CMS has released the 2022 Physician Fee Schedule and Quality Payment Program (QPP) Final Rule, and the message of these 2,414 pages is clear: CMS wants to push providers into value-based care arrangements. That intent was foreshadowed by the Proposed Rule released over the summer, which confirmed our predictions of trends under the Biden administration. Specifically, we saw a push…
The Next Generation Accountable Care Organization (ACO) Model has saved Medicare millions of dollars over the past four performance years. But with one more year to go due to the COVID-19 pandemic, the Model is actually operating at a loss. Next Generation ACOs have saved Medicare nearly $667 million thanks to reductions in Parts A…
Medicaid will be an increasing focus of alternative payment models (APMs) from the Center for Medicare & Medicaid Innovation (CMMI), Ellen Lukens, MPH, said Wednesday at the annual Population Health Colloquium hosted by Thomas Jefferson University. “Models have been predominantly Medicare-oriented, and have disproportionately served white beneficiaries,” said Lukens, who is policy and programs group…
As we reported in a news article on Sept. 30, “A dispute has arisen over controversial statements made by two prominent healthcare policy leaders around the Medicare Advantage program. On Sept. 30, Donald Berwick, M.D., and Richard Gilfillan, M.D., published an article in the Health Affairs Blog entitled “Medicare Advantage, Direct Contracting, And The Medicare ‘Money Machine,’ Part 2:…
Fee-for-service reimbursement is still an integral part of the healthcare system as providers are scattered along a spectrum of payment models, Emily Sokol, director of research at Xtelligent Healthcare Media, explained on Healthcare Strategies. An Xtelligent Healthcare Media Insights report shed light on how pervasive fee-for-service reimbursement models are in today’s healthcare system. Over 200 providers responded to…
On Wednesday, Aug 25, leaders at the Washington, D.C.-based NAACOS—the National Association of ACOs—trumpeted the progress of accountable care organizations in saving money for the Medicare program, one day after joining eleven fellow national healthcare associations in pleading with members of Congress to include legislation supporting alternative payment model acceleration in upcoming federal legislation. On…
In a highly competitive world, winning requires unconventional thinking. Consider professional sports – MLB scouts understand that finding the right players to add to their roster means looking beyond the surface. And healthcare professionals, especially those participating in value-based care models, have to do the same. Billy Beane, General Manager of the Oakland A’s, knew…
Over the last ten years, policymakers of both parties have identified health care payment reform as a critical national priority. Payment incentives offered by Medicare and other large payers create the environment in which providers must choose between being rewarded for performing more services and procedures, as in fee-for-service medicine or, for efficiently managing the…
Social determinants of health (SDOH) are associated with increased Medicare spending per beneficiary in certain geographic areas, according to a study from the Journal of the American Medical Association. Addressing social determinants of health in these regions can potentially lead to reduced healthcare spending and better quality healthcare. The results show that Medicare spending was higher in geographic locations where…
States that benchmark their healthcare cost growth improve transparency, strengthen primary care and boost alternative payment models, according to a new report. Eight states have implemented or are developing the regulatory and data gathering infrastructure to track annual healthcare cost growth, and more are expected to follow suit. Standardizing how those benchmarks are created and…