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

Revenue Cycle Risk

Practices Still Averse to Risk-Based Alternative Payment Models

October 29, 2018 - 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 physician practice leaders, frontline physicians, and other healthcare stakeholders participating in a 2014 AMA and RAND study expressed enthusiasm...


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AMA, AHIP, and Others Oppose Upside-Only ACO Changes for MSSP

by Jacqueline LaPointe

The American Medical Association (AMA), Medical Group Management Association (MGMA), and Health Care Transformation Task Force (HCTTF) are among nine industry groups calling on CMS to reconsider proposed changes to the Medicare Shared...

MSSP ACOs Saved $1.84B, Nearly Double CMS Estimate, Study Finds

by Jacqueline LaPointe

CMS estimates that accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) saved $954 million from 2013 to 2015. However, a new Dobson DaVanzo & Associates analysis, commissioned by the National Association...

How Next Generation ACOs Built a Foundation for Success

by Jacqueline LaPointe

Employing additional administrative staff, prioritizing care management, and building data analytics capacity were key strategies accountable care organizations (ACOs) implemented to participate in the Next Generation model, CMS recently...

CMS to Offer More Flexibility to Risk-Bearing ACOs, Verma Says

by Jacqueline LaPointe

Federal regulations and rules are commonly cited as barriers to implementing value-based reimbursement models. The rules can prevent care coordination and appropriate transitions of care, which negatively impact an accountable care...

Next Generation ACOs Save Medicare $62M, Maintain Care Quality

by Jacqueline LaPointe

Accountable care organizations (ACOs) in the Next Generation ACO program produced nearly $62 million in net savings to Medicare while maintaining care quality in 2016, CMS recently reported in the newly released evaluation of the...

Leading Accountable Care Organization Group Opposes MSSP Overhaul

by Jacqueline LaPointe

The proposal to overhaul the Medicare Shared Savings Program (MSSP) would significantly harm the accountable care organization (ACO) movement, the National Association of ACOs (NAACOS) recently stated. “The administration’s...

CMS Plans to Transform MSSP to Encourage ACOs to Assume More Risk

by Jacqueline LaPointe

CMS recently proposed an overhaul of Medicare’s largest accountable care organization (ACO) program, transforming it from the Medicare Shared Savings Program (MSSP) to the Pathways to Success initiative. The redesigned MSSP program...

A Provider-Sponsored Health Plan Is A Hospital’s Natural Next Step

by Jacqueline LaPointe

Many hospitals and health systems are bypassing the ultimate opportunity to gain greater control of the outcomes and costs of their patients. That opportunity is developing their own provider-sponsored health plan, according to Geisinger...

Giving Providers Hospital Cost Accounting Data Will Lower Costs

by Jacqueline LaPointe

Engaging physicians with hospital cost accounting data will be key to lowering costs under accountable care organizations (ACOs) and other population-based reimbursement models, Stanford researchers recently explained. Population-based...

Key Issues Impacting Two-Sided Risk Accountable Care Organizations

by Jacqueline LaPointe

Medicare accountable care organizations (ACOs) operating under two-sided financial risk arrangements save the federal healthcare program more than one-sided risk organizations. But policymakers must address financial incentives,...

Medicare Spending Greater on Patients in Downside Risk MSSP ACOs

by Jacqueline LaPointe

Moving accountable care organizations (ACOs) to Medicare Shared Savings Program (MSSP) tracks with downside financial risk may not help the accountable care initiative generate savings, according to a new analysis from the Center for...

71% of MSSP ACOs Likely to Quit Rather Than Assume Downside Risk

by Jacqueline LaPointe

The Medicare Shared Savings Program (MSSP) is requiring the 82 accountable care organizations (ACOs) that started in upside-only financial risk tracks in 2012 or 2013 to take on downside financial risk by 2019. However, the majority of...

Orgs Not Living Up to Risk-Based Revenue Goals, C-Suite Says

by Jacqueline LaPointe

Provider organizations failed to achieve their risk-based revenue goals in 2017, according to the most recent State of Population Health survey by Numerof & Associates. The survey of healthcare C-suite executives showed that the...

A Holistic View of the Patient Enables Risk-Based ACO Success

by Jacqueline LaPointe

Giving providers a holistic view of the patient resulted in accountable care organization (ACO) success for a risk-based organization in southern Florida, which earned a place on the list of ACOs achieving the greatest shared savings in...

Risk-Averse MSSP ACOs Missed $966M By Not Assuming Downside Risk

by Jacqueline LaPointe

Accountable care organizations (ACOs) in the non-risk bearing track of the Medicare Shared Savings Program (MSSP) could have boosted their bottom lines by an additional $966 million in net payments in 2016 if they had assumed downside risk...

ACO, Bundled Payments Alignment Key to Success for Both Models

by Jacqueline LaPointe

CMS should align accountable care organizations (ACOs) and bundled payments by creating a blended accountability structure that allows organizations to participate in both alternative payment models without financial conflicts, industry...

60% of Federal Revenue to Come from Risk-Based Models by 2019

by Jacqueline LaPointe

Almost 60 percent of federal revenue and 37 percent of commercial revenue will stem from risk-based models by 2019, according to a new AMGA survey. The survey of 74 AMGA medical groups uncovered that Medicare and Medicaid fee-for-service...

Industry Orgs Urge CMS to Lower Risk for MACRA’s Advanced APMs

by Jacqueline LaPointe

Healthcare stakeholders recently encouraged CMS to reconsider the financial risk requirements for Advanced Alternative Payment Models (Advanced APMs), arguing that the risk criteria limit participation in the models. Industry groups,...

Full Risk Value-Based Care Key to Treating Vulnerable Patients

by Jacqueline LaPointe

Oak Street Health, a 24-primary care network headquartered in Chicago, aims to rebuild healthcare as it should be using value-based care contracts with full financial risk. The health system’s mission is to deliver personal,...

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