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

Risk Management

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

September 25, 2018 - 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 Savings Program (MSSP). Proposals to shorten the time new ACOs have to assume downside financial risk from six to two years and reduce the shared savings...


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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...

House Reps Want to Extend MSSP Track 1 ACO Participation

by Jacqueline LaPointe

Seven House Representatives are calling on CMS to allow successful accountable care organizations (ACOs) in the Medicare Shared Savings Program’s (MSSP) Track 1 to continue in the upside-only financial risk track for a third...

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...

How Mercy Improved Care Transitions for Risk-Based Care Success

by Jacqueline LaPointe

For the thousands of patients released from their 23 acute care hospitals a year, Mercy Health ensures that each patient receives the highest value care. But there is only so much providers can do within the walls of their health system to...

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...

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,...

Addressing Quadruple Aim, Physician Burnout Key to Risk Success

by Jacqueline LaPointe

From capturing patient risk to meeting quality measures, providers face a daunting list of items needed to achieve the Triple Aim of value-based care. But healthcare organizations will not see lasting cost savings and care quality...

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,...

ACOs Plan to Move to Downside Financial Risk, Capitation Contracts

by Jacqueline LaPointe

Accountable care organizations (ACOs) are planning to enter downside financial risk arrangements, with 47 percent planning on entering a shared savings and losses contract and 38 percent pursuing capitation, uncovered a recent survey of...

Bringing Back House Calls to Cut Spending on High-Risk Patients

by Jacqueline LaPointe

Before the early 1960s, the majority of healthcare visits were performed in patient homes. But as healthcare evolved, providers could no longer fit their tools in a transportable medical bag and the proportion of visits made by house calls...

Patient-Reported Data Helps Providers Find High-Cost Patients

by Jacqueline LaPointe

Self-reported patient data on health conditions, status, and utilization may be the key to identifying high-cost patients and guiding them to care management models to reduce their spending, a recent American Journal of Managed Care study...

Accountable Care Organizations Grow, But Face New Challenges

by Jacqueline LaPointe

Since the Affordable Care Act paved the way for accountable care organizations (ACOs) in 2010, healthcare providers have increasingly turned to the alternative payment model as a way to engage in value-based care across patient...

MSSP ACOs Missed $886M in Potential Revenue By Avoiding Risk

by Jacqueline LaPointe

Accountable care organizations (ACOs) in Track 1 of the Medicare Shared Savings Program (MSSP) could have received an additional $886 million in net payments in 2015 if the organizations took on downside financial risk and earned the 5...

10 Orgs Call for Medicare Advantage APMs to Qualify for MACRA

by Jacqueline LaPointe

A coalition of ten healthcare industry groups recently urged HHS Secretary Tom Price to weigh risk-based Medicare Advantage alternative payment models the same as Advanced Alternative Payment Models under MACRA. Qualifying participants in...

Creating Alternative Payment Models to Support Health Centers

by Jacqueline LaPointe

Healthcare stakeholders and lawmakers should encourage community health centers to engage in alternative payment models to financially incentivize providers to improve safety-net care, a recent Journal of the American Medical Association...

Value-Based Penalties Target Hospitals With High Risk Patients

by Jacqueline LaPointe

Hospitals that serve greater volumes of African-American patients and those with more severe conditions are more likely to receive a value-based penalty under the Medicare Hospital Readmissions Reduction Program (HRRP), a new JAMA...

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