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

Care Quality

Reducing Low-Value Care Key to Value-Based Reimbursement Success

February 1, 2018 - Value-based reimbursement success hinges on decreasing low-value care across patient populations, explained Scott Weingarten, MD, MPH, Senior Vice President and Chief Clinical Transformation Officer at Cedars-Sinai Medical Center. While hospitals and health systems have flocked to value-based care strategies, such as population health management programs and high-risk patient interventions,...


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Six Characteristics of High-Value Primary Care Practices

by Jacqueline Belliveau

High-value primary care practices that achieved exceptional care quality at reduced costs shared six attributes centered around risk-stratified care management, mindful specialist selections, and care coordination, a new study in the Annals of...

Type of Provider Data Presented Influences Patient Volume, Choice

by Jacqueline Belliveau

Healthcare consumers who initially prioritized appointment availability when choosing a physician were four times more likely to select a physician based on provider data on quality performance and clinical expertise when presented with more...

Low-Cost, Low-Value Resource Use Drives $586M in Wasteful Spending

by Jacqueline Belliveau

Inexpensive low-value resource use resulted in over $586 million, or $9.09 per beneficiary per month, in unnecessary healthcare spending in Virginia, a new Health Affairs study showed. The total amount spent on low-cost, low-value resource use...

Driven by Fee-For-Service, Docs Say Up to 30% of Care Unnecessary

by Jacqueline Belliveau

At least 15 percent to 30 percent of medical care is unnecessary, contributing to low-value resource use and wasteful healthcare spending, stated the majority of physicians surveyed in a recent PLOS ONE study. While the survey of over 2,100...

MSSP ACOs Decreased Spending by $1B, Improved Care Quality

by Jacqueline Belliveau

Accountable care organizations (ACOs) participating in the first three years of the Medicare Shared Savings Program (MSSP) reduced Medicare spending, with a net reduction of almost $1 billion, according to a new OIG report. The analysis of 428...

Exploring Quality Measures Under Value-Based Purchasing Models

by Jacqueline Belliveau

CHICAGO – Jason Goldwater, MPA, MA, Senior Director of the National Quality Forum, recently likened the value-based purchasing transition to the evolution of music at Xtelligent Media’s Value-Based Care Summit in Chicago. Music started...

Care Standardization Key to Healthcare Revenue Cycle Excellence

by Jacqueline Belliveau

To be named a top health system by Truven Health Analytics and IBM Watson Health, it takes a range of clinical quality improvements and healthcare revenue cycle efficiencies. But for St. Luke’s Health System, one of 15 top health systems...

AMGA: Align Medicare Reimbursement, Measures for High-Value Care

by Jacqueline Belliveau

AMGA recently called on CMS to align quality measures with spending performance as well as Medicare reimbursement policies across Medicare Advantage, fee-for-service models, and accountable care organizations (ACOs). In two letters to CMS Acting...

How Do Hospital Mergers Lower Costs, Drive Quality Improvement?

by Jacqueline Belliveau

Recent hospital mergers and acquisitions led to significant healthcare costs savings without sacrificing care quality and affordable prices, a recent Charles River Associates and American Hospital Association (AHA) report indicated. Based on...

AHA Seeks Changes to Post-Acute Care Medicare Reimbursement

by Jacqueline Belliveau

The American Hospital Association (AHA) has called on the Centers of Medicare and Medicaid Services (CMS) to revise proposed Medicare reimbursement reforms for two post-acute care models. In separate letters, the AHA outlined several issues with...

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