SDoH): What You Need to Know Moving into 2024!

    Posted On: December 20, 2023

    As we all know, until the release of the 2024 Physician Fee Schedule Final Rule on November 2, 2023; SDoH assessments were “voluntary” reporting measures for the Centers for Medicare and Medicaid Services (CMS).  That will no longer be the case moving forward to January 1, 2024.

    To ultimately define the goals of both Joint Commission and the Centers for Medicare and Medicaid Services, CMS has established a stand-alone code G0136 for the assessment of Social Determinants of Health. CMS goes on to define SDoH into broad categories of assessment(s) including: economic stability, access to education along ...

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  • Three Value-Based Care Models That Continue the Shift Away from Fee-For-Service (FFS)

    Posted On: December 12, 2023

    This article discusses two forthcoming initiatives set to launch in July 2024, aimed at moving away from fee-for-service payments in healthcare. Additionally, it introduces a third model, the AHEAD Model, which is designed to transform state and regional healthcare systems by aligning multiple payers and improving overall population health while reducing costs. Furthermore, the article underscores the importance of primary care as the cornerstone of a high-performing healthcare system.

     

    The Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model

    The AHEAD Model, a new voluntary “state total cost of care (TCOC),” is focused on driving healthcare ...

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  • Calendar Year 2024 Physician Fee Schedule Final Rule – How do they affect ACOs? Are You Ready?

    Posted On: December 4, 2023

    The Centers for Medicare and Medicaid Services finalized changes to the 2024 Physician Fee Schedule – Medicare Shared Savings Program on November 2, 2023. The changes in the final rule aim to advance CMS’ value-based care strategy.  Here are some of the major highlights of the changes:

    • Quality Measure Collection Types. CMS established a new collection type for ACOs called the Medicare Clinical Quality Measure (CQM) starting January 1, 2025. This addresses the concerns ACOs had with Electronic Clinical Quality Measures (eCQMs), which would have required ACOs to submit quality measures on ALL populations, not just Medicare, ...
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  • Interventional Neuroradiology: A Specialty on the Rise

    Posted On: November 28, 2023

    Background

    With increases in technology and breakthroughs in the healthcare field, new and innovative medical specialties and/or sub-specialties are gaining prominence.  Amongst those specialties is the field of interventional neuroradiology – a marriage of radiology, neurology, and neurosurgery.  As discussed in the following sections, we examine the origins and purpose of the specialty as well as key trends and compensation considerations as this field is seemingly here to stay.

     

    What is Interventional Neuroradiology?

    In recent years, hospitals have seen an increased use in Interventional Neuroradiology, also referred to as “INR”.  As defined by Columbia ...

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  • The How, Why, and Who: Capturing Social Determinants of Health (SDoH)

    Posted On: October 19, 2023

    The Centers for Medicare and Medicaid Services (CMS) issued the FY 2023 Final Rule, which required hospitals to report the new Inpatient Quality Reporting (IQR) program to submit two (2) new measures (SDOH-1) and (SDOH-2).  The measures were voluntary in FY 2023; however, are required in FY 2024.

    On September 6, 2023, CMS released the Improving the Collection of Social Determinants of Health (SDOH) Data with ICD-10-CM Z-Codes.  The data informatic was very “busy,” so Pinnacle is going to break down the information for you!

     

    What Are Z-Codes?

    • SDoH-related Z-Codes are located within categories Z55-Z65 in the ICD-10-CM diagnosis coding manual.
    • Used to ...
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  • Teaching Physician Basics

    Posted On: October 12, 2023

    Some facilities allow for a medical graduate training program where residents and medical students can participate in the care of patients under the direction of a licensed attending physician (teaching physician). This allows the residents and medical students to further expand their medical knowledge and get real-world experience with their patients and colleagues.  Teaching physician services have specific documentation requirements, and it is important to understand these requirements to stay in compliance with CMS regulations.

    Per CMS guidance and policy, “When billing Evaluation and Management (E/M) services for a teaching physician you must look for, at a ...

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  • Determining the Fair Market Value of HCP Compensation: Five Considerations When Engaging Speakers, Consultants, and Researchers Outside the U.S.

    Posted On: October 10, 2023

    In many countries and regions of the world, access to valid, reliable, and comprehensive healthcare professional (“HCP”) compensation data can be a challenging task. Notwithstanding, in countries outside of the U.S. (“OUS”), determining FMV compensation for speakers, advisory board members, consultants, researchers, and others is crucial to maintaining compliance with global laws (e.g., FCPA, U.K. Bribery Act), country-specific laws (e.g., France, Portugal, others), and industry organizations (e.g., EFPIA, IFPMA, MedTech Europe, GMTA, etc.). Consequently, companies often utilize a range of informal sources of information to obtain what is erroneously represented as the FMV of HCP compensation. Typically, informal ...

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  • Decoding 2024 ICD-10 CM Changes: A Four-Part Series

    Posted On: September 14, 2023

    Pinnacle is conducting a four-part series to delve into the upcoming 2024 ICD-10 CM code changes and break them down chapter by chapter.  On June 16, 2023, The Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2024 ICD-10-CM code set, which is set to take effect October 1, 2023.  With 395 new code additions, 25 deletions, and 13 revisions, read on to learn more about changes within chapters 1-22.

    Part One: Chapters 1-6

    Chapter 1 – Certain infectious and parasitic diseases (A00-B99)

    Two (2) new code additions ...

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  • CMS Proposes Significant Changes to the Medicare Shared Savings Program for 2024 – How will they affect ACOs? A Three-Part Blog Series

    Posted On: September 7, 2023

    The Centers for Medicare & Medicaid Services (CMS) has put forth a proposed rule that outlines significant changes to the Medicare Shared Savings Program (Shared Savings Program) for the calendar year (CY) 2024. The aim of these proposed changes is to further advance CMS’ value-based care strategy, promote growth, alignment, and equity in the program, and address concerns raised by stakeholders, particularly accountable care organizations (ACOs). A large part of the strategy refresh for value-based care comes from the bold goal to have all Medicare fee-for-service beneficiaries in a care relationship with accountability for quality and total cost ...

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Meet the Authors

Michaela Blaha

MBA, CPC

Manager


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