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

Value-Based Care News

Mandatory Bundled Payments Drive Value-Based Care, Docs Argue

January 17, 2018 - 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 in a new Journal of the American Medical Association editorial. CMS announced in November 2017 that the federal agency would no longer move forward...


Limited Quality Benefits for Early Pay-For-Performance Adopters


The impact of hospital pay-for-performance models, such as Medicare’s Hospital Value-Based Purchasing Program (HVBP), have been “limited and disappointing” over the past decade, researchers stated in a new BMJ study. The analysis...

3 Strategies to Reduce Hospital Readmission Rates, Costs


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


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...

Stakeholders Back Standard ACO Measures for Commercial Orgs in CA


The Integrated Healthcare Association (IHA) and Pacific Business Group on Health (PBGH) recently embarked on a joint mission to standardize accountable care organization (ACO) measures for quality and cost performance and benchmarking for commercial...

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


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....

OIG: Practice Aid, QPP Integrity Needed for MACRA Implementation


A recent Office of the Inspector General (OIG) investigation found two major vulnerabilities with MACRA implementation. The HHS watchdog reported that CMS still needs to provide practice-specific technical assistance and implement a Quality Payment...

Physician-Led Advanced APMs to Support Independent Docs, Orgs Say


CMS should support small and independent practices by developing physician-led Advanced Alternative Payment Models (APMs), advised a group of provider and industry organizations. The American Academy of Family Physicians (AAFP), Medical Group...

60% of Federal Revenue to Come from Risk-Based Models by 2019


Almost 60 percent of federal revenue and 37 percent of commercial revenue will stem from risk-based models by 2019, according to a new AMGA survey. The survey of 74 AMGA medical groups uncovered that Medicare and Medicaid fee-for-service revenue...

High-Risk Patient Management Did Not Drive Early ACO Cost Savings


Care coordination and care management strategies focused on high-risk and chronically ill patients did not drive early cost savings among accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP), a recent Health Affairs...

Key Capabilities for Value-Based Reimbursement Models


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


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)...

Collaboration Key to Independent Physicians in Value-Based Care


At first glance, value-based care models appear to work against independent physicians. The risk-based arrangement requires a coordination of services across care continuum — primarily between primary care physicians and specialists but...

Family Physicians Slowly Embracing Value-Based Reimbursement


Slightly more family physicians are actively pursuing value-based reimbursement opportunities compared to two years ago despite persistent barriers, Humana and the American Academy of Family Physicians (AAFP) recently announced. The survey of...

Value-Based Contracts Rely on Patient Attribution, Data Sharing


CMS aims to tie 90 percent of Medicare fee-for-service payments to quality by the end of 2018, with one-half of those payments to be paid under a value-based contract with some degree of financial risk. With ambitious goals from the federal government,...

MSSP ACOs Improve Care Quality, Struggle to Realize Savings


Medicare accountable care organizations (ACOs) found overwhelming success with care quality improvements in 2016, but the organizations were still working on reducing costs, according to a recent analysis published in the Health Affairs blog....

Mortality Rates Rose After HRRP Value-Based Penalty Enforced


Short and long-term mortality rates increased for Medicare beneficiaries hospitalized for heart failure after Medicare implemented the value-based penalty component of the Hospital Readmission Reduction Program (HRRP), a new JAMA Cardiology study...

Addressing Quadruple Aim, Physician Burnout Key to Risk Success


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 improvements...

Post-Acute Care Orgs Lack IT, Data Analytics for Value-Based Care


Value-based care hinges on data analytics and provider communication across the care continuum. However, post-acute care providers do not have the health IT infrastructure or communication workflows in place to support value-based reimbursement...

40+ States Have A Value-Based Reimbursement Adoption Strategy


Over 40 states have a plan for value-based reimbursement adoption and only seven states have engaged in little to no activities relating to value-based healthcare payment reform, according to a new Change Healthcare report. The report showed...

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