We’ve seen unprecedented consolidation among hospitals, hospital systems and physician groups in recent years, sparked by the drive for greater market share. As systems organize competitively to participate in risk models such as ACOs and bundled payments, however, the dramatic surge in hospital employment of physicians hasn’t helped ACO success. In fact, most Medicare ACOs […]
Don’t Hit the Medicare Revenue Wall: What You Must Know About 2016 PQRS-VBPM Benchmarks
What will it take for health care providers actually to focus on improving patient outcomes, while keeping costs under control? CMS has structured quality reporting under the Value-Based Payment Modifier (VBPM) to reward providers who surpass PQRS measure benchmarks, and penalize those who lag behind. But inherent in the new quality tiering is a serious […]
Bundled Payments Aren’t Mandatory for Everyone (Yet): Is Your Group Ready?
It’s taken more than a half-century, but the Medicare Final Rule on Comprehensive Care for Joint Replacement (CCJR) has set in motion utilization reporting that will shift the focus from static data about diagnoses, services and days in hospital to meaningful information about care transitions and outcomes. It’s taken a long time. But now that […]
Expanding Your ACO: The Best Recruiting Strategy for Bigger ACO Savings
Whether your ACO is in its infancy or is established and growing, you’ve probably had to make some difficult choices about which groups to include—and exclude. Your ACO’s success is almost entirely driven by your ACO network’s participating providers (and their patients). They provide the care and generate beneficiary costs, and help to ensure better […]
Don’t Let Wishful Thinking and Healthy Patients Harm Your ACO
Can healthy patients actually hinder your ACO’s ability to generate shared savings? Without a multi-layered strategy to improve continually over the course of the ACO agreement, the answer is yes. With the majority of ACOs failing to generate shared savings, a growing number of groups are beginning to realize that serving either the healthy or […]
Questions You Should Ask (or Should Have) About Medicare’s Alternative Payment Models
Are you prepared for your risk or reward under Medicare payment reforms? It’s hard to give up current revenues that reward volume, sooner than absolutely necessary. That’s the dilemma facing all providers who realize that Medicare is serious about moving 50 percent of its provider reimbursement to Alternative Payment Models (APMs) by the end of […]
ICLOPS Case Study: VBPM Consultation Lifts Specialty Group’s Quality Tier and Medicare Revenues
Medicare’s Value-Based Health Care programs aren’t just about penalties. You can also earn a reward. Case in point—an ICLOPS orthopedic client recently asked The Big Question: Are there really incentives to be earned through Medicare’s Value-Based Care? With the release on September 9 of the Annual Quality and Resource Use Reports (QRURs), the answer is a […]
Be Prepared for Medicare’s Transition to Bundled Payments—or Risk Future Revenues
As specialists face increasing pressure to lower costs, particularly by Medicare, so-called Bundled Payments are becoming an increasingly significant—and preferred—method of reimbursement. Although this form of Alternative Payment Method (APM) is not yet mandatory, most industry experts believe that bundled payments will form the basis of how Medicare will pay specialty services in the future, […]
Medicare’s MIPS: The Not-So New Face of Value-Based Care
Rumors that PQRS and VBPM have died may be wishful thinking, but are far from true. Value-Based Care is here to stay, even as Medicare’s programs evolve. You still have a chance to help shape those initiatives before they become law. So it’s well worth your time now to learn all about Medicare’s newest program, […]
Does Your EMR Tell Medicare the Right Story About Your Patient Quality?
Reporting physician quality to Medicare through an EMR is an easy and affordable approach—at least on the surface. But be careful when using EHR Direct Reporting for PQRS 2015, so you don’t cost your organization as much as 4 percent in Medicare penalties or create an unappealing profile of your quality in Medicare’s public reporting. […]