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

Value Based Purchasing

Exploring Quality Measures Under Value-Based Purchasing Models

June 22, 2017 - CHICAGO – Jason Goldwater, MPA, MA, Senior Director of the National Quality Forum, recently likened the value-based purchasing transition to the evolution of music at Xtelligent Media’s Value-Based Care Summit in Chicago. Music started with the radio. Individuals could listen to whatever came out of the device. Fast forward to the age of the iPod and individuals can now store up...


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AHA to IRS: Foster Hospital Participation in Commercial ACOs

by Jacqueline Belliveau

The American Hospital Association (AHA) recently called on leaders from the Department of Treasury and IRS to issue formal guidance that would permit non-profit hospitals to participate in commercial accountable care organizations (ACOs) without...

Providers Lack Tools, Payer Alignment for Value-Based Purchasing

by Jacqueline Belliveau

Healthcare providers still lack the necessary tools for value-based purchasing success with only 43 percent of providers reporting that they have access to the appropriate solutions, a recent Quest Diagnostics and Inovalon survey uncovered. However,...

Count Medicare Advantage Patients for Advanced APMs, Orgs Say

by Jacqueline Belliveau

Eligible clinicians participating in appropriate alternative payment models under a Medicare Advantage plan should qualify for Advanced Alternative Payment Model (Advanced APM) incentive payments in 2019, the AMGA and nine other healthcare industry...

Lab Experts Help Providers Reduce Low-Value Resource Use, Costs

by Jacqueline Belliveau

Collaboration between laboratory medicine experts and clinicians is critical to reducing unnecessary and low-value resource use for value-based purchasing success, the American Association For Clinical Chemistry (AACC) recently stated. “The...

Commitment Key to Successful Value-Based Reimbursement Adoption

by Jacqueline Belliveau

It is time for healthcare providers to move past understanding the concept and start the value-based reimbursement adoption process. Otherwise, they may face profitability decreases from operating both fee-for-service and alternative payment...

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...

Execs To Continue Value-Based Purchasing Despite Uncertainty

by Jacqueline Belliveau

Despite a possible Affordable Care Act repeal, healthcare executives still plan to stay the course with value-based purchasing implementation and healthcare cost reduction initiatives, a recent BDC Advisors survey reported. Although the C-suite...

How Clinicians Add Value to Healthcare Supply Chain Management

by Jacqueline Belliveau

Engaging clinical staff is key to adding value to healthcare supply chain management, according to three supply chain leaders at MaineHealth, a recent ECRI Institute Healthcare Supply Chain Achievement award recipient. The healthcare network...

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...

Key Capabilities for Population-Based Alternative Payment Models

by Jacqueline Belliveau

To succeed in population-based alternative payment models with two-sided financial risk, health systems should embrace assuming the role of the payer and work to get all staff on board with the model, suggested Jackie Selby, a healthcare and...

Execs Say Value-Based Purchasing to Hit Tipping Point by 2020

by Jacqueline Belliveau

Over one-half (55 percent) of healthcare executives surveyed after the recent presidential election stated that the industry should reach the value-based purchasing tipping point before 2020, a recent Lazard report revealed. The survey of 203...

Will Behavioral Economics Improve Alternative Payment Models?

by Jacqueline Belliveau

Alternative payment models may need to account for the behavioral economics behind provider prescribing habits to effectively reduce healthcare costs from expensive medications and treatments, a recent American Journal of Managed Care study stated....

Engaging Providers Key to Value-Based Reimbursement Adoption

by Jacqueline Belliveau

Nearly three-quarters (73 percent) of providers prefer a fee-for-service model over value-based reimbursement structures even though almost one-half acknowledged that the traditional payment model contributed to higher healthcare costs, a recent...

56% of Top Performing Med Groups Plan Value-Based Purchasing

by Jacqueline Belliveau

About 56 percent of medical groups that were financially high-performing have a plan for a value-based purchasing transition versus just 32 percent of medical groups falling behind with healthcare revenue cycle management, a recent CareCloud...

Post-Acute Care Network Key to Value-Based Purchasing Success

by Jacqueline Belliveau

Health systems should develop a post-acute care network and strategy to succeed in value-based purchasing models, a recent Deloitte survey indicated. The survey of 36 executives from health systems, payers, post-acute care organizations, and...

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...

Value-Based Penalties Target Hospitals With High Risk Patients

by Jacqueline Belliveau

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 Cardiology...

Bundled Payment Models Here to Stay Despite CMS Program Delays

by Jacqueline Belliveau

CMS may have issued three-month delays for several new healthcare bundled payment models, but providers should still anticipate the shift to value-based purchasing through the episodic alternative payment model, said Colin Luke, a partner at...

AMGA President, CEO Donald W. Fisher, PhD, Passes at 71

by Jacqueline Belliveau

AMGA President and CEO, Donald W. Fisher, PhD, CAE, passed earlier this week after battling cancer, the healthcare industry group reported. Fisher, who was 71 years old, had led the organization since 1980. “Don leaves a professional and...

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