The Centers for Medicare & Medicaid Services (CMS) recently established CJR-X, a national episode- based payment model for lower extremity joint replacement (LEJR) procedures in the FY 2027 Medicare Inpatient Prospective Payment System (IPPS) Final Rule. This bundled payment model assesses cost and quality for 90-day episode for inpatient and outpatient hip, knee, and ankle…
Download Slides Uncover the powerful connection between supplemental benefits and overall member health in our upcoming webinar, “Hidden Benefits. Unexpected Savings.” Designed specifically for health plan leaders and health system executives, this session features industry experts from Versant Health, Amplifon Hearing Health Care, and HRI Dental. Together, they will reveal how integrating vision, hearing,…
Mounting financial pressures among both Medicaid and Medicare payers, fragmented health care settings, and the growing use of value-based care as a cost-cutting measure are creating unique challenges and opportunities for nursing homes serving dual-eligible beneficiaries. Maintaining and evolving such plans will depend on how adept nursing homes are at providing strong data to demonstrate…
CMS on July 31 finalized its Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System rule for fiscal 2027, setting a 2.3% payment increase for acute care and long-term care hospitals and locking in the first mandatory, nationwide episode-based payment model for joint replacements. “Knee, hip, and ankle replacements are important for helping seniors preserve their mobility and…
With downside risk on the horizon, TEAM offers a critical learning opportunity for hospitals and health systems. Learn how organizations can move beyond compliance to succeed under TEAM. CMS’ Transforming Episode Accountability Model (TEAM) went into effect in January 2026. TEAM is a bundled payment model that uses risk-adjusted benchmarks to evaluate total Medicare spending across 30-day…
Download Slides Are you dreading hundreds of pages of regulatory statute only to find that a few small sections relate to your ACO and/or practice? Let Patient360 clear the noise for you during this informative session which will cover the major proposed changes for the ASM model, MIPS, MVPs, and MSSP ACOs. In addition,…
CMS value-based payment models underrepresent Black, Hispanic, dual-eligible, and disadvantaged Medicare beneficiaries compared with the broader population. Medicare beneficiaries who receive care through CMS’s largest voluntary value-based payment models are disproportionately White and less likely to be dual eligible for Medicare and Medicaid or live in disadvantaged or rural areas than those outside these models, according to a…
Over the last few years, the excitement over value-based care had decreased, if not vanished. Growth in MSSP was steady but unspectacular. ACO REACH was an interesting experiment with no clear path forward. Specialists stayed mostly outside the tent. In conference rooms, the former golden child “value-based care” was dismissed as a has-been. The CY2027 Physician…
Why value-based care requires AI that tells clinicians not just who is at risk, but which interventions are most likely to change outcomes. Population health teams have made meaningful progress in identifying risk. Predictive models can flag patients at higher risk of complications, deterioration, or avoidable utilization. That visibility matters, but what comes next? Care teams may…
This summer, cool off with a cold drink and the 1,592-page 2027 CMS Physician Fee Schedule Proposed Rule! CMS has teased the elimination of Traditional MIPS and full transition to MIPS Value Pathways (MVPs for several years), and we now have a proposed date. Starting in Performance Year 2029, MVPs will be the only option for MIPS…