Though the Trusted Exchange Framework and Common Agreement (TEFCA), is a relatively new development in healthcare, it has major implications for every healthcare organization and its patients. In short, TEFCA outlines the terms and conditions that will allow for the exchange of electronic health information (EHI) across different Health Information Networks (HINs). This will make…
Before the pandemic, hospitals in the U.S. were making notable progress in the effort to address flagging patient safety and care quality metrics. And that effort paid off — adverse events and safety and quality issues plummeted in the decade before Covid-19. But the latest numbers available demonstrated a reversal in that trend, as hospitals…
To provider organizations, the Change Healthcare hack in February was a painful reminder of a lesson learned during the first year of the COVID-19 pandemic: A disruption in revenue flow can lead to financial disaster or even closure. Many smaller hospitals and medical offices have struggled to get paid since the ransomware attack shut down…
The answer is ‘yes’ from a paper by Lin et al. (2024). Using 2009-2013 data from the Massachusetts All-Payer Claims Database, the authors measured physician–hospital integration within an accountable care organization (ACO) based on the proportion of primary care physicians (PCPs) in an ACO who billed for outpatient services with a place-of-service code indicating that…
At first glance, CMS’s recently released 2022 QPP Experience Report (PDF) seems reassuring, because the majority of clinicians avoided financial penalties under MIPS. Don’t be fooled! While overall success and failure rates in the report may lead you to conclude that merely participating in the QPP (either in MIPS or as an APM) is enough…
The BCDA (Beneficiary Claims Data API) is a powerful tool made available by CMS (Centers for Medicare and Medicaid Services), allowing providers access to timely insights from Medicare claims data. This helps providers facilitate proactive interventions aimed at preventing potential health problems and optimizing healthcare delivery. As a provider, leveraging BCDA insights is the key…
Operational and financial challenges can make it difficult for nursing homes and other health care facilities to transition to the federal government’s Value-Based Program (VBP), which ties payment to quality and outcomes. An editorial published in JAMA Internal Medicine Monday expresses the need for more data and improved measurement of outcomes, better methods of financial…
Medical billing is a field that is constantly evolving, with new updates and developments. One such development is value-based care, which is currently transforming the medical billing industry. Value-based care is a provider payment model that prioritizes high-quality healthcare over the quantity of services. The goal of this payment model is to provide better care…
Since the introduction of the Triple Aim by the Institute for Healthcare Improvement (IHI) more than15 years ago, efforts to improve the US health care system have been guided by the goals of enhancing patients’ experience of care, improving population health, and reducing per capita health care spending. In 2022, it was proposed that the…
The press release published jointly by the offices of the two senators began thus: “As part of their ongoing work to address primary care challenges and reform physician payment models, U.S. Senators Sheldon Whitehouse (D-RI) and Bill Cassidy, M.D. (R-LA) released a Request for Information (RFI) to accompany the introduction of the senators’ bipartisan Pay…