One of the largest and most significant changes to specialty care payments in Medicare commences in January. TEAM (Transforming Episode Accountability Model) is poised to put hospitals at risk for total costs of care for the highest cost Medicare surgical episodes, including Coronary Artery Bypass Graft (CABG), Lower Extremity Joint Replacements (LEJR), major bowel procedures, […]
The 2026 CMS PFS Final Rule: The 5 Ways CMS Aims to Control Total Cost of Care
The CMS PFS Final Rule is out . . . early? If you’re wondering how, in the midst of the Shutdown, a 2,375-page Rule could be released, the answer is simple: most of the proposals from this summer were finalized as is. There are always exceptions, but the big takeaway is that this Rule solidifies […]
Three Strategies for ACOs to Optimize Specialty Care through TEAM
Both the greatest strength and weakness of the ACO shared savings (MSSP) model is its focus on primary care, particularly chronic disease. ACOs have put patients with diabetes, hypertension, and other conditions usually handled through primary care physicians at the center of care coordination, population health, and care management. But as CMS Value-Based Care’s central […]
Roji Health Intelligence Response to CMS RFI for Health Technology Ecosystem
Data and technology, once simply functional assets to facilitate health care, are now a leading force for health care advancement, improvement of health care outcomes, and control of costs. Yet the panoply of technologies has not optimized information for one key actor: the patient. The Center for Medicare and Medicaid Services (CMS) is attempting to […]
Multi-Payer VBC Strategy Is Essential for Cost Control, but Providers Must Get a Fair Deal
To meet its goals of controlling costs and improving patient care, Value-Based Care requires a near-universal, multi-payer strategy.
The 2025 CMS PFS Final Rule: The Five-Pronged Strategy Towards Comprehensive Accountable Care
The 2025 CMS PFS Rule landed with a bang, and it’s not just the weight of the 3,088 pages. We’re one year closer to 2030, the year that CMS intends to have all Traditional Medicare patients in a relationship with a clinician who is accountable for total cost of care. The push to the finish […]
ACOs Need a Strategic Map for Cost Control
For ACOs to remain relevant and viable under risk payment models, they must step up now to generate more cost savings for Medicare patient care. Medicare’s budget cuts are once again under consideration as political pressure mounts to lower governmental spending. CMS is expanding risk through Medicare value-based payment models, such as the new ACO […]
2022 QPP Experience Report: Address 3 Key Findings Now to Avoid Future Penalties
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 […]
How Your ACO Can Optimize APP Reporting Using Medicare CQMs
ACOs just gained a reprieve from implementing all-patient APP quality reporting in 2024. A provision in CMS’s Physician Fee Schedule Final Rule, which goes into effect on January 1, 2024, enables ACOs to report on Medicare patients only, based on CMS provision of eligible patient lists for three APP measures. If your ACO decides to […]
The 2024 CMS PFS Final Rule: Post-PHE, Value-Based Care Returns to the Forefront
The 2024 Physician Fee Schedule Final Rule—all 2,709 pages worth—was released on November 3, and the significance of the “Post-COVID” rule cannot be understated. With the Public Health Emergency expiring earlier this year, these finalized policies are intended to get the proverbial train back on its tracks, following the massive derailment in March 2020. Although […]