The U.S. Centers for Medicare & Medicaid Services (CMS) has proposed a new avenue of funding for Accountable Care Organizations (ACOs) with implications for palliative care providers. The agency’s 2025 Physician Fee Schedule proposed rule contains a provision that would establish a new “prepaid shared savings” option for Medicare Shared Savings Program (MSSP) participants. This…
The Centers for Medicare & Medicaid Services (CMS) quietly released changes to the ACO REACH Model, prompting one industry group to react to the modifications. The National Association of ACOs (NAACOS) said it is still digesting the changes and listening to members’ initial thoughts. “I think it’s a bit mixed,” Aisha Pittman, senior vice president…
The Department of Health and Human Services (HHS) regularly refines its policies and operational guidelines in an ongoing effort to better serve patients and support sustainable value-based care delivery. To that end, HHS and CMS recently announced three important updates: Revisions to HHS risk adjustment model algorithm software Changes to cost-sharing reductions (CSRs) Deployment of…
In creating your strategies for cost control, your ACO must consider how to reduce Total Per Capita Cost (TPCC) while ensuring the financial survival of your ACO and participating providers. This balancing act is the dilemma facing all providers adopting Value-Based Care: how to achieve more savings while replacing revenue lost from services. Here’s how…
The Impact of Meaningful Patient-Provider Relationships In the evolving landscape of healthcare, the dynamic between patient and provider is increasingly scrutinized. As technology continues to integrate into everyday healthcare practices, it’s essential to assess whether these tools foster meaningful relationships or if they inadvertently encourage a more transactional approach. Drawing from Adam Grant’s insights on…
Value-based behavioral health involves measuring an organization’s impact on a patient’s health. How impact is defined and translated into value varies depending on several factors. At the broadest level, the various levels of care acuity require different approaches. They may also have advantages and disadvantages when it comes to value-based care in the first place….
The release on July 10 of the proposed Calendar Year 2025 Medicare Physician Fee Schedule from the Centers for Medicare & Medicaid Services (CMS) prompted discussions among healthcare industry professionals. On July 16, the Washington, D.C.-based Primary Care Collaborative (PCC) hosted an online discussion with CMS leaders about how Medicare Part B payment policy could…
In the U.S. health system, various determinants and factors such as income, race, education, gender, sexuality, and even zip code significantly influence our health outcomes. These factors affect how healthy we are, the frequency and severity of illnesses, our access to care, and even our life expectancy. Consider these stats: Non-Hispanic Blacks/African Americans have 2.4…
Accountable care organizations (ACOs) face unique burdens to comply with CMS’s new quality reporting requirements as summarized in this 2021 MedCity News article. Challenges are particularly acute for ACOs that delayed conversion from CMS’s Web Interface to the new electronic clinical quality measures (eCQM) quality reporting. Many ACOs have made the change. But many have…
Meticulous documentation is the name of the game for nursing home operators looking to keep up with Minimum Data Set (MDS) changes and maintaining a good rating in the Five-Star Quality Rating System. This is especially because inaccurate or insufficient data could affect a facility for at least a year in the future. Leaders in…