March 29, 2018

MedPAC to Congress: Replace MIPS With Voluntary Value Program

Congress should repeal MIPS and replace it with a new Voluntary Value Program (VVP), according to a report released recently by the Medicare Payment Advisory Commission (MedPAC), the independent advisory agency tasked with making recommendations on Medicare policy.

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Topics: Payment Models, MIPS Healthcare, MedPAC

March 26, 2018

Bipartisan Budget Act Taps the Brakes on MIPS—But Don’t Slow Down!

The Bipartisan Budget Act of 2018 (BBA18), signed by President Trump on February 9, includes several provisions that will affect healthcare providers’ Medicare reimbursement—in both positive and negative ways.

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Topics: Payment Models, MACRA

February 16, 2018

CMS Bundled Payment Train Back on Track. Should You Board?

After scaling back its two mandatory bundled payment programs last year, CMS recently signaled that the value-based payment train remains on track for the current administration.

Bundled Payments for Care Improvement Advanced (BPCI-A) opened to applicants on January 11. With the application deadline of March 12, 2018, just around the corner, the pressure is on to decide whether your hospital or physician group practice is going to participate.

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Topics: Physician Compensation, Payment Models

October 19, 2017

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

July 27, 2017

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

June 09, 2017

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

April 28, 2017

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

April 20, 2017

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

March 09, 2017

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

March 03, 2017

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

January 26, 2017

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

October 13, 2016

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

October 11, 2016

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