Oct 19, 2017 11:30:00 AM

Employers Are Catalyzing Payment Model Reform; Are You with Them?

Employers increasingly are holding providers accountable for outcomes, and providers that can’t adapt will have a hard time competing.

As they continue to seek solutions to rising healthcare cost, employers are working with providers and health systems to optimize the value of their healthcare spend through options such as onsite care clinics, wellness programs, and value-based payment models for healthcare.

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Topics: Payment Models, APMs

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, Payment Models, APMs

Jun 9, 2017 9:00:00 AM

Activity-Based Costing: The Rock Star of Payment Model Reform

Think you can’t afford to invest in a cost-accounting system? The truth is, you can’t afford not to. As Medicare and other payers increasingly tie payments to value, understanding and reducing your cost structure will become an even more urgent priority.

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Topics: Payment Models, Cost Accounting

Apr 28, 2017 10:00:00 AM

MedPAC to US Congress: Act Now to Reform Post-Acute Payments

The post-acute care (PAC) sector is a target for significant change. Facing criticism of excessive spending, the sector is facing an overhaul of the payment system that, when it finally arrives, could disrupt the healthcare landscape once again.

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Topics: Fee-for-Service, Payment Models

Apr 20, 2017 2:30:00 PM

In Latest Report, MedPAC Reiterates Call to Equalize Payments

With health care spending growth still increasing, the Medicare Payment Advisory Commission (MedPAC or the Commission) continues to pursue its mission to advise US Congress on the Medicare program and its costs, which ultimately are borne by all taxpayers.

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Topics: Healthcare Quality, Payment Models

Mar 9, 2017 10:00:00 AM

The Provider Must Become the Payer. There Can Be Only One!

A long time ago (the mid-90’s), there was a television series titled Highlander. It was a sci-fi action series whose main character, Duncan MacLeod, hailed from a race of immortals. The opening voice-over would end with the proclamation, “There can be only one!” You see, these immortals sought each other out until it was the “last man standing.” Duncan was a force for good that battled other immortals of darkness. Each episode featured an epic battle that ended with Duncan annihilating his immortal foe, whose power transferred to Duncan.

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Topics: Payment Models

Mar 3, 2017 9:00:00 AM

Catalyze Practice Transformation With Pay-For-Performance Contracting

Many physicians are subject to participation in the new Merit-Based Incentive Payment System (MIPS) through CMS’s ongoing payment model reform initiatives encouraging providers to deliver better healthcare at lower costs.

CMS is just the tip of the spear. Commercial payers are developing their own pay-for-performance contracts as they slowly transition away from fee-for-service reimbursement. Yet many independent practice physicians and even employed physicians lack a strong strategy to participate in a healthcare environment where the Triple Aim is the ultimate mission.

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Topics: Value-Based Care, Payment Models

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: Payment Models, MIPS Healthcare, MACRA Summary

Oct 13, 2016 11:00:00 AM

Manage Your Risk When Choosing Payment Models – One Size Does Not Fit All

When Congress passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), “risk” moved front and center as a feature of provider reimbursement models. These days, we’re using terms such as “at risk” and “risk-based” more and more, but what do they really mean? And why should healthcare providers be more concerned with risk now than they have been in years past?

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Topics: Payment Models, MACRA Summary

Oct 11, 2016 11:00:00 AM

Preparing for Payment Reform: Shared Savings Arrangements

Shared savings arrangements began as a key component of the Medicare delivery system reform initiatives included in the Affordable Care Act, the intent being threefold: to generate better care for individuals, to generate better health for the population, and to lower growth expenditures. To participate in a Medicare shared savings arrangement, eligible providers and suppliers are required to form an accountable care organization (ACO).

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Topics: Payment Models, MACRA Summary

Sep 8, 2016 10:30:00 AM

Alternative Payment Model Overview: Do You Have the Data to Succeed?

The introduction of the dual track Quality Payment Program within the MACRA proposed rule has many healthcare systems considering their options. My most recent blog focused on the MIPS track of QPP, so today I will focus on an overview of Advanced Alternative Payment Models. 

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Topics: Payment Models, MACRA Summary

May 5, 2016 11:00:00 AM

How to Determine ROI on Your Data Analytics System

The healthcare industry is in a state of constant change, and with change comes opportunity. With the passage of the ACA and MACRA, healthcare providers are, or will be, paid differently for their services. No longer can they rely upon the volume of services rendered to generate sustained income. With the transition from volume-based payments to value-based payments, many health systems are investing in data analytics platforms to help expose cost savings, as well as uncover hidden revenue. But is investing in data analytics worth the cost?

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Topics: Payment Models

Aug 7, 2014 10:30:00 AM

Hospital CFOs Still Seeking Clarity About Allina DSH

Are you wondering about the status of your Medicare Disproportionate Share Hospital (DSH) payments in light of the recent Allina DSH court ruling? You’re not alone.  An April 2014 ruling from a U.S. Court of Appeals for the District of Columbia Circuit upheld a previous ruling that a Health and Human Services (HHS) rule change in 2004 (codified in 2007) was procedurally defective. The lawsuit had to do with a rule change the HHS made to determine DSH payments in 2007. The hospitals claimed there was not proper notification. Although the court ruled favorably for the hospitals, what happens next is still unknown. 

The appeals court included instructions in the ruling that gave the HHS room to reach the same policy decision through administrative adjudication. The bad news for providers is that adjudicatory findings can be applied retroactively. The Centers for Medicare and Medicaid Services (CMS) has not yet issued a definitive guideline on how to retrofit the reimbursement fractions for the years in question. 

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Topics: Affordable Care Act Summary, Payment Models, Hospital Management