When Rob Lazerow, a managing director at the Advisory Board Co., recently met with the executive team of a large health system, he noticed a construction project had been downsized from the prior year. The organization decided to replace its aging facilities with smaller structures, which would potentially allow it to fine-tune its staffing model…
Medicare and commercial insurers are adamant about moving providers from Fee-for-Service to financial risk for services, and CMS is losing patience over providers’ reluctance to embrace downside-risk ACOs. Why are providers so worried about accepting risk? Because, they say, provider choice will ruin their potential for savings. With an estimated 25 percent of patients seeking…
Today, the Centers for Medicare & Medicaid Services (CMS) proposed significant changes to the Home Health Prospective Payment System to strengthen and modernize Medicare, drive value, and focus on individual patient needs rather than volume of care. Specifically, CMS is proposing changes to improve access to solutions via remote patient monitoring technology, and to update…
Home health agencies may soon be able to include the costs associated with remote patient monitoring into Medicare reimbursement. Under a proposed payment rule (PDF) released by the Centers for Medicare & Medicaid Services (CMS) on Monday, home health providers would be able to include the costs of remote patient monitoring as an allowable cost in…
CMS recently announced that it advanced a demonstration that would waive Merit-Based Incentive Payment System (MIPS) requirements for eligible clinicians participating in at-risk Medicare Advantage plans. If approved, the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration would apply to eligible clinicians sufficiently involved in Medicare Advantage plans that resemble Advanced Alternative Payment Models (Advanced…
Due to high magnitude and variation in spending on post-acute care, accountable care organizations (ACOs) are focusing on transforming management of hospital discharge through relationships with preferred skilled nursing facilities (SNFs). Using a mixed-methods design, we examined survey data from 366 respondents to the National Survey of ACOs along with 16 semi-structured interviews with ACOs…
With the rise of value-based care, payers increasingly require specialists to take on financial and holistic accountability for patients with some of our healthcare system’s most complex – and costly – diseases, from diabetes and congestive heart failure to cancer. This has precipitated a significant shift in what many healthcare stakeholders considered specialists’ traditional responsibilities….
A diverse group of accountable care organizations, insurers, patient advocacy and health IT companies want the federal government to require data sharing among providers to participate in Medicare. The organizations didn’t stop there. They also urged the Centers for Medicare & Medicaid Services (CMS) to use other policy levers to drive interoperability by requiring the…
Population health management and value-based reimbursement success hinge on reducing healthcare costs not only when a patient is in the exam room, but also when they are beyond the walls of the practice or hospital. Therefore, understanding where a patient lives, their income, education level, job status, and other social determinants of health (SDOH) is critical…
Roughly 20 percent of the United States population lives in rural areas. Despite this, rural America faces a number of health-related challenges, some of which are structural, while some are related to regional differences in health and health care in this country. Compounding these issues, incomes are lower and poverty rates are higher in many…