CMS Reporting for GUIDE: What You Need To Know

What to Know About CMS Reporting Requirements 

If you’re a seasoned healthcare provider already up to your ears in paperwork, the words “CMS reporting requirements” may send shivers down your spine. 

This time it’s for the new Guiding an Improved Dementia Experience (GUIDE) model, a voluntary nationwide 8-year program, announced by the Center for Medicare and Medicaid Services (CMS).

CMS is a U.S. federal government agency that provides healthcare coverage for more than 160 million patients through Medicare, Medicaid, and more.

With the promise of big benefits for patients, caregivers, and healthcare providers alike, the GUIDE is nevertheless a huge change. Many providers are scrambling to understand how to participate in this new model.

So what standards need to be met, and what data collection is required?

Don’t worry. We'll break down the CMS data reporting requirements, so you can make an informed decision before you apply.

What’s Special About the GUIDE Model?

The U.S. healthcare landscape is undergoing a rapid transformation. As the population ages, chronic diseases like dementia and Alzheimer's are becoming increasingly prevalent. 

New care models like GUIDE intend to address the following:

1. Benefits for Patients

The new GUIDE model prioritizes health equity, ensuring all patients, regardless of background, have access to quality dementia care. As a participant, you play a crucial role in achieving this goal. 

2. Benefits for Providers

Participating in the GUIDE model allows healthcare organizations to explore innovative methods of team-based dementia care. This helps improve patient outcomes and alleviate caregiver burden.

In addition, GUIDE participants will receive monthly payments based on the quality of care they deliver, and the number of beneficiaries they support. In other words, successful participation and CMS reporting may mean increased revenue for your business. 

3. Model Optimization through Data Collection

Active data collection is a critical component of the new model. Reporting data demonstrates your efforts to reach underserved populations, and contribute to a more inclusive healthcare landscape. Remember, your valuable feedback contributes to the program’s overall long-term success and improvement. 

Data Collection & CMS Reporting Doesn't Have to Be Hard

In the new GUIDE model, meticulous data tracking for participating healthcare organizations is not only best practice, but it is required for participation.

What do you need to track for CMS Reports? 

Participants of the GUIDE model will need to independently collect and track data, including but not limited to:

• Quality data: for non-claims-based performance metrics;
• Care delivery data: including how provider/supplier participants are implementing the model;
• Beneficiary and caregiver assessment data: including if the patient has a caregiver and the level of burden for that caregiver;
• Sociodemographic information: including social determinants of health and other health-related social needs data.

These reports will allow CMS and CMMI (Center for Medicare and Medicaid Innovation) to monitor and evaluate the success of the GUIDE model on an ongoing basis. 

In turn, CMS plans to share data feedback with participants through a specified GUIDE dashboard. These reports will also help CMS compensate providers on a per beneficiary per month (PBPM) basis, known as a dementia care management payment (DCMP). 

How will DCMP rates be determined?

CMS will determine DCMP rates by: 

• Geographic Location
• Health Equity Adjustment (HEA)
• Performance Based Adjustment (PBA)

For more details on the CMS’ payment methodology, please visit the CMS FAQ page.

Best Practices for GUIDE and CMS Reporting 

1. Attribution of beneficiaries: Always ensure you are properly documenting your care delivery methods. This includes how you have identified patients who meet eligibility criteria and how you’ve assigned them to your program.

2. Diagnosis validation: Ensure proper documentation for  assessment data, including evidence of patients’ dementia diagnoses. 

3. Voluntary patient enrollment: All patients must elect to participate in the GUIDE program. Always ensure you obtain evidence of informed consent from patients or their legal representatives. 

4. Data Reconciliation: CMS Reports will require gathering data from multiple sources like patient records and claims data. Ensure your systems are prepared for proper data organization.

5. Financial Reconciliation: To receive payment, GUIDE model participants will need to bill CMS per beneficiary per month for DCMP and respite services. To maximize your monthly return, get to know GUIDE’s payment structure. 

6. Continuous Monitoring and Adjustment: By monitoring key metrics and adjusting your approach as needed, you can maintain program compliance and improve patient outcomes.

7. Legal Considerations: The model comes with specific legal requirements, including documentation of patient or legal representative consent, details on available services, and more. 

8. Partner Organizations and Engagements: Collaborating with community organizations, specialists, and respite providers is vital for holistic patient care. 

9. Document Control: Effective document management is key for program audits and ensuring you have easy access to necessary records. 

10. Health equity: The GUIDE model ensures all patients, regardless of background, have access to quality dementia care. This is also reflected in model payments, requiring participants to collect and identify beneficiary demographic data, to ensure equity policies are upheld. 

The Road Ahead: Embracing Change and Proactive Participation

The new model for dementia care signifies a positive step towards a future where patients receive the support they need. While some aspects remain uncertain, the program's adaptability and focus on continuous improvement are encouraging. 

Remember, success hinges on three key pillars:

• Proactive data tracking
• Open communication with CMS and CMMI
• And aligning with claims-based metrics for quality measures. 

By actively engaging with the model and providing valuable feedback, you'll be instrumental in shaping a brighter future for dementia care.

Focus on Patient Care, Not Paperwork:

Spend less time on CMS reporting and more time providing exceptional care to your dementia patients.

The GUIDE Model presents exciting opportunities to improve patient outcomes and potentially increase reimbursement. Let us guide you through the program, maximizing its benefits while minimizing administrative burdens.

‍Contact us today and ensure your organization thrives in this new era of dementia care.