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

Value-Based Care News

2018 Advanced APM Options Added to Quality Payment Program

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Eligible clinicians now have more opportunities to earn value-based incentive payments by participating in the Advanced Alternative Payment Model track of the Quality Payment Program in 2018, according to a recent CMS announcement. Starting in...

Developing Post-Acute Networks for APM Reimbursement Success

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About 85 percent of healthcare C-suite leaders expect to expand post-acute care partnerships over the next three years, especially as their organizations aim to maximize alternative payment model reimbursement, a recent Premier report found....

How Palliative Care Can Maximize Value-Based Reimbursement

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Providers can boost value-based reimbursement success by incorporating early palliative care into routine cancer care delivery, a new study in the American Journal of Managed Care indicated. Researchers at the Center to Advance Palliative Care...

HHS Sec. Burwell Shares Vision for Value-Based Care Future

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In a recent Health Affairs blog post, HHS Secretary Sylvia Mathews Burwell called for value-based care progress after the Obama administration ends through more alternative payment models, care delivery transformation, and health data access....

GAO Finds Value-Based Care Issues for Small, Rural Practices

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A recent Government Accountability Office (GAO) report found that small and rural practices faced several challenges with implementing value-based care models, such as limited financial resources, a lack of interoperable health IT, population...

AMGA: Value-Based Reimbursement Transition Slower Than Expected

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Fee-for-service revenue decreased by more than 20 percent as value-based reimbursement payments increased, reported the American Medical Group Association (AMGA). But the transition to value-based reimbursement may be slowing down compared to...

Slavitt Offers Value-Based Care Steps Post MACRA Implementation

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As CMS gets ready for MACRA implementation in the new year, CMS Acting Administrator Andy Slavitt urged healthcare and political leaders to carry on value-based care progress made under the Affordable Care Act. In a statement at the MACRA MIPS/APM...

How Alternative Payment Models Decrease Cancer Care Costs

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As cancer care spending is expected to grow in the next four years, an oncology alternative payment model that incorporates clinical pathways and patient-centered approaches could reduce healthcare spending by 22 percent, or $9.1 million across...

Premier Medicare ACOs Outperform Peers in Cost, Quality By 2:1

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Medicare accountable care organizations (ACOs) that are part of Premier Inc.’s Population Health Management Collaborative (PHMC) outperformed other Medicare Shared Savings Program (MSSP) and Pioneer ACOs in earning shared savings and improving...

Using an Alternative Payment Model to Reduce Hospitalizations

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Are clinical interventions enough to alter provider behavior to align with value-based care? Or are providers more motivated to change because of financial incentives under alternative payment models? CMS recently partnered with the University...

How to Develop a Value-Based Care Implementation Strategy

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When building a value-based care strategy, healthcare organizations should focus on improving care delivery across skilled nursing facilities, at-home services, and end-of-life services, Steven Strongwater, MD, President and CEO of Atrius Health,...

Potential Challenges, Benefits of the Cardiac Bundled Payment

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Earlier this year, CMS proposed a cardiac bundled payment model that would reduce Medicare spending by $170 million on five years, but a new report in the Journal of the American Medical Association identified several potential drawbacks of the...

Top 5 Facts About the Merit-Based Incentive Payment System

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In October, CMS released the final MACRA implementation rule that will put the Quality Payment Program into action on Jan. 1, 2017. Under the new value-based reimbursement program, the federal agency anticipates 592,000 to 642,000 Medicare providers...

CMS Grants $1.8B to MA Value-Based ACO Implementation Program

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The MassHealth program in Massachusetts will received about $1.8 billion over the next five years to implement value-based reimbursement structures in the statewide accountable care organization (ACO) component of the program, announced CMS....

Key Ways to Succeed Under MACRA’s Quality Payment Program

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Do not feel overwhelmed by the upcoming Quality Payment Program, a healthcare expert at CAPG, a non-profit trade association for accountable physician organizations, advised the projected 592,000 to 642,000 eligible clinicians participating in...

FQHCs Push for Health Center Medicaid Payment Reform Models

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Federally qualified health centers (FQHCs) in five states voiced strong interest in Medicaid payment reform model participation to improve value-based care delivery and boost healthcare employment strategies, a recent Geiger Gibson RCHN Community...

Large Hospitals Fare Worse in Value-Based Reimbursement Model

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Large hospitals averaging approximately 260 staffed beds were more likely to receive a negative value-based reimbursement adjustment under a hospital-specific Medicare program in 2016, according to a recent report from Definitive Healthcare,...

CMS: Over Half in Value-Based Care Program to Earn Bonuses

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Over 1,600 hospitals in the Hospital Value-Based Purchasing Program, representing over 50 percent of total participants, will receive positive Medicare payment adjustments in 2017 for value-based care performance, CMS reported in a recent fact...

CMS Launches VT All-Payer Accountable Care Organization Model

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Starting in January 2017, Vermont will implement the first voluntary all-payer accountable care organization (ACO) model that will align ACO design across Medicare, Medicaid, and commercial payers, according to a recent CMS announcement. With...

CMS Announces New Advanced Alternative Payment Model Options

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CMS recently announced new opportunities for eligible clinicians to participate in an Advanced Alternative Payment Model (APM) under the Quality Payment Program in 2017 and 2018. The Oncology Care Model’s two-sided financial risk track...

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