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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

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

Aug 16, 2016 10:00:00 AM

Setting Quality Metrics for Value-Based Pay, Part Two: Evaluating MACRA Metrics and Physician Impact

In the previous installment of this two-part series, we considered how the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is the game-changer in the transformation of physician payment from fee-for-service to value-based payment. We further contemplated the fact that about 19 in 20 MACRA-affected providers will fall under the Merit-Based Incentive Payment System (MIPS), which consolidates the current Physician Quality Reporting Program (PQRS), Value-Based Payment Modifier (VM), and Meaningful Use (MU) programs into a single Quality Payment Program (QPP). We also pondered critical actions to take today to prepare for MACRA, one of which is identifying preferred MIPS metrics.

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Topics: Quality Improvement, Valuation

May 10, 2016 11:00:00 AM

What Has Value – Shifting Our Focus

The healthcare industry has been buzzing about payment reform and pay for performance for some time now, especially since the release of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the introduction of the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). The recent release of the MACRA Proposed Rule has further fueled the discussion and has those of us living in the healthcare industry focusing our sights on the items CMS says have value (or impact reimbursement).

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Topics: Value-Based Care, Valuation, CMS