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

Value-Based Care News

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...

Ensuring Success in the Transition to Value-Based Care

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Most recently, the Department of Health & Human Services issued a final rule for the Quality Payment Program as part of implementing provisions of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. The program comprising the...

Rural Hospitals Faced Less Value-Based Reimbursement Penalties

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Rural hospitals outperformed urban hospitals in several Medicare value-based reimbursement programs in 2015, receiving fewer financial penalties, according to a recent report from the Department of Health and Human Services (HHS). Researchers...

Industry Groups React to Final MACRA Implementation Rule

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In the week that the healthcare industry has had to digest the 2,400-page final MACRA implementation rule, many industry groups have come forward to express support for the rule, especially attestation flexibilities, while others have challenged...

Primary Care Initiative Continues to Reduce Medicare Spending

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The Comprehensive Primary Care Initiative (CPC) continued to improve quality of care and reduce Medicare spending in 2015 even though the initiative has yet to generate net healthcare savings, according to an official CMS blog post. In the initiative’s...

Provider Engagement Key to Accountable Care Organization Success

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Accountable care organizations (ACOs) leaders may need to boost healthcare provider engagement to foster value-based care success, a recent study in the American Journal of Accountable Care indicates. In a case study at the Johns Hopkins Medicine...

CMS Launches Provider Engagement, Value-Based Care Initiative

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CMS recently announced a new provider engagement initiative designed to improve the clinician experience within the Medicare program, especially as value-based care models are developed under the Affordable Care Act and MACRA. As alternative...

AMA Releases New MACRA Implementation Resources for Providers

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With a final ruling on the proposed MACRA implementation rule expected to arrive in early November, the American Medical Association (AMA) recently released three new tools to help healthcare providers prepare for the value-based reimbursement...

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