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Sep 21, 2017 10:30:00 AM

“Moneyball” and “Hoosiers”: Models for Optimizing Participation in the QPP

Participation in value-based programs is on the rise. Growth of ACOs is up 11%, and CMS estimates that 30% of Medicare payments are currently flowing through alternative payment models (APM). This milestone was reached 11 months ahead of schedule according to the Department of Health and Human Services (HHS), which expects Medicare payments flowing through APMs to reach 50% by the end of 2018.

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Topics: Data Analytics

Sep 15, 2017 9:00:00 AM

CMS May Want Their Money Back

The old adage, "Money can make you do crazy things," can easily be applied to both our personal and business lives. Within the healthcare industry, HITECH incentive payments were offered by the U.S. government several years ago to implement electronic health record (EHR) systems at hospitals and other healthcare organizations. In order to qualify for these incentive payments, healthcare organizations were required to carry out regular security risk assessments to show they were meeting the HIPAA Security Rule requirements. While a large number of healthcare organizations properly followed the rules and carried out the security risk assessment required, a select number received the incentives without doing so.

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Topics: Risk Assessment, HIPAA, HITECH

Sep 1, 2017 10:00:00 AM

Are Your Medical Devices Secure?

If your hospital or clinic uses a Windows 7-based version of a Siemens PET/CT or SPECT system, it could be vulnerable to attack by a relatively low-skill hacker, according to a July 26 security advisory from the company.

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Topics: Cybersecurity, Vulnerability Scans, Cyber Resilience, Medical Device Risks

Aug 25, 2017 10:00:00 AM

Why Your Hospital or Physician Practice Must Embrace Risk

Risk tolerance is an interesting thing. Those who make the biggest bets often are actually control freaks—maybe because they know that, by having a strong grasp on the factors that influence the deal, they greatly increase the likelihood that they will come out ahead.

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Topics: ACO, MACRA, Cost Accounting, Value-Based Pay, Risk Management

Aug 17, 2017 11:30:00 AM

What Small Medical Groups Need to Know About Virtual Groups - Part 2

By banding together into what CMS has termed “virtual groups,” solo practitioners and small medical groups can take advantage of significant flexibility currently available to help them succeed in the Merit-based Incentive Payment System (MIPS).

In Part 1 of this series, we answered some FAQs about these MIPS virtual groups. In Part 2, we share items to consider before joining a virtual group.

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Topics: MACRA, CMS, MIPs, APMs

Aug 3, 2017 2:00:00 PM

What Small Medical Groups Need to Know About Virtual Groups for MIPS Reporting – Part 1

Small physician groups and solo practitioners take heart: CMS wants you to be successful in the Merit-based Incentive Payment System (MIPS) without having to merge or be acquired.

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Topics: MIPs, APMs, Networking

Jul 27, 2017 11:00:00 AM

Is It Time to Transition From CCMAs to APMs?

A Bridge for Healthcare Reform

Over the past decade, clinical co-management arrangements (CCMAs) have risen in popularity as a means to achieve a more integrated care delivery model. CCMAs have often been touted as an interim strategy to bridge hospitals to newer emerging models, but many hospitals have yet to cross that bridge.

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Topics: Healthcare Reform, APMs, Payment Model Reform, CMMAs

Jul 20, 2017 10:00:00 AM

The IRS Isn't the Only One Monitoring Your Exempt Hospital

As discussed in my previous blog post, the IRS is ramping up compliance audits of governmental hospitals who are exempt under 501(c)3. However, the IRS isn’t the only one monitoring your tax-exempt hospital. Other organizations have started policing these requirements.

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Topics: IRS, 501(r), 501(c)3

Jul 13, 2017 11:00:00 AM

What’s the Value of Innovation? (Part 2)

The previous installment of this blog series described the CMS Innovation Center and its mission to test innovative payment and delivery models and to implement the MACRA Quality Payment Program (QPP).

The QPP is designed to help achieve HHS’ goal of tying half of Medicare fee-for-service payments to quality or value through Advanced Payment Models (APMs) by 2018. Advanced APMs, one of the two tracks of MACRA, allows physician practices to earn more by assuming some financial risk related to patients’ outcomes. Certain Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program (MSSP), including the new MSSP Track 1+ ACO, qualify as Advanced APMs.

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Topics: ACO, Value-Based Care, MACRA, Valuation, APMs, QPP

Jun 26, 2017 10:00:00 AM

Top Takeaways from MACRA Proposed Rule

With the proposed changes to the Quality Payment Program (QPP) released Wednesday, the new administration aims to reduce some administrative complexity and extend the flexibility that CMS provided in the initial year of the program, while incentivizing more providers to move into Alternative Payment Models (APMs).

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Topics: MACRA, CMS, APMs, Alternative Payment Models

Jun 22, 2017 4:00:00 PM

What’s the Value of Innovation? (Part 1 in a 2-part series)

The Affordable Care Act created the CMS Innovation Center to allow Medicare and Medicaid programs to test innovative payment and delivery models that improve patient care and lower healthcare costs.

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Topics: Affordable Care Act, ACO, ACA, APMs

Jun 19, 2017 10:30:00 AM

Dual Status Hospitals Beware of IRS Compliance Audits

Is your governmental hospital exempt under Section 501(c)3? If you have a 403(b) plan, the answer is yes; and even if you don’t—you need to check. 

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Topics: Audit, Compliance, CHNA, Dual Status Hospitals

Jun 15, 2017 10:00:00 AM

A Primer on Operationalizing Alternative Payment Models

MACRA’s anticipated future impact on the healthcare industry has many provider organizations contemplating what actions and resources are necessary to participate in alternative payment models (“APMs”). Provider organizations facing the immediate options of getting involved with a CMS or commercial APM have significant operational decisions to make that will impact the future make-up of their organizations. Today we will discuss some of the considerations in preparing for APM participation.

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Topics: MACRA, CMS, APMs, Alternative Payment Models