Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Alternative Payment Models

Medical Spending, Utilization the Same for Cancer Patients in ACOs

October 18, 2018 - Cancer patients treated by providers in a Medicare accountable care organization (ACO) did not see lower medical spending or healthcare utilization compared to similar patients treated at non-ACO practices, a new study in the Journal of Clinical Oncology showed. “Although it may be too early to see an impact of ACOs on patients with cancer, it is also possible that ACOs may need...


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61% of Doctors Say Value-Based Care Will Damage Their Practice

by Jacqueline LaPointe

Physicians are still on the fence about the impact value-based care will have on their business and patient care, a recent survey showed. Forty-nine percent of over 3,400 physicians recently surveyed by the nation’s largest...

Medicare Bundled Payments Model Cut Costs, Maintained Quality

by Jacqueline LaPointe

Payments declined for approximately three-quarters of the clinical episode combinations in the Medicare Bundled Payments for Care Improvement (BPCI) model without impacting care quality, CMS recently reported. Of the 67 BPCI model,...

Real Costs Up to 8% Higher for Some Cancers in Oncology Care Model

by Jacqueline LaPointe

New research shows actual episode costs for certain cancers covered by Medicare’s Oncology Care Model differed by as much as eight percent, on average, from the predicted costs per episode. The Oncology Care Model (OCM) is a...

Patient Attribution Key Component to APMs, Value-Based Contracts

by Jacqueline LaPointe

Patient attribution is a critical component of alternative payment models (APMs) that appropriately hold providers accountable for their care performance. “Attribution methodology is at the core of constructing actuarially sound,...

Medicare Spending Falls 3.3% in First Year of CJR Bundled Payments

by Jacqueline LaPointe

Hospitals reduced average Medicare spending on lower extremity joint replacements (LEJRs) by 3.3 percent during the first performance year of Medicare’s mandatory bundled payments model for joint replacements, CMS recently...

New Alternative Payment Model Tackles Holistic Addiction Recovery

by Jacqueline LaPointe

A national multi-sector alliance of healthcare industry leaders is looking to incentivize providers and payers to deliver coordinated, holistic addiction recovery services to patients through a new alternative payment model. Nearly 21...

CMS Initiative to Create Pediatric APMs to Address Opioid Crisis

by Jacqueline LaPointe

A new CMS Innovation Center initiative will call on local stakeholders and Medicaid agencies to develop alternative payment models that address the impact of the opioid crisis for children, CMS recently announced. Medicaid and local...

Do Proposed Quality Payment Program Changes Support Specialists?

by Jacqueline LaPointe

The American Society of Clinical Oncology (ASCO) recently expressed their concerns with proposed Quality Payment Program changes, arguing the potential implementation policies for the third year of the program do not align with specialty...

Employers Play Bigger Role in Value-Based Reimbursement Transition

by Jacqueline LaPointe

Providers wanting to expand their value-based reimbursement contracts may want to look to the employer-sponsored health plan market, according to a new report from the Duke-Margolis Center for Health Policy and the Robert Wood Johnson...

Giving Providers Hospital Cost Accounting Data Will Lower Costs

by Jacqueline LaPointe

Engaging physicians with hospital cost accounting data will be key to lowering costs under accountable care organizations (ACOs) and other population-based reimbursement models, Stanford researchers recently explained. Population-based...

CMS Considers Stark Law Changes to Support Value-Based Care, APMs

by Jacqueline LaPointe

CMS is seeking input on how to potentially modify the physician self-referral law, otherwise known as the Stark Law, to encourage value-based reimbursement and care delivery. In a new Request for Information (RFI), the federal agency is...

Level the Playing Field for Medicare Advantage in MACRA, Orgs Urge

by Jacqueline LaPointe

Eleven industry groups are urging CMS to include Medicare Advantage (MA) in MACRA as soon as possible to provide the same incentives to eligible clinicians in risk-based MA models as those offered to clinicians in Medicare Advanced...

Hospitalization-Based Bundled Payment Models Key to Lowering Costs

by Jacqueline LaPointe

Bundled payment models should center on acute hospitalizations, rather than outpatient care, because hospitalization-based bundles can more effectively impact post-acute care (PAC) spending, industry experts from the USC-Brookings...

CMS OKs Maryland’s All-Payer Alternative Payment Model Expansion

by Jacqueline LaPointe

CMS greenlighted an expansion of an all-payer alternative payment model in Maryland that allows the state to set hospital reimbursement rates, the office of Governor Larry Hogan recently announced. Maryland’s unique alternative...

Only 4 CMMI Alternative Payment Models Met Spending, Quality Goals

by Jacqueline LaPointe

The CMS Innovation Center is on the path to reducing healthcare costs while improving care quality through alternative payment and care delivery models, a recent Government Accountability Office (GAO) report found. But only four...

CMS Targets Value-Based Purchasing, Drug Costs to Reduce Spending

by Jacqueline LaPointe

Healthcare spending is growing at an unstainable rate, and CMS aims to curb spending through initiatives that promote value-based purchasing, reduce administrative burdens, and lower prescription drug costs, CMS Administrator Seema Verma...

CMS Seeks Info on a Direct Provider Contracting Model for Medicare

by Jacqueline LaPointe

CMS is seeking comments on a potential alternative payment model that would allow primary care providers to directly bill Medicare beneficiaries through a direct provider contracting model. Currently, providers must opt out of Medicare...

AMA, ASAM Create Alternative Payment Model for Opioid Use Disorder

by Jacqueline LaPointe

The American Society of Addiction Medicine (ASAM) and the American Medical Association (AMA) recently unveiled an alternative payment model that aims to improve care and reduce costs associated with opioid use disorder. The new...

Bundled Payments with Drug Costs Threaten Cancer Care Quality

by Jacqueline LaPointe

Oncology bundled payments that include drug costs would negatively impact cancer care, a new report in the Journal of Oncology Practice showed. According to the report done by Milliman, Inc. for the American Society of Clinical Oncology...

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