For now its a delay of three months but the CMS is considering pushing back the Comprehensive Care for Joint Replacement program and its cardiac bundles until 2018
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The average total cost to replace worn hips or knees in Tuscaloosa, Ala., can top $31,780—one of the highest prices across dozens of U.S. metropolitan areas, including Los Angeles and Seattle, where just about everything else costs more.
Starting April 1, the clock starts ticking for Tuscaloosa's hospitals to lower their price for new hips and knees or lose money.
The western Alabama city is one of 67 markets where Medicare will for three months combine all the costs for joint-replacement surgery and any associated care into a single payment, what federal officials call a “target price” or “bundled payment.”
Hospitals that hold costs below that amount can keep the difference. Hospitals that don't must repay the government. The model isn't new to Medicare, but so far its experiments with bundles have been voluntary. The effort that begins next month—which will run for five years—is the first to be mandatory and is projected to save Medicare $343 million.
“We have a good bit of ground to cover,” said Nina Dusang, chief financial officer for the DCH Regional Health System in Tuscaloosa.
The CMS Innovation Center deliberately selected markets of different sizes, and with varying spending trends for the mandatory pilot, said Amy Bassano, director of the agency's patient care- models group. Bundled payments, she said, “hold great promise,” but it's not yet clear how broadly the model can work. Federal officials selected joint replacements because the procedures are common for Medicare beneficiaries and cost the program $7 billion a year for hospital care.
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Revenue cycle management has gone from being a "back office" function to an "end-to-end" system that begins at patient intake or even before, claims specialists say. Advanced technologies, in tandem with improved workflows and better data have resulted in RCM systems that encompass the entire healthcare enterprise.
With the right automation tools and revenue cycle support, experts say healthcare providers should be able to improve their cash flows by collecting patient payments up front, determining precise eligibilities and filing clean claims to payers.
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373 2 |about 2 years ago
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Innovaccer has unveiled a Merit-based Incentive Payment System (MIPS) Calculator, a free tool for healthcare providers to estimate the financial impacts of MIPS as per the latest MACRA rule.
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386 2 |about 1 year ago
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Drew Altman: It will be more difficult to inform a meaningful national discussion if a Republican Congress moves quickly and attaches many changes to budget reconciliation bills.
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WellCare Health Plans will acquire Universal American in a deal valued at $800 million, bolstering the company's investment in Medicare Advantage and accountable care organizations. The Medicare Advantage market could boom under President-elect Donald Trump and the Republican-controlled Congress.
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Patients carrying high-deductible insurance plans under the Affordable Care Act presented Ascension Health's leadership with a walk-the-walk moment last month.Hundreds of patients, many newly insured, were leaving Ascension Health's hospitals and other facilities drowning in debt from the deductibles not covered by their plans, said Rhonda Anderson, chief financial officer of the nation's largest not-for-profit health system
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287 14 |about 2 years ago
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The CMS announced Thursday that it will allow providers to choose the level and pace at which they comply with the new payment reform model aimed at emphasizing quality patient care over volume.
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315 10 |about 2 years ago
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Blockchain technologywith all its promise to transform interoperabilityhas yet to make practical inroads into the healthcare industry But the ongoing march toward value-based care could play a primary role in incentivizing health systems to adopt the innovative technology once it becomes available
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http://www.fiercehealthcare.com/story/michael-leavitt-value-based-payments-ignore-weak-signals-your-own-peril/2016-03-15
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The organizations intend to apply Watson supercomputing capabilities to analyze EHR and claims data alongside social determinants of health to fuel personalized care and population management
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228 2 |about 1 year ago
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The CMS has revealed where it plans to launch the forthcoming Comprehensive Primary Care Plus initiative. There had been concern the model wasn't going to move forward because of lack of payer interest.
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The times are changing – not only in how care is delivered but, equally as important, in the ways hospitals, doctors and healthcare workers will be paid.
"The regulatory landscape is getting tougher," said Caleb Anderson, who heads up the ambulatory reimbursement business for Cerner. The market for revenue cycle management is poised to grow big time – and practices and technologies are bound to change as well. "I don’t see it slowing down by any means between now and 2019."
That’s because in 2019 the Medicare Access and CHIP Reauthorization Act will create a fundamental shift in physician reimbursement. And MACRA is poised to arrive against the backdrop of health systems getting larger via consolidation, acquiring physician practices and other partnerships.
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Everybody’s talking about value-based care, but what does that mean? The Centers for Medicare & Medicaid Services has already met its goal of converting 30% of fee-for-service Medicare payment to value-based payment models and it hopes to bring this up to 50% of payments by 2018.
Yet who defines value and how is it measured? Healthcare Dive turned to experts in the provider community for the answer.
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The move toward population health and alternative payment models has seen providers embracing innovative approaches to care delivery, including significant investments in health information technology, according to the spring 2016 Economic Outlook survey from Premier.
The study – which polled health system chief executive officers, chief financial officers and chief operating officers – found the requirements of the Affordable Care Act and the demands of population health management leading to big changes in care processes.
Most notably, Premier found that the expansion and integration of post-acute care networks is a major priority, cited by 95 percent of C-suite respondents as a key area of focus over the next three years.
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200 0 |about 2 years ago
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The American College of Emergency Physicians is suing HHS, claiming a provision of the Affordable Care Act allows insurers to underpay for out-of-network emergency medical services.
The federal lawsuit asks that insurers be transparent on the data they're using to pay for services rendered by an out-of-network hospital.
The ACA established that in these cases, insurers must pay the greatest of three costs: the insurers' in-network amount, the Medicare amount or the usual, customary and reasonable amount. The UCR, the amount physicians charge for care, is often the greatest of the three.
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133 1 |about 2 years ago
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CMS has announced a new expanded initiative for bringing value-based repayment to primary care. The Comprehensive Primary Care Plus (CPC+) program, builds on the Comprehensive Primary Care program introduced in 2012, but will expand the program to a larger number of practices and includes some tweaks to the model.
“Strengthening primary care is critical to an effective health care system,” said Dr. Patrick Conway, CMS deputy administrator and chief medical officer. “By supporting primary care doctors and clinicians to spend time with patients, serve patients’ needs outside of the office visit, and better coordinate care with specialists we can continue to build a health care system that results in healthier people and smarter spending of our health care dollars. The Comprehensive Primary Care Plus model represents the future of health care that we’re striving towards.”
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162 2 |about 2 years ago
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Value-based payment (VBP) models have the dual aim of reducing costs and improving quality of care. A typical VBP approach identifies potential savings by establishing baseline health care costs for specific conditions or populations. The model assumes that the potential for sharing savings generated against the baseline costs will incentivize providers within the network to use more effective treatments and improve outcomes.
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133 2 |about 1 year ago
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The CMS is about to try rewarding hospitals that can get eligible patients to show up for cardiac rehabilitation But cardiologists think it will take something more creative than financial incentives to get some patients to go
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The venture will use data and analytics to help customers make the transition to new payment models and patient-centered care
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