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

Value-Based Care News

Putting Both Feet in the Value-Based Care, Reimbursement Boat

October 23, 2018 - “Do not put each foot in a different boat,” warned Partners HealthCare CFO Peter Markell at Xtelligent Healthcare Media’s third annual Value-Based Care Summit in Boston. But the current reality in healthcare is that providers are doing just that. Healthcare organizations are operating in both the traditional fee-for-service and value-based reimbursement worlds even...


Articles

Healthcare Dollars Moving to Alternative Payment Models, LAN Finds

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Approximately 34 percent of all healthcare payments made in 2017 were tied to an alternative payment model (APM) with shared savings, shared risk, bundled payments, or population-based payments, according to a new report from the Health...

Medical Spending, Utilization the Same for Cancer Patients in ACOs

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Cancer patients treated by providers in a Medicare accountable care organization (ACO) did not see lower medical spending or healthcare utilization compared to similar patients treated at non-ACO practices, a new study in the Journal of...

Maximizing MIPS Scores Through Chronic Disease Prevention

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The healthcare industry is moving beyond a “sick care” system and shifting to chronic disease prevention to lower costs and improve quality. However, the healthcare payment system is just catching up to the preventative care...

Hospital Readmission Program Penalties Didn’t Raise Mortality Rates

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The Hospital Readmission Reduction Program (HRRP) achieved a significant drop in readmission rates for Medicare patients hospitalized for pneumonia, acute myocardial infarction (AMI), and heart failure without bringing an increase of...

61% of Doctors Say Value-Based Care Will Damage Their Practice

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Physicians are still on the fence about the impact value-based care will have on their business and patient care, a recent survey showed. Forty-nine percent of over 3,400 physicians recently surveyed by the nation’s largest...

Medicare Bundled Payments Model Cut Costs, Maintained Quality

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Payments declined for approximately three-quarters of the clinical episode combinations in the Medicare Bundled Payments for Care Improvement (BPCI) model without impacting care quality, CMS recently reported. Of the 67 BPCI model,...

Exploring Virtual Groups in the Quality Payment Program, MIPS

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Virtual groups enable independent physicians and clinicians in small practices to participate in Medicare’s historic push to transition to value-based reimbursement: the Quality Payment Program. The Quality Payment Program, or QPP,...

Quality Payment Program Top Regulatory Burden for Practices

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For the second year in a row, medical practice leaders said the Quality Payment Program was their top regulatory burden in 2018. Eighty-percent of the 426 group practice leaders recently surveyed by the Medical Group Management...

Real Costs Up to 8% Higher for Some Cancers in Oncology Care Model

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New research shows actual episode costs for certain cancers covered by Medicare’s Oncology Care Model differed by as much as eight percent, on average, from the predicted costs per episode. The Oncology Care Model (OCM) is a...

Aligning Incentives for Providers, Payers Improves Primary Care

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How the healthcare industry delivers and pays for primary care is changing as the country finds their healthcare spending skyrocketing. Healthcare spending across the country is slated to increase at an average annual rate of 5.5 percent...

Value-Based Purchasing, Consumerism Top Healthcare Exec Challenges

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Transitioning to value-based purchasing and responding to healthcare consumerism continue to be among the top challenges, issues, and opportunities healthcare C-suite leaders are facing in 2019, according to a new poll from the Healthcare...

Time Helps Accountable Care Organizations Realize Savings in MSSP

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Experience is a key factor to realizing greater cost savings in the Medicare Shared Savings Program (MSSP), a new Avalere analysis found. Accountable care organizations (ACOs) in the MSSP for four or more years generated nearly all of the...

Hospitals Seek Non-Acute, Supplier Partners for Value-Based Care

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Hospitals are looking to strategically expand their footprint in the non-acute care space to succeed in value-based care and alternative payment models, a new study of hospital decisionmakers found. L.E.K.’s ninth annual...

Medicare Spending Falls 3.3% in First Year of CJR Bundled Payments

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Hospitals reduced average Medicare spending on lower extremity joint replacements (LEJRs) by 3.3 percent during the first performance year of Medicare’s mandatory bundled payments model for joint replacements, CMS recently...

New Alternative Payment Model Tackles Holistic Addiction Recovery

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A national multi-sector alliance of healthcare industry leaders is looking to incentivize providers and payers to deliver coordinated, holistic addiction recovery services to patients through a new alternative payment model. Nearly 21...

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

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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...

Developing a 2018 MIPS Reporting Strategy to Avoid a Penalty

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Eligible clinicians can avoid a financial penalty under the Merit-Based Incentive Payment System (MIPS) in 2020 by focusing their reporting on one of three performance categories: Quality, Improvement Activities, or Promoting...

How Next Generation ACOs Built a Foundation for Success

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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...

More MSSP ACOs Saved Money, Earned Shared Savings in 2017

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Accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) generated about $314 million in net Medicare savings in 2017, according to new MSSP performance data from CMS. In 2017, 472 ACOs in the largest Medicare...

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