Hospitals are increasingly turning to value-based care initiatives to transform care delivery, lower the total cost of care, and improve patient outcomes. Unlike traditional fee-for-service (FFS) models that reimburse providers based on volume (i.e., the number of patient visits), providers are reimbursed based on the quality of care delivered in value-based care. Ultimately, success under…
Incentivized by the Centers for Medicare & Medicaid Services (CMS) to transform care delivery to improve outcomes, healthcare stakeholders are increasingly turning to value-based care initiatives. Outcomes are now contingent on providers working together across the continuum for shared goals, but hospitals are often not equipped with the resources necessary to do so. That’s where…
Attend any healthcare conference and you’ll quickly discover that it’s become downright fashionable for healthcare leaders to talk about their unwavering commitment to “value-based care.” The expression has become ubiquitous in healthcare circles. Its virtuousness goes unchallenged. But should that be the case? Michael E. Porter and Elizabeth Teisberg (with whom I worked as a…
Accountable care organization (ACO) success depends in part on a broad network of health information exchange (HIE) partners to effectively coordinate care. Our study illustrates that although ACO participation broadens HIE networks, the effects accrue differently across markets with varying levels of ACO penetration. ACO hospitals in high–ACO penetration markets increase their HIE network breadth…
Z codes, which are ICD-10-CM codes used to identify non-medical factors that may affect a patient’s health status, are a useful way to track social determinants of health and capture standardized data for Medicare beneficiaries. However, they are underused, with Z codes reported from only 1.59 percent of beneficiaries in 2019, according to a new…
Hospitals and health systems can implement value-based payment models to ensure preparedness for seasonal and pandemic capacity surges, according to industry experts. Hospitals experienced increased demand for tangible resources and staff during the COVID-19 pandemic, demand health systems typically only face during peak flu season. Unlike organizations in other industries, hospitals and health systems tend to lose…
Despite claiming to have prioritized health equity, the Biden administration just missed an opportunity to address poor nutrition—an important health and equity issue for older adults in particular. When the Centers for Medicare and Medicaid Services (CMS) recently released its FY 2022 Hospital Inpatient Prospective Payment System Final Rule, something was conspicuously absent from the Hospital…
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…
As the millennium’s third decade begins, Risk has taken hold as THE strategy for tackling health care costs. Virtually overnight (in health care years) the industry has moved—albeit not uniformly—to accept Risk. This transition is already beginning to impact hospitals and hospital-based systems, and raises serious questions about the viability of their role as the…
In its first two years, the Next Generation ACO model was not linked with reduced net Medicare spending, and had no effect on use or spending for hospitalizations, according to a new evaluation of the government program. Five things to know: 1. In its second evaluation report of the Next Generation ACO model, researchers from the University…