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

Value Based Care

Practices Push for Quicker Value-Based Purchasing Transition

April 12, 2018 - The Council of Accountable Physician Practices (CAPP) recently urged policymakers to prioritize the value-based purchasing transition by accelerating the shift away from fee-for-service. “We recognize that much of policymakers’ and the public’s attention is focused on potential changes to our systems of insurance coverage,” the coalition of multi-specialty medical groups...


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3 Strategies to Decrease Low-Value Care, Healthcare Costs

by Jacqueline Belliveau

Low-value care, or care for which the potential harm outweighs the possible benefits or there are little to no benefits, is unnecessarily driving up already high healthcare costs and putting providers at risk under value-based reimbursement models....

House Reps Create Caucus for Value-Based Reimbursement, Health IT

by Jacqueline Belliveau

Four House Representatives recently announced the creation of a new bipartisan group dedicated to supporting and promoting healthcare innovation through value-based reimbursement. Representatives Mike Kelly (R-PA), Ron Kind (D-WI), Markwayne...

MIPS Will Impede Value-Based Purchasing Transition, MedPAC Argues

by Jacqueline Belliveau

The Medicare Payment Advisory Commission (MedPAC) recently suggested that Congress repeal the Merit-Based Incentive Payment System (MIPS), arguing the new value-based purchasing program “impedes the movement toward high-value care.”...

AMA, Anthem Team Up to Streamline Prior Authorizations

by Jacqueline Belliveau

The American Medical Association (AMA) and Anthem, Inc. recently announced that they will work together over the next year to streamline prior authorization requirements and improve the healthcare experience overall through provider and payer...

Accelerating the Value-Based Payment Transition Top HHS Priority

by Jacqueline Belliveau

Quickening the pace of the value-based payment transition is a major focus for HHS, the department’s new Secretary Alex Azar recently told attendees of the Federation of American Hospitals’ annual Public Policy Conference in Washington...

Value-Based Purchasing Top Health Reform Priority for Governors

by Jacqueline Belliveau

In a recent healthcare reform proposal, a bipartisan group of governors emphasized that value-based purchasing implementation will be the key to reducing healthcare costs while improving outcomes. “Coverage is important, and coverage reforms...

Slow and Steady Still the Motto for Value-Based Reimbursement

by Jacqueline Belliveau

The healthcare industry has boarded the train to value-based reimbursement. But recent roadblocks have provider organizations pumping the brakes with the shift away from fee-for-service, explained industry experts Doral Jacobsen, MBA, FACMPE,...

Hospital Execs, Payers Face Similar Value-Based Purchasing Barriers

by Jacqueline Belliveau

Payers and hospital finance executives agree that health IT inadequacies and insufficient physician buy-in are top barriers to value-based purchasing adoption, two recent surveys revealed. The Healthcare Financial Management Association’s...

Healthcare Supply Chain Management Market to Reach $2.3B by 2022

by Jacqueline Belliveau

Growing at a compound annual growth rate (CAGR) of 8.4 percent, researchers projected the global healthcare supply chain management market to reach $2.31 billion by 2022, a recent Markets and Markets report showed. The value of the healthcare...

Reducing Low-Value Care Key to Value-Based Reimbursement Success

by Jacqueline Belliveau

Value-based reimbursement success hinges on decreasing low-value care across patient populations, explained Scott Weingarten, MD, MPH, Senior Vice President and Chief Clinical Transformation Officer at Cedars-Sinai Medical Center. While hospitals...

AMGA: Link Spending, Quality Performance for True Value-Based Care

by Jacqueline Belliveau

In response to a Request for Information from the Assistant Secretary for Planning and Evaluation (ASPE), AMGA recently called on CMS to “define value in a meaningful way” to ensure value-based care models incentivize providers to...

72% of Clinicians See No Adjustment Under Value Modifier in 2018

by Jacqueline Belliveau

An overwhelming majority of clinicians who participated in the final year of the Value-Based Payment Modifier (Value Modifier) program will receive neutral payment adjustments in 2018, according to new CMS data. Out of over 1.1 million eligible...

AMGA: Align Medicare Advantage, APMs to Promote Value-Based Care

by Jacqueline Belliveau

If CMS moves forward with relaxing Medicare Advantage benefit requirements, then the federal agency should offer the same flexibilities to providers and beneficiaries in Medicare Part B alternative payment models, such as accountable care organizations...

Mandatory Bundled Payments Drive Value-Based Care, Docs Argue

by Jacqueline Belliveau

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...

3 Strategies to Reduce Hospital Readmission Rates, Costs

by Jacqueline Belliveau

Providers understand that high hospital readmission rates spell trouble for patient outcomes. But excessive rates may also threaten a hospital's financial health, especially in a value-based reimbursement environment. Readmissions are...

Vermont ACO Receives $620M to Lead Healthcare Reform Efforts

by Jacqueline Belliveau

Vermont’s healthcare reform group, Green Mountain Care Board, recently approved a budget of $620 million for OneCare Vermont, an accountable care organization (ACO) working with Medicare, Medicaid, and private payers, local news sources...

Nearly 71% of Practice Revenue Under Fee-For-Service in 2016

by Jacqueline Belliveau

Fee-for-service was still the dominant source of medical practice revenue in 2016, the American Medical Association (AMA) recently reported. Almost 84 percent of physicians stated that their practice received fee-for-service revenue in 2016....

Key Capabilities for Value-Based Reimbursement Models

by Jacqueline Belliveau

Rising healthcare costs, shrinking reimbursement rates, and federal policies are driving hospitals and health systems to adopt value-based reimbursement, according to a new American Hospital Association (AHA) report. But the models are not one-size-fits-all...

High-Value Culture, Population Health Programs Key to ACO Success

by Jacqueline Belliveau

Creating a high-value culture, engaging in proactive population health management, and implementing an infrastructure that promotes continuous performance improvement were key characteristics of 11 successful accountable care organizations (ACOs)...

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