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

Value-Based Care News

Mortality Rates Rose After HRRP Value-Based Penalty Enforced

November 20, 2017 - 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 uncovered. The HRRP penalizes hospitals up to 3 percent of their Medicare reimbursement if the organization has excessive 30-day readmission rates...


Articles

Addressing Quadruple Aim, Physician Burnout Key to Risk Success

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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

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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

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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...

PTAC Recommends 2 APMs for Potential MACRA Implementation

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The Physician-Focused Payment Model Technical Advisory Committee (PTAC) recently recommended two alternative payment models to HHS for possible MACRA implementation. Stakeholders have submitted 19 alternative payment model proposals since the...

The Pros and Cons of Quality Measure Choices In MACRA, MIPS

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Uprooting the fee-for-service payment system and changing the way clinicians provide care is no easy feat. With this in mind, CMS designed MACRA’s Merit-Based Incentive Payment System (MIPS) to gradually ramp up participation and offer...

Importance of Post-Acute Alignment, Integration to Value-Based Care

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To achieve the ultimate goals of value-based care, healthcare organizations will need to assume greater responsibility over the patient’s experience across multiple care settings based on the appropriate level of acuity.   While the...

Full Risk Value-Based Care Key to Treating Vulnerable Patients

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Oak Street Health, a 24-primary care network headquartered in Chicago, aims to rebuild healthcare as it should be using value-based care contracts with full financial risk. The health system’s mission is to deliver personal, equitable,...

Accountable Care Organizations Cut Medicare Spending by $836M

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Accountable care organizations (ACOs) decreased Medicare spending by $836 million in 2016, new data from CMS revealed. As a result, the organizations from four Medicare ACO programs returned about $70.6 million in healthcare savings to the Medicare...

Choosing Wisely Slow to Reduce Low-Value Care, Resource Use

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Participation in the Choosing Wisely campaign has significantly increased since its launch in 2012. But the campaign has yet to realize its goal of decreasing low-value care and resource use, a recent Health Affairs report showed. Researchers...

Pay-for-Performance Models Hurt Safety-Net Hospital Finances

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Medicare pay-for-performance models may disproportionately penalize safety-net hospitals and other organizations that serve the most vulnerable patient populations, a new study in Medical Care found. Hospitals in one of the most socioeconomically...

Value-Based Reimbursement Shift Slows, But CEOs Still Preparing

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Hospital and health system CEOS are gearing up for alternative payment models and population health management, but the transition to value-based reimbursement is taking more time than expected, a recent survey from Deloitte Center for Health...

AMA Pres: Align MIPS Improvement Activities with APM Demands

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Providers can ensure their investments in the Merit-Based Incentive Payment System (MIPS) are worth it by engaging in Improvement Activities and other practice transformations that enhance overall Medicare performance and lead them to the alternative...

Using EHR Systems, Supports to Aid MIPS Reporting, Boost Scores

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Delivering high-quality care is already a complicated process for healthcare providers. Understanding, as well as reporting, to MACRA’s Merit-Based Incentive Payment System (MIPS) has made the task even more complex, explained Brad J. Abrams,...

61% of Next Generation ACOs Earned Shared Savings in 2016

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The majority of Next Generation Accountable Care Organizations (ACOs) earned shared savings in the first year of the model, recent data from CMS revealed. Eleven of 18 total Next Generation ACOs will receive a shared savings payment from CMS,...

AHA Supports Bundled Payment Cancellation, Voices MACRA Concerns

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Despite back the decision by CMS to cancel two bundled payment models and modify another, the American Hospital Association contends that the federal agency is moving a bit too quickly in shifting providers to value-based payment. According to...

Do Alternative Payment Models Overcome Fee-for-Service Flaws?

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While alternative payment models, such as pay-for-performance, shared savings and risk, and bundled payments, were designed to improve the flawed fee-for-service system, the models are not addressing volume-based payment issues, according to...

CO’s Pediatric Care Network Brings Value-Based Care to Children

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Medicare has led the healthcare industry as it shifts from fee-for-service to value-based care, with 30 percent of traditional Medicare reimbursements already paid under an alternative payment model. The federal government plans to further transition...

Prioritizing Value-Based Care, Affordability in Medicaid

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WASHINGTON DC - The future of Medicaid involves providing value-based care at an affordable price for all beneficiaries in the program, Kaiser Permanente’s CEO Bernard J. Tyson told attendees at AHIP’s National Conference on Medicaid....

MIPS Quality Reporting Flexibilities Trouble Providers, EHR Vendors

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It’s good to have options when it comes to the clothes we wear, cars we drive, and things we do. But having too many options when it comes to quality reporting under MACRA’s Merit-Based Incentive Payment System (MIPS) may prove to...

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