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

Value-Based Care News

Key Capabilities for Value-Based Reimbursement Models

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Rising healthcare costs, shrinking reimbursement rates, and federal policies are driving hospitals and health systems to adopt value-based reimbursement, according to a new American Hospital Association (AHA) report. But the models are...

High-Value Culture, Population Health Programs Key to ACO Success

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Creating a high-value culture, engaging in proactive population health management, and implementing an infrastructure that promotes continuous performance improvement were key characteristics of 11 successful accountable care organizations...

Collaboration Key to Independent Physicians in Value-Based Care

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At first glance, value-based care models appear to work against independent physicians. The risk-based arrangement requires a coordination of services across care continuum — primarily between primary care physicians and specialists...

Family Physicians Slowly Embracing Value-Based Reimbursement

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Slightly more family physicians are actively pursuing value-based reimbursement opportunities compared to two years ago despite persistent barriers, Humana and the American Academy of Family Physicians (AAFP) recently announced. The...

Value-Based Contracts Rely on Patient Attribution, Data Sharing

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CMS aims to tie 90 percent of Medicare fee-for-service payments to quality by the end of 2018, with one-half of those payments to be paid under a value-based contract with some degree of financial risk. With ambitious goals from the...

MSSP ACOs Improve Care Quality, Struggle to Realize Savings

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Medicare accountable care organizations (ACOs) found overwhelming success with care quality improvements in 2016, but the organizations were still working on reducing costs, according to a recent analysis published in the Health Affairs...

Mortality Rates Rose After HRRP Value-Based Penalty Enforced

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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...

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...

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...

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...

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 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...

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....

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,...

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...

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...

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...

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...

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...

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...

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