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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

Jul 21, 2016 10:30:00 AM

Questions to Ask While Moving from Volume to Value

In 1978, REO Speedwagon released an album with its feature song, “Roll with the Changes.”  This song never fails to give me an adrenaline rush, especially as I run or bike, and I think it’s pertinent to what healthcare professionals are experiencing since health reform became law in 2010 and CMS began its reimbursement initiatives to transition from volume to value.

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Topics: Value-Based Care, MACRA, Cost Accounting

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

Apr 28, 2016 10:30:00 AM

The Shifting Role of the Rural Hospital

Here’s a potentially disturbing statement: “Rural healthcare needs healthcare – not buildings.”

I’ve been watching rural hospitals closely as they cope with the changing healthcare landscape, and I’ve come to believe this statement is true. You might find it disturbing because of its implications – if rural hospitals don’t need buildings, what happens to their staffs, their service, their presence in the community and their stakeholders? And most of all, without a physical presence in a community, what happens to urgent care and its lifesaving role in rural areas? 

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Topics: Rural Health Care, Value-Based Care, Bundled Payment, ACA

Feb 18, 2016 10:00:00 AM

How the Transition from Volume to Value Will Impact Your Physician Compensation Models

With the passage of MACRA in April 2015 we began to get some real clarity regarding Medicare’s plans for moving physician reimbursement from volume-based to value-based. With MACRA set to be implemented over the next few years, now is the time to begin addressing how changing reimbursement will impact physician compensation models. Because future reimbursement will be greatly impacted by physicians’ ability to deliver value and quality, hospitals will need to design compensation models that reward and encourage physician behaviors that support these goals.

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Topics: Physician Compensation, Value-Based Care

Feb 10, 2016 7:39:22 AM

How’s the Volume-to-Value Transition Working for YOU?

After our second day at the AHLA Physicians and Hospitals Law Institute, some clear themes are beginning to come into focus around the volume-to-value transformation in physician compensation. Quality-based compensation is fraught with challenges—quantifying value as compared to physician productivity is foreign to many. Also, missteps in the implementation can wreck the entire process.

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Topics: Physician Compensation, Value-Based Care

Feb 9, 2016 7:30:00 AM

2 Reasons Fair Market Value Needs to Evolve

In nearly any value proposition, the appropriate reward depends on the level of risk assumed. In the transformation to quality-based pay, the same is true. Paying physicians for quality likewise considers the value of the services contributed and the risk borne by the provider; nobody has the silver bullet as of yet, but hospitals and physicians both need to begin the journey now.

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Topics: Healthcare, Value-Based Care

Nov 17, 2015 12:00:00 PM

2 Key Takeaways from HFMA Region 9

Historic times are taking place in the healthcare industry.  Are you going to stay on the sidelines or are you going to get in the game? 

Yesterday’s sessions at the HFMA Region 9 Conference in New Orleans reinforced two key themes:

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Topics: Healthcare, Value-Based Care

Mar 20, 2015 3:09:00 PM

Trends in Hospital Acquisition of Physician Practices

Surveys such as the Health Leaders Media survey, Physician Alignment: New Leadership Models for Integration, indicate that physician employment will continue to be a primary integration strategy for many hospitals and health systems. Where saturation of primary care and specialist practice acquisitions and employment has occurred, several markets have moved to a second or third tier, such as urgent care centers and related physician employment. It seems that some markets are only limited by the supply of viable targets.

Physician practices, however, are not created equal, and hospitals and health systems are becoming increasingly savvy in targeting groups for alignment that can demonstrate delivery of high-quality care. As the reimbursement model continues the shift from a volume-based to value-based system, physician participation in meeting quality and cost-saving targets will require a greater nexus to methods of physician compensation. In an increasingly competitive environment, it may be difficult to meet the need for quality care without a carefully selected and motivated physician network.

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Topics: Quality Improvement, Value-Based Care