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

Alternative Payment Models

Prescription Drug Costs Challenge Value-Based Care in Oncology

March 21, 2019 - Approximately 57 percent of community oncologists in value-based care models identified prescription drug costs as their top challenge with alternative payment model success, a recent survey uncovered. The survey of 530 community oncologists conducted by Integra Connect also showed 93 percent cited rising prescription drug costs as a major issue impacting the overall wellbeing of their...


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Value-Based Contracts with Risk 3 to 5 Years Away for Providers

by Jacqueline LaPointe

Taking on upside and downside financial risk through value-based contracts is still years away, according to healthcare leaders in a recent survey conducted by HealthCare Executive Group (HCEG) and Change Healthcare. Approximately 90...

Implementation of Risk-Based Contracts in Healthcare Stalling

by Jacqueline LaPointe

A new survey of more than 500 C-suite executives showed that most organizations are still experimenting with risk-based contracts in healthcare despite having more ambitious goals for implementation by 2018. The fourth annual The State of...

5 Rural Hospitals Take on All-Payer Global Budgets to Boost Care

by Jacqueline LaPointe

Pennsylvania Governor Tom Wolf recently tapped the first five hospitals and five payers to participate in a new alternative payment model from the CMS Innovation Center that uses all-payer global budgets to support rural hospital...

Medicare Reimbursement Changes Coming for Kidney Care, Dialysis

by Jacqueline LaPointe

HHS is reexamining Medicare reimbursement structures in kidney care that encourage more dialysis center treatment, rather than home-based care or even transplants. HHS Secretary Alex Azar made the announcement at the sixth annual Kidney...

Make Value-Based Reimbursement Implementation Easier, AMGA Says

by Jacqueline LaPointe

Promoting the implementation of risk- and value-based reimbursement models is key to reducing healthcare costs in the US, AMGA recently told policymakers. “The rising cost of healthcare in this country is an unnecessary burden on...

Aligning the Medicare Physician Fee Schedule with Value

by Jacqueline LaPointe

The healthcare industry is committed to moving to value-based reimbursement. However, like many transformations in healthcare, the shift away from fee-for-service has been a long journey. CMS and other major payers cannot transition...

HCTTF Helps Providers Find Value-Based Purchasing Partnerships

by Jacqueline LaPointe

A new open-sourced tool from the Health Care Transformation Task Force (HCTTF) is helping providers and payers assess value-based purchasing partnerships. The Partnership Evaluation Tool is a new resource that allows healthcare...

HHS Releases Alternative Payment Model for Ambulance Providers

by Jacqueline LaPointe

HHS and the CMS Innovation Center (CMMI) recently announced a new alternative payment model for ambulance providers that aims to improve Medicare emergency transport services. The five-year Emergency Triage, Treat, and Transport (ET3)...

AHA Wants More Alternative Payment Models for Rural Hospitals

by Jacqueline LaPointe

In its 2019 Rural Advocacy Agenda, the American Hospital Association (AHA) called for more opportunities for rural hospitals to successfully participate in bundled payment models, the Quality Payment Program, and other alternative payment...

Only 13% of Hospital CFOs Prepared for Value-Based Reimbursement

by Jacqueline LaPointe

Fewer hospital CFOs are prepared to manage the financial impact of evolving business conditions, such as value-based reimbursement and care delivery models, a new survey finds. Consulting firm Kaufman Hall recently surveyed CFOs and other...

Post-Acute, At-Home Care Saves Next Gen ACO Atrius Health $19.9M

by Jacqueline LaPointe

“You can't emphasize enough the right setting and the right care,” stressed Peggy Chou, MD, the Senior Medical Director of Performance Excellence of Atrius Health in Massachusetts. Atrius Health is a non-profit system of...

HHS Sets New Priorities for Physician-Focused Payment Models

by Jacqueline LaPointe

Healthcare stakeholders looking to develop their own alternative payment models for HHS implementation should look to new guidance before submitting their applications to the Physician-Focused Payment Model Technical Advisory Committee...

GAO: Advantages of Voluntary and Mandatory Bundled Payments

by Jacqueline LaPointe

Voluntary and mandatory bundled payment models each have their own pros and cons. But providers like voluntary models because they offer more favorable financial terms, a new Government Accountability Office (GAO) report showed. “In...

Hospitals, Blue Cross NC Share Risk with New Value-Based Contract

by Jacqueline LaPointe

Five major health systems recently entered a value-based contract with Blue Cross and Blue Shield of North Carolina (Blue Cross NC) that will hold them financially accountable for total costs of care and overall quality performance. Cone...

Beta Testing Alternative Payment Models to Advance Value-Based Care

by Jacqueline LaPointe

Forcing providers to participate in alternative payment models (APMs) will do little to incentivize providers to make the care delivery and payment changes needed to reduce costs and improve quality, experts at the Center for Healthcare...

Congress Wants More on CMMI Alternative Payment Model Development

by Jacqueline LaPointe

The House Committee on Ways and Means is calling on CMS to boost transparency with alternative payment model development in the Center for Medicare and Medicaid Innovation (CMMI), which develops and operates alternative payment and care...

Investing in Primary Care Delivers Value-Based Care Results

by Jacqueline LaPointe

Supporting primary care will bring value-based care results, asserts Humana’s Chief Medical Officer Roy Beveridge, MD. Value-based arrangements between providers and payers have the lofty, yet admirable goals of improving care...

Exploring Changes to the Quality Payment Program in 2019

by Jacqueline LaPointe

The final 2019 Medicare Physician Fee Schedule (PFS) rule contained a number of changes to evaluation and management (E/M) payment rates, site-neutral payments, and remote patient monitoring coverage. But the rule also included key MACRA...

Practices Still Averse to Risk-Based Alternative Payment Models

by Jacqueline LaPointe

Physician practices are less willing to participate in alternative payment models with downside financial risk compared to four years ago, revealed a new study from the RAND Corporation and the American Medical Association (AMA). Several...

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