Bundled Payments

Reimbursement Adequacy, Timely Data Needed for Risk-Based Payment

by Jacqueline LaPointe

Reimbursement inadequacy, timeliness of data, and access to data are preventing hospitals and health systems from moving to risk-based payment, according to a recent survey from healthcare improvement...

Stakeholders Pick Apart Bundled Payments for Radiation Oncology

by Jacqueline LaPointe

The American Hospital Association (AHA), Community Oncology Alliance (COA), and other key stakeholders voiced concerns about a mandatory bundled payments model for radiation oncology slated to take...

Chronic Disease Patients with Mental Health Disorders Cost More

by Jacqueline LaPointe

For chronic disease patients, having a mental health disorder was associated with higher healthcare costs and resource use, confirms a new study in JAMA Network Open. The study of hospitalization and...

Oncology Practices Oppose Mandatory Bundled Payment Model

by Jacqueline LaPointe

Implementing a mandatory bundled payment model for radiation oncology oversteps CMS authority and could potentially harm cancer patients, the Community Oncology Alliance (COA) stated in response to a...

Unpacking the Proposed Radiation Oncology Bundled Payment Model

by Jacqueline LaPointe

On July 10, 2019, CMS proposed a mandatory radiation oncology bundled payment model that aims to improve the quality of care for cancer patients undergoing radiotherapy treatment and reduce provider...

Joint Replacement Bundled Payments Save Nearly $1K Per Episode

by Jacqueline LaPointe

Hospitals participating in a joint replacement bundled payments model through Medicare saved $997 per episode during the first two performance periods, according to a second annual report on the model...

Value-Based Payment Reform Key to Moving Forward with Value

by Jacqueline LaPointe

Value-based payment reform will be the key to lowering healthcare costs and improving care quality, according to health economist Michael Chernew, PhD. At AHIP’s 2019 Institute & Expo in...

COA Proposes New Oncology Care Model with Value-Based Purchasing

by Jacqueline LaPointe

The Community Oncology Alliance (COA) recently submitted an alternative payment model proposal to the Physician-Focused Payment Model Technical Advisory Committee (PTAC) that builds on the work done by...

Teaching Hospitals Aren’t More Expensive Than Non-Teaching Peers

by Jacqueline LaPointe

Medicare beneficiaries treated for common medical conditions and surgical conditions incurred lower total costs of care over a 30-day episode when hospitalized at a major teaching hospital versus a...

Practices Ask for Downside Risk Delay for Oncology Care Model

by Jacqueline LaPointe

An association of community oncology practices recently urged CMS to delay the October 2019 deadline for practices in the Oncology Care Model (OCM) to assume downside financial risk. In a letter to...

70% of Practices to Owe Under Risk Tracks in Oncology Care Model

by Jacqueline LaPointe

Seventy percent of practices in Medicare’s Oncology Care Model (OCM) would owe payments to CMS if they transition to the program’s two-sided financial risk tracks, a new Avalere analysis...

Hospitals Oppose Bundled Payments as Surprise Medical Bill Fix

by Jacqueline LaPointe

Payers, providers, and other healthcare stakeholders agree that the industry needs a solution for surprise medical bills. But major hospital associations are saying that proposals to implement bundled...

Participation in Advanced Bundled Payments Model Falls 16%

by Jacqueline LaPointe

Provider participation in Medicare’s new advanced bundled payments model dropped by about 16 percent in the first five months, according to updated data from CMS. The federal agency recently...

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...

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...

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...

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...

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...

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...

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...