What Will Our Future Be?

What Will Our Future Be?

Our brains are hardwired to hypothesize. An interesting study shows that our brains use a statistical method called Bayesian inference, which combines prior knowledge with new evidence to make intelligent guesses. For example, you know what a dog looks like, and you see a furry animal with four legs, so you use your prior knowledge with the new evidence to guess it's a dog!

Over the past month, the Medisolv leadership team has been utilizing our Bayesian inference capabilities to examine all possible scenarios regarding potential changes to CMS regulations this year. Our goal is to determine how Medisolv can adjust to effectively support our clients in response to any future changes.

Dr. Mehmet Oz's nomination was passed at the beginning of April, which means he is now the head of CMS. His opening remarks during his confirmation hearings were a good place to start hypothesizing. You can watch his opening remarks at about the 7:30-minute mark.

He highlighted a few key points that might provide clues about how CMS could shift their requirements.

He emphasized the importance of transparency and cost in empowering patients to make informed choices. Transparency, I believe, refers to measurement. He aims to ensure that consumers have a clear understanding of the expenses and results associated with healthcare providers.

He then discussed the latest developments in technology as key influences on how CMS can ease the workload for healthcare providers and maintain visibility into outcomes. To me, this means utilizing dQMs and transitioning eCQMs to FHIR standards. Additionally, implementing tools such as FHIR and AI to revamp the methods of gathering and evaluating data for healthcare systems.

To my surprise, he discussed the excessive expenses of Medicare Advantage in contrast to traditional Medicare. Despite being a strong advocate for Medicare Advantage, it seems that Dr. Oz may have changed his perspective on the matter. This suggests that he does not support replacing Medicare with Medicare Advantage.

We are anxiously awaiting the IPPS and IPF PPS rulings, which govern the IQR, TEAM, and IPFQR programs. We could see CMS release these proposed rulings as early as April 1st. Until then, it’s all just guesswork.