The Centers for Medicare & Medicaid Services (CMS) released the 2022 Medicare Physician Fee Schedule and Quality Payment Program final rule on Nov. 2 and there are big changes to physician payments. In particular, the Medicare conversion factor, which forms the basis for payments to clinicians, will be lowered by 3.7%. There’s nuance in calculating the payments, but you can sum this up as most doctors will take a pay cut in 2022. And since the final rule goes into effect on January 1, 2022, doctors will begin feeling the cuts in Q1 revenue.

The rule is specific to Medicare, but there are plans to push similar changes in Medicaid and we all know commercial payers tend to follow CMS’ lead. We believe this change will have a ripple effect across the industry.

On this episode, I talk with Gail Zahtz, CEO at PropHealth, as part of our ongoing Value-based Payment in 2022 series about what doctors can expect in terms of Medicare FFS payment come January 1, 2022. We discuss this as another example of CMS trying to make Fee-for-Service less “comfy” and expedite the move to value-based payment models. Gail helps us to understand what options exist and we lay out a framework for how to evaluate those options.

This is a heavy episode, and there are no clear answers. However, there is a known direction and a viable path forward. We’ll try to get you moving in the right direction.


Gail Zahtz

Zahtz has been founding and running mission-driven organizations from the get-go.

Today, Gail Zahtz is the CEO of PropHealth, a value-based administrator that creates and manages healthcare collaboratives to drive clinical and financial success. Their expertise and services focus on contracting, operations and growth for clinically integrated networks, risk bearing entities, and those that fund and deliver healthcare innovation. 

Her healthcare career has been guided by these truths: 1) Sustainable change will only happen when every stakeholder gets value, 2) It is good business to “do good” 3) Mission matters, 4) Business can only sustain service with profit (it’s not a necessary evil, it fuels growth), 5) It’s all about experience, 6) The true north is the patient journey – always. 

Being mission-driven always has and continues to shape her career. Right out of college, Gail helped to shape health policy in Washington DC. In her first start-up, she addressed work-related health issues for employees through a cause-related marketing agency. Independently she created an award-winning program to reduce the stigma of mental illness by creating a novel public-private partnership.

On many occasions, Gail has spoken to small and large audiences and through social media platforms. She advised the industry on designing for health outcomes and won numerous awards including – Top 100 in Health Info Technology, Top 100 International Influencers in Health Online, Healthcare IT News’ #HIT100, Recipient Walking Gallery of Healthcare, and Top 50 Most Influential Health Leaders. Her public health education campaigns have also been nationally recognized including being awarded the most influential public education campaign by the National Mental Health Association.

As a survivor of late-stage cancer and of domestic violence, she is particularly inspired when sharing her stories of how to survive and thrive despite the most challenging of circumstances to show a way forward to young women everywhere.

To connect with Gail, reach out on Linked In @ https://www.linkedin.com/in/gailzahtz/

Or, on Twitter: @GailZahtz


PropHealth

PropHealth is a value-based administrator that creates and manages healthcare collaboratives to drive clinical and financial success. Our expertise and services focus on contracting, operations, and growth for clinically integrated networks, risk-bearing entities, and those that fund and deliver healthcare innovation.


Links and Resources


Listen to the Medicare Physician Fee Schedule and Quality Payment Program Final Rule episode here:

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