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

Value-Based Care News

Accountable Care Organizations Grow, But Face New Challenges

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Since the Affordable Care Act paved the way for accountable care organizations (ACOs) in 2010, healthcare providers have increasingly turned to the alternative payment model as a way to engage in value-based care across patient...

NQF Eyes Adding Social Risk Factors to Value-Based Purchasing

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In response to stakeholder concerns that value-based purchasing programs unfairly penalize providers who treat greater proportions of disadvantaged patients, the National Quality Forum (NQF) recently endorsed 17 quality measures that...

Understanding the Top 10 Terms of Value-Based Purchasing

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Whether providers favor it or not, the healthcare industry is inevitability moving to value-based purchasing. CMS reported in 2016 that Medicare already linked 30 percent of traditional fee-for-service payments to value-based purchasing...

Small Hospitals, Systems Grapple with Value-Based Reimbursement

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Approximately 67 percent of small hospitals and health systems do not plan on undertaking value-based reimbursement initiatives in 2017, a recent Ernst & Young LLP Advisory Health survey revealed. The survey of 700 healthcare...

Core Competencies for Accountable Care Organization Development

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The National Business Group on Health (NBGH) recently identified the core competencies accountable care organizations (ACOs) should have at each stage of its development. The two resources from NBGH on ACO competencies are meant to help...

Bundled Payments Rely on Robust Networks, Healthcare Markets

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Healthcare providers are finding that it takes a village to succeed in bundled payment models. From primary care to specialists and post-acute care, providers need an integrated network of provider types and to play to their healthcare...

GAO: Hospital Value-Based Purchasing Model Rewards Low Quality

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A new Government Accountability Office (GAO) report found that CMS gave financial bonuses to hospitals participating in the Hospital Value-Based Purchasing Program despite the facilities earning composite quality scores below the...

Accountable Care Organizations Continue to Grow With 11% Boost

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The number of accountable care organizations (ACOs) increased with 92 more organizations operating since the first quarter of 2016, reaching a total of 923 ACOs nationwide by the start of 2017, a recent Health Affairs blogpost stated. The...

Surveys Reveal MACRA Implementation, QPP Knowledge Lacking

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Two recent surveys indicated that healthcare provider and executive knowledge of and readiness for MACRA implementation and the Quality Payment Program are lacking despite the value-based reimbursement program launching in January 2017. A...

Payer Collaboration Key to Value-Based Reimbursement Strategy

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Value-based reimbursement arrangements come in a myriad of shapes and sizes much like provider organizations. But successful value-based contracts will align provider and payer goals for care quality and healthcare utilization as well as...

Exploring Quality Measures Under Value-Based Purchasing Models

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CHICAGO – Jason Goldwater, MPA, MA, Senior Director of the National Quality Forum, recently likened the value-based purchasing transition to the evolution of music at Xtelligent Media’s Value-Based Care Summit in...

Do Financial Benchmarks Truly Measure ACO Savings, Spending?

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Healthcare stakeholders should not use financial benchmarks developed by CMS to evaluate actual accountable care organization (ACO) savings, three Harvard Medical School experts in a recent Health Affairs blogpost. As Medicare ACOs grow...

Oncology Care Model Overcomes Specialty Bundled Payment Hurdles

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Episode-based payment models aim to shift financial accountability to providers for furnishing services for specific conditions or procedures. But develop specialty bundled payment models that target clinical areas, such as oncology, have...

Targeting Skilled Nursing Facility, ESRD Care Saves ACO $15M

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A Medicare Shared Savings Program (MSSP) accountable care organization (ACO) realized over $15 million in healthcare savings between 2014 and 2015 by improving skilled nursing facility utilization and targeting end-stage renal disease...

AHA to IRS: Foster Hospital Participation in Commercial ACOs

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The American Hospital Association (AHA) recently called on leaders from the Department of Treasury and IRS to issue formal guidance that would permit non-profit hospitals to participate in commercial accountable care organizations (ACOs)...

Patient Engagement Critical to Bundled Payment Model Success

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Under bundled payment models, healthcare providers take on the clinical and financial risk payers traditionally managed. But providers at OrthoCarolina found that patients also play a major role in improving care quality and decreasing...

Providers Lack Tools, Payer Alignment for Value-Based Purchasing

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Healthcare providers still lack the necessary tools for value-based purchasing success with only 43 percent of providers reporting that they have access to the appropriate solutions, a recent Quest Diagnostics and Inovalon survey...

Count Medicare Advantage Patients for Advanced APMs, Orgs Say

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Eligible clinicians participating in appropriate alternative payment models under a Medicare Advantage plan should qualify for Advanced Alternative Payment Model (Advanced APM) incentive payments in 2019, the AMGA and nine other healthcare...

Lab Experts Help Providers Reduce Low-Value Resource Use, Costs

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Collaboration between laboratory medicine experts and clinicians is critical to reducing unnecessary and low-value resource use for value-based purchasing success, the American Association For Clinical Chemistry (AACC) recently...

87% of Practices Not Adding Staff for MACRA Implementation

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About 87 percent of physician practices do not plan on hiring additional healthcare staff to help with MACRA implementation, a recent Physicians Practice survey showed. The survey of over 1,000 practice managers and physicians revealed...

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