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Feb 17, 2017 10:00:00 AM

Let CMS Pay for Your MACRA and ACO Readiness Costs

Welcome to MACRA—the Medicare Access and CHIP Reauthorization Act. MACRA represents the end of a long history of perpetually delayed Medicare physician fee schedule cuts that were to be automatically triggered under the punitive SGR formula absent Congress’ annual postponement ritual. After providing for a series of annual physician payment increases, MACRA’s reimbursement methodology transitions to a value-based model that includes two pathways—the Alternative Payment Model (“APM”) and the Merit-Based Incentive Payment System (“MIPS”).

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Topics: Healthcare, MACRA, CMS

Feb 9, 2017 11:00:00 AM

What Level of MACRA Investment Makes Sense for Rural Hospitals?

Rural hospitals have some tough decisions to make about their level of participation in the new CMS Quality Payment Program created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). 

For a number of reasons, the MACRA cards are stacked against small and rural providers. Given the limited number of Advanced Alternative Payment Models (APMs) that are being approved, many providers will start out in the Merit-Based Incentive Payment System (MIPS), and that track offers limited upside potential compared with APMs.

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Topics: MACRA, CMS, Quality Payment Program

Feb 3, 2017 4:30:00 PM

3 Big Themes at the 2017 AHLA Physicians and Hospitals Law Institute

During AHLA’s Physicians and Hospitals Law Institute this week, we saw three recurring themes as sessions focused on issues affecting the industry.

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Topics: AHLA

Jan 27, 2017 9:00:00 AM

HFMA Mid-South Institute 2017 Highlights

We’re gearing up for what’s in store in the healthcare arena in 2017 by attending HFMA’s Mid-South Institute. Attendees from Missouri, Arkansas, Mississippi, and Tennessee have gathered to learn of updates in healthcare and how to embrace for the year ahead. Here are a couple of themes that were reinforced during the conference:

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Topics: Healthcare, Electronic Health Records, Cybersecurity, HFMA

Jan 26, 2017 12:00:00 PM

The Road to MACRA Success Does Not End With MIPS

It is important to recognize that the road to long-term success does not end with the implementation of the Merit-based Incentive Payment System (MIPS). In CMS’ own words, MACRA’s final rule was established, in part, to incentivize and promote participation in Advanced Alternative Payment Models (APMs). These incentives include a 5% participation bonus from 2019 to 2024 and a 0.5% annual increase above the MIPS track beginning in 2026.

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Topics: MACRA, MIPs, Payment Model Reform

Jan 20, 2017 1:00:00 PM

7 Key Steps to Take Now to Get Ahead With MACRA

Like it or not, MACRA is here. MACRA created the new Quality Payment Program (QPP), comprised of two pathways to higher quality: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs). MACRA changed the rules, leaving many to face an uncertain future. Amid the uncertainty, however, one thing is sure: passivity will be costly. Indecision will not prevent or delay physician’s placement into the quality and efficiency compensation measurements of MIPS.

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Topics: MACRA

Jan 12, 2017 11:00:00 AM

MACRA: Are You Ready?

Wait-and-see is no longer a viable strategy for payment reform—especially with regard to MACRA implementation.

In my 30 years serving healthcare practices, I have seen innovations come and go. I certainly understand the impulse to sit back and let the dust settle before rushing to implement a new regulation, and the steady Republican drumbeat of “repeal and replace” is enough to give any provider pause.

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Topics: MACRA

Jan 5, 2017 10:30:00 AM

Medicare-Medicaid ACO Model: Urge Your State to Apply by Jan. 20

January 20 is a significant date for healthcare providers—but not necessarily for the reason you think.

Yes, there is the inauguration of the 45th President of the United States, who has vowed to “repeal and replace” the most significant healthcare legislation in recent history.

But that date has even greater significance for the many providers across the country who are struggling to cover the cost of care of an increasingly high-risk, low-income population.

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Topics: Medicare, ACO, Medicaid

Dec 29, 2016 12:00:00 PM

Healthcare in 2016—May You Live in Interesting Times

Living in interesting times may be a blessing or a curse, but 2016 proves that it certainly isn't boring. Healthcare in the United States continues to evolve—sometimes very rapidly—and those guiding healthcare organizations have particular challenges ahead of them in the coming years.

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Topics: Healthcare

Dec 15, 2016 10:30:00 AM

4 Tips to Keep Healthcare Consumers Happy and Loyal

Last week, I had the privilege of attending the Health Care Advisory Board’s National Meeting in St. Louis, Missouri. One of the topics that really struck me was the last presentation about the importance of building a consumer-focused organization and increasing consumer loyalty.

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Topics: Customer Experience, Customer Service, Consumerism

Dec 8, 2016 11:00:00 AM

Will MACRA Fall Victim to Repeal and Replace?

I've just returned from the National MACRA MIPS/APM Summit in Washington, D.C., where the overarching discussion centered on how to create and implement strategies that pay physicians fairly, while controlling spending in the Medicare program. It's a question we've wrestled with for almost 20 years and a challenge we must solve.

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Topics: Medicare, MACRA, CMS, MIPs, APMs

Dec 6, 2016 10:00:00 AM

My Hospital is Losing Millions on Physician Practices—Part Two

We described in the previous installment in this series how recent case law and DOJ settlements provide clear evidence of the position of qui tam relators, prosecutors, and government experts that losses on hospital operation of physician practices are being targeted. Because evidence suggests that hospital losses on physician practices are common in many markets, the questions on everyone’s mind are whether health system losses on physician practices put the organization and key individuals at significant fraud and abuse compliance risk, to what degree can existing physician practice losses be justified through documentation, whether the health system has a functional Fair Market Value (FMV) and Commercial Reasonableness (CR) enterprise risk management process, and—the subject of this series--is a plan at the ready to begin mitigating practice losses?

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Topics: Valuation, Hospitals

Nov 18, 2016 10:00:00 AM

New Bill Proposes Expanded Telehealth Services for Hospitals & Healthcare Providers

Virtual healthcare is a godsend to struggling healthcare systems as they try to offer the right care in the right setting. Every day, these systems face enormous pressure to provide both high-quality and cost-effective healthcare to their communities. Their clinics are filled with scheduled patients, while others wait for a “work in.”

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Topics: Telehealth, MACRA, MIPs