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

Value-Based Care News

Creating a Population Health Management Operating Model

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ORLANDO - “Collaboration is a critical piece,” Steven Merahn, MD, emphasized during his HIMSS17 session on developing an operating model for population health management that functions regardless of payment model participation. “Collaboration...

CMS Awards $100M for Small, Rural Clinician MACRA Help

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ORLANDO - CMS recently selected 11 healthcare organizations to receive a total of $100 million in funding to help small and rural eligible clinicians participate in the newly-launched MACRA. Each organization received $20 million to provide hands-on...

Coalition Offers CMMI, Alternative Payment Model Improvements

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Thirty-five healthcare industry groups recently banded together to offer the newly-approved Department of Health and Human Services (HHS) Secretary a set of guidelines for CMS Innovation Center (CMMI) and alternative payment model development...

FFS, Risk-Based Medicaid ACO Programs Similarly Reduce Costs

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In a comparison of two state Medicaid Accountable Care Organization (ACO) programs, researchers in a JAMA Internal Medicine study found that Oregon’s global capitation ACO model produced similar healthcare savings and care quality improvements...

One-Third of Healthcare Execs Ready for MACRA Implementation

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Only 35 percent of healthcare executives said that their organization has a MACRA implementation strategy and feels prepared for the new value-based reimbursement program, according to a recent Health Catalyst and peer60 survey. The survey of...

2012 MSSP ACOs Decreased Post-Acute Care Spending by 9%

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A new JAMA Internal Medicine study showed that Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) established in 2012 decreased post-acute care spending by a 9 percent differential reduction by 2014 without compromising...

Stakeholders Propose 4 MACRA Physician-Focused Payment Models

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MACRA’s Quality Payment Program offers 5 percent maximum incentive payments if eligible clinicians sufficiently participate in an Advanced Alternative Payment Model (APM) from 2017 to 2022. But many specialists are still waiting for CMS...

Key Considerations for Bundled Payment Model Adoption, Success

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As the value-based reimbursement transition pushes on, many provider organizations have turned to bundled payment models as a stepping stone to alternative payment model adoption. “Bundled payments can be an organization’s first step...

How Radiologists Can Join an Advanced Alternative Payment Model

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Radiologists may want to look to the physician-focused payment model path in MACRA to develop specialty-specific Advanced Alternative Payment Models (APM), suggested a recent Journal of the American College of Radiology report. Harvey L. Neiman...

Maryland All-Payer APM Reduces Medicare Hospital Costs by $429M

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As the Maryland All-Payer alternative payment model starts its fourth year, a Health Affairs report shows that the program reduced Medicare hospital costs by $429 million, exceeding CMS requirements that the model save $330 million five years....

Patient Care Navigation Program Reduces Cancer Care Costs

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Using non-physician and nurse providers as part of a patient navigation program can significantly lower healthcare costs and utilization for cancer patients while generating a return on investment, a recent JAMA Oncology study revealed. From...

Industry Orgs Urge Lawmakers to Continue Value-Based Care Push

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Over 120 healthcare industry groups, including hospitals, healthcare systems, payers, and professional organizations, recently urged the Trump administration and Congress to not discontinue or slow the transition to value-based care. In the letter...

CMS Reopens 2018 Next Generation ACO Model Applications

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Providers interested in participating in the Next Generation Accountable Care Organization (ACO) model in 2018 can now submit a letter of intent to CMS, according to the alternative payment model’s webpage. The Next Generation ACO model...

359K Clinicians to Join CMS Alternative Payment Models in 2017

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CMS recently announced that the federal agency selected over 359,000 clinicians to participate in four of the federal agency’s alternative payment models in 2017. The new participants will be joining the Medicare Shared Savings Program...

Avoidable Hospitalizations Drop 31% for Long-Term Care Patients

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Avoidable hospitalizations among dual-eligible long-term care facility residents dropped by 31 percent between 2010 and 2015 largely because of value-based care programs, CMS recently stated in an official blog post. “Family members want...

CMS: Providers Need Data Access for Value-Based Reimbursement

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Value-based reimbursement success rests on providing clinicians with convenient and increased access to meaningful data, the leaders of the Office of the National Coordinator (ONC) and CMS stated in a recent official CMS blog post. “Data...

All-Payer Alternative Payment Model Targets PA Rural Hospitals

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A new six-year all-payer alternative payment model will focus on improving care quality and reducing healthcare costs at rural hospitals in Pennsylvania, CMS announced in a recent fact sheet. The CMS Innovation Center’s latest project,...

Do Pay-for-Performance Programs Improve Patient Outcomes?

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Value-based reimbursement models that pay for performance modestly incentivized providers to stick to clinical guidelines, but they may not be linked to better patient outcomes, a recent Annals of Internal Medicine study indicates. The literature...

Addressing Social Risk in Medicare Value-Based Reimbursement

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Hospitals that disproportionately treat patients with social risk factors, such as low income and race, may be unfairly penalized under some Medicare value-based reimbursement programs. But the National Academies of Science, Engineering, and...

CMS Releases MSSP Track 1+ Model Risk Structures, Eligibility

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In a new Medicare Shared Savings Program (MSSP) Track 1+ fact sheet, CMS clarified model details for 2018 to 2020 participation, including maximum shared savings and losses rates, risk assignments, and eligibility requirements. CMS announced...

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