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

Value-Based Care News

55% of Hospitals Earn Incentive in Value-Based Purchasing Program


More hospitals participating in the Hospital Value-Based Purchasing (VBP) Program will see a Medicare payment increase in 2019, CMS recently reported. The Hospital Value-Based Purchasing Program adjusts Medicare reimbursement to hospitals...

Clinicians Less Optimistic About Value-Based Care Than Execs


Clinicians are more skeptical about the benefits or viability of value-based care and reimbursement compared to healthcare executives, a new survey shows. Only about one-third of clinicians (38 percent) in a recent NEJM Catalyst survey...

Investing in Primary Care Delivers Value-Based Care Results


Supporting primary care will bring value-based care results, asserts Humana’s Chief Medical Officer Roy Beveridge, MD. Value-based arrangements between providers and payers have the lofty, yet admirable goals of improving care...

Value-Based Reimbursement Reduces Costs 15.6%, Improves Quality


Value-based reimbursement models are moving the needle on quality and cost, a new analysis from Humana shows. In 2017, medical costs for patients attributed to primary care practices (PCPs) in Humana’s value-based reimbursement...

OIG: Healthcare Fraud Exceptions for 2 Value-Based Payment Models


Two recent advisory opinions from the Office of the Inspector General (OIG) at HHS are demonstrating why current healthcare fraud and abuse laws are not aligned with value-based payment and care delivery. The federal watchdog recently...

Putting Both Feet in the Value-Based Care, Reimbursement Boat


“Do not put each foot in a different boat,” warned Partners HealthCare CFO Peter Markell at Xtelligent Healthcare Media’s third annual Value-Based Care Summit in Boston. But the current reality in healthcare is that...

Healthcare Dollars Moving to Alternative Payment Models, LAN Finds


Approximately 34 percent of all healthcare payments made in 2017 were tied to an alternative payment model (APM) with shared savings, shared risk, bundled payments, or population-based payments, according to a new report from the Health...

Medical Spending, Utilization the Same for Cancer Patients in ACOs


Cancer patients treated by providers in a Medicare accountable care organization (ACO) did not see lower medical spending or healthcare utilization compared to similar patients treated at non-ACO practices, a new study in the Journal of...

Maximizing MIPS Scores Through Chronic Disease Prevention


The healthcare industry is moving beyond a “sick care” system and shifting to chronic disease prevention to lower costs and improve quality. However, the healthcare payment system is just catching up to the preventative care...

Hospital Readmission Program Penalties Didn’t Raise Mortality Rates


The Hospital Readmission Reduction Program (HRRP) achieved a significant drop in readmission rates for Medicare patients hospitalized for pneumonia, acute myocardial infarction (AMI), and heart failure without bringing an increase of...

61% of Doctors Say Value-Based Care Will Damage Their Practice


Physicians are still on the fence about the impact value-based care will have on their business and patient care, a recent survey showed. Forty-nine percent of over 3,400 physicians recently surveyed by the nation’s largest...

Medicare Bundled Payments Model Cut Costs, Maintained Quality


Payments declined for approximately three-quarters of the clinical episode combinations in the Medicare Bundled Payments for Care Improvement (BPCI) model without impacting care quality, CMS recently reported. Of the 67 BPCI model,...

Exploring Virtual Groups in the Quality Payment Program, MIPS


Virtual groups enable independent physicians and clinicians in small practices to participate in Medicare’s historic push to transition to value-based reimbursement: the Quality Payment Program. The Quality Payment Program, or QPP,...

Quality Payment Program Top Regulatory Burden for Practices


For the second year in a row, medical practice leaders said the Quality Payment Program was their top regulatory burden in 2018. Eighty-percent of the 426 group practice leaders recently surveyed by the Medical Group Management...

Real Costs Up to 8% Higher for Some Cancers in Oncology Care Model


New research shows actual episode costs for certain cancers covered by Medicare’s Oncology Care Model differed by as much as eight percent, on average, from the predicted costs per episode. The Oncology Care Model (OCM) is a...

Aligning Incentives for Providers, Payers Improves Primary Care


How the healthcare industry delivers and pays for primary care is changing as the country finds their healthcare spending skyrocketing. Healthcare spending across the country is slated to increase at an average annual rate of 5.5 percent...

Value-Based Purchasing, Consumerism Top Healthcare Exec Challenges


Transitioning to value-based purchasing and responding to healthcare consumerism continue to be among the top challenges, issues, and opportunities healthcare C-suite leaders are facing in 2019, according to a new poll from the Healthcare...

Time Helps Accountable Care Organizations Realize Savings in MSSP


Experience is a key factor to realizing greater cost savings in the Medicare Shared Savings Program (MSSP), a new Avalere analysis found. Accountable care organizations (ACOs) in the MSSP for four or more years generated nearly all of the...

Hospitals Seek Non-Acute, Supplier Partners for Value-Based Care


Hospitals are looking to strategically expand their footprint in the non-acute care space to succeed in value-based care and alternative payment models, a new study of hospital decisionmakers found. L.E.K.’s ninth annual...

Medicare Spending Falls 3.3% in First Year of CJR Bundled Payments


Hospitals reduced average Medicare spending on lower extremity joint replacements (LEJRs) by 3.3 percent during the first performance year of Medicare’s mandatory bundled payments model for joint replacements, CMS recently...

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