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: Value-Based Care, Cost Accounting, MACRA Summary

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: Value-Based Care, APMs, Quality Payment Program, MACRA Summary

May 25, 2017 10:00:00 AM

A Prescription for Reviving Your Financial Outlook: A Medicare Risk Strategy

Healthcare providers face $42 billion in cuts in 2018 under Medicare’s traditional fee-for-service program. Those payment rate reductions, which were put in place by the Affordable Care Act, are scheduled to cut deeper with each year—from $53 billion in 2019 to $86 billion in 2022.

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Topics: Fee-for-Service, Value-Based Care

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

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: Patient Care, Value-Based Care, Hospital Management

Jul 12, 2016 11:00:00 AM

Setting Quality Metrics for Value-Based Pay - Part One

Government and commercial insurers are transforming payment models from fee-for-service (FFS) to arrangements that include incentives for quality, outcomes, improved patient satisfaction, and reduced cost. In the FFS environment, hospitals, physicians, and other providers have been subjected to insignificant financial risk relative to the risk borne by payers; however, with time, transformed payment arrangements have encouraged, if not required, more providers to assume downside risk. Why? One reason is to hold providers accountable for the cost and quality of care. The table below by The Commonwealth Fund summarizes this need by showing where the United States ranks relative to other industrialized nations in health outcomes and risk factors:

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Topics: Physician Compensation, Value-Based Care

Jun 16, 2016 12:00:00 PM

So You Have a Cost Accounting System, Now What?

As I help healthcare organizations create effective cost accounting systems, the number one complaint I hear is: “I don’t think this report is accurate” or its second cousin “This just doesn’t look right.” My own father gives me grief because he doesn’t trust accounting systems.

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Topics: Patient Care, Value-Based Care, 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

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, Affordable Care Act Summary, Value-Based Care

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: 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: Value-Based Care

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