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

Healthcare Bundled Payments

Mandatory Bundled Payments Drive Value-Based Care, Docs Argue

January 17, 2018 - 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 argued in a new Journal of the American Medical Association editorial. CMS announced in November 2017 that the federal agency would no longer move forward...


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Exploring the Bundled Payments for Care Improvement Advanced Model

by Jacqueline Belliveau

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 (APM) under...

Voluntary Bundled Payments Launch, HHS Nominee Backs Mandatory APMs

by Jacqueline Belliveau

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 voluntary...

CMS Cancels Mandatory Hip, Cardiac Bundled Payment Models

by Jacqueline Belliveau

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 initiative....

PTAC Recommends 2 APMs for Potential MACRA Implementation

by Jacqueline Belliveau

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 the...

382 Hospitals Earn Initial Reconciliation Payments Under CJR Model

by Jacqueline Belliveau

Out of approximately 800 hospitals required to participate in Medicare’s Comprehensive Joint Replacement (CJR) model, 382 facilities will receive a reconciliation payment based on cost savings and care quality, according to preliminary...

Readmissions, Post-Acute Care Drive Variation in Bundled Payments

by Jacqueline Belliveau

Hospital readmissions, professional fees, and post-acute care payments are key drivers of cost variations for providers participating in 90-day cardiac bundled payment models, a recent JAMA Surgery study revealed. “These results underscore...

Private Sector to Drive Bundled Payments After CMS Cancellations

by Jacqueline Belliveau

CMS recently announced its intention to modify its bundled payments strategy by proposing to eliminate forthcoming mandatory cardiac models and decreasing the scope of the Comprehensive Care for Joint Replacement (CJR) program. The pull away...

Cost Savings Unclear for Medicaid Alternative Payment Models

by Jacqueline Belliveau

Alongside Medicare and private payers, states are making the switch to value-based reimbursement, but states and independent researchers have yet to demonstrate the impact of Medicaid alternative payment models on healthcare costs and patient...

CMS May Cancel Upcoming Cardiac, Ortho Bundled Payment Models

by Jacqueline Belliveau

UPDATE: CMS released the complete proposed rule, which would cancel the Episode Payment Models and the Cardiac Rehabilitation Incentive Payment Model. The proposed rule would also decrease the number of mandatory geographic regions in the Comprehensive...

Do Oncology Bundled Payments Promote Low-Value Drug Use?

by Jacqueline Belliveau

Oncology bundled payments are not the answer to lowering prescription drug costs for cancer care delivery, the American Society of Clinical Oncology recently contended. In a position statement on addressing the affordability of cancer drugs,...

3 Challenges Providers Face with Healthcare Bundled Payments

by Jacqueline Belliveau

Healthcare bundled payments are becoming one of the most popular alternative payment models available to providers. Providers are drawn to the episode-based structure’s ability to decrease healthcare costs while maintaining or improving...

Bundled Payments Rely on Robust Networks, Healthcare Markets

by Jacqueline Belliveau

Healthcare providers are finding that it takes a village to succeed in bundled payment models. From primary care to specialists and post-acute care, providers need an integrated network of provider types and to play to their healthcare market...

Oncology Care Model Overcomes Specialty Bundled Payment Hurdles

by Jacqueline Belliveau

Episode-based payment models aim to shift financial accountability to providers for furnishing services for specific conditions or procedures. But develop specialty bundled payment models that target clinical areas, such as oncology, have proven...

Patient Engagement Critical to Bundled Payment Model Success

by Jacqueline Belliveau

Under bundled payment models, healthcare providers take on the clinical and financial risk payers traditionally managed. But providers at OrthoCarolina found that patients also play a major role in improving care quality and decreasing healthcare...

Incorporating Population Health in Next Gen of Bundled Payments

by Jacqueline Belliveau

The next generation of bundled payments should focus on population health management, researchers recently argued in a Journal of the American Medical Association report. Bundled payment models can align with population health management by extending...

Medicare Cardiac, Ortho Bundled Payments Delayed Until 2018

by Jacqueline Belliveau

CMS recently delayed the launch date of three mandatory Medicare cardiac and orthopedic bundled payment models and the Cardiac Rehabilitation Incentive Payment program from May 20, 2017, to Jan. 1, 2018. The final ruling from the federal agency...

Post-Acute Care Costs by Market Affect Bundled Payment Models

by Jacqueline Belliveau

A recent study in Medical Care found that post-acute care variations by healthcare market significantly impacted total episode costs in 30-day hip and knee replacement bundled payment models, suggesting financial strategies should focus on high-utilizers...

Bundled Payments, Clinical Pathways Drive Cancer Care Savings

by Jacqueline Belliveau

Early adopters of value-based reimbursement models for oncology realized significant cancer care savings through bundled payments and clinical pathways, a recent Evidence-Based Oncology study revealed. But the financial incentives for the models...

NAACOS: Mandatory Bundled Payments Impede ACO Financial Success

by Jacqueline Belliveau

The National Association of ACOs (NAACOS) recently urged CMS to indefinitely suspend upcoming mandatory Medicare bundled payment models until the federal agency resolves financial conflicts between the episodic arrangements and accountable care...

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