Risk Management News

Patient Attribution Key Component to APMs, Value-Based Contracts

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Patient attribution is a critical component of alternative payment models (APMs) that appropriately hold providers accountable for their care performance. “Attribution methodology is at the core...

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

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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...

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

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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...

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

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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...

Giving Providers Hospital Cost Accounting Data Will Lower Costs

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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...

CMS to Waive MIPS for Providers in At-Risk Medicare Advantage Plans

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CMS recently announced that it advanced a demonstration that would waive Merit-Based Incentive Payment System (MIPS) requirements for eligible clinicians participating in at-risk Medicare Advantage...

Key Issues Impacting Two-Sided Risk Accountable Care Organizations

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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...

Medicare Spending Greater on Patients in Downside Risk MSSP ACOs

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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...

House Reps Want to Extend MSSP Track 1 ACO Participation

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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...

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

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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...

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

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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...

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

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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...

How Mercy Improved Care Transitions for Risk-Based Care Success

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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...

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

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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...

MSSP Accountable Care Organizations Moving to Risk in 2018

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According to a new fact sheet from CMS, the Medicare Shared Savings Program (MSSP) will see some fresh faces in 2018, as well as more accountable care organizations (ACOs) entering downside financial...

ACO, Bundled Payments Alignment Key to Success for Both Models

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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...

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

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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...

Home Health Owners Face Charges for Medicare Fraud, Upcoding

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The federal government filed a lawsuit against the two owners of Gateway Health Systems in Chicago for their involvement in a Medicare fraud scheme that cost the federal healthcare program millions,...

ACOs Plan to Move to Downside Financial Risk, Capitation Contracts

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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...