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

Healthcare Bundled Payments

Medicare Bundled Payments Model Cut Costs, Maintained Quality

October 10, 2018 - 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, participant, and clinical episode combinations analyzed in the evaluation of the bundled payment model’s fifth performance year, CMS found that...


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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...

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...

CMS Postpones Deadlines for New Bundled Payments Model

by Jacqueline LaPointe

Participants in the Bundled Payments for Care Improvement (BPCI) Advanced model will have another week to return their signed participation agreements and select clinical episodes. CMS delayed the deadline for returning the BPCI Advanced...

Value-Based Care Reduces Costs by 5.6%, Improves Care Quality

by Jacqueline LaPointe

Value-based care strategies are starting to achieve the goals of the Triple Aim, payers reported in a new ORC International study commissioned by Change Healthcare. The analysis of 120 payers across a range of organization size and type...

CMS Accounts for Extreme Situations in CJR Bundled Payments

by Jacqueline LaPointe

CMS updated rules for the Comprehensive Care for Joint Replacement (CJR) bundled payments model to protect participating hospitals from uncontrollable episodes costs incurred during an emergency period, like the recent Hurricanes or...

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...

Emory Healthcare, Walmart Team Up for an ACO, Bundled Payments

by Jacqueline LaPointe

Atlanta-based Emory Healthcare recently announced the creation of an accountable care organization (ACO) with retail giant Walmart, known as the Accountable Care Plan. Walmart employees at 55 Walmart, Sam’s Club, and Walmart...

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...

Orgs Troubled by Post-Acute Care’s Role in New Bundled Payments

by Jacqueline LaPointe

Long-term and post-acute care provider organizations recently voiced their concerns with the new Bundled Payments for Care Improvement (BPCI) Advanced model’s reduced role of post-acute care providers. Eliminating the post-acute...

Large, High-Volume Hospitals Save in CJR Bundled Payments Model

by Jacqueline LaPointe

Larger hospitals with greater knee and hip replacement volumes were more likely to realize cost savings under Medicare’s mandatory lower joint replacement bundled payments model, a new analysis from Penn Medicine showed. The...

72% of Medical Groups Oppose Mandatory Alternative Payment Models

by Jacqueline LaPointe

The mandatory versus voluntary alternative payment model debate continues. This time medical group practices are voicing their opinions in a new MGMA Stat poll that found 72 percent of group leaders oppose required participation in...

AHA Calls for Bundled Payments Delay, Reform for BPCI Advanced

by Jacqueline LaPointe

Though supportive of the Bundled Payments for Care Improvement Advanced (BPCI Advanced), the American Hospital Association (AHA) recently urged CMS to delay the model’s application deadline until the federal agency provides...

Patient Education Boosts Revenue, Quality for Joint Replacements

by Jacqueline LaPointe

Offering interactive patient education pre- and post-total joint replacement surgery is key to improving patient outcomes and generating new revenue, a multi-specialty hospital system in the Twin Cities area recently found. An estimated 7...

Prehabilitation Lowers Episode Costs Under Bundled Payment Models

by Jacqueline LaPointe

Dedicating even a couple hours to helping patients understand and prepare for a procedure prior to surgery can save providers millions under bundled payment models, explained healthcare industry expert and former CMS official Charlene...

Mandatory Bundled Payments Drive Value-Based Care, Docs Argue

by Jacqueline LaPointe

The recent decision from CMS to cancel two mandatory bundled payments programs slated to launch in 2018 was a “step in the wrong direction for pursuing a healthcare system that focuses on value and not volume,” three physicians...

Exploring the Bundled Payments for Care Improvement Advanced Model

by Jacqueline LaPointe

CMS recently unveiled the Bundled Payments for Care Improvement (BPCI) Advanced initiative, a new bundled payments model that will include inpatient and outpatient clinical episodes and qualify as an Advanced Alternative Payment Model...

Voluntary Bundled Payments Launch, HHS Nominee Backs Mandatory APMs

by Jacqueline LaPointe

CMS announced a new voluntary bundled payments opportunity starting in late 2018 on the same day that HHS Secretary nominee Alex Azar seemingly backed mandatory alternative payment models during a Senate Finance committee hearing. The new...

CMS Cancels Mandatory Hip, Cardiac Bundled Payment Models

by Jacqueline LaPointe

CMS recently finalized proposals to eliminate mandatory hip fracture and cardiac bundled payment models slated to launch on Jan. 1, 2018 and decrease the scope of the existing Comprehensive Care for Joint Replacement (CJR) bundled payment...

PTAC Recommends 2 APMs for Potential MACRA Implementation

by Jacqueline LaPointe

The Physician-Focused Payment Model Technical Advisory Committee (PTAC) recently recommended two alternative payment models to HHS for possible MACRA implementation. Stakeholders have submitted 19 alternative payment model proposals since...

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