A parade of headlines announcing record-breaking settlements (chart below) has left healthcare executives, lawyers, consultants, and even physicians wondering if they could be exposed to regulatory or legal action as a result of any of their employment or other physician-hospital alignment arrangements. The government’s incredible return on investment on enforcement actions, as well as a […]
Medicare issued the final rule for its first mandatory bundled payment program, Comprehensive Care for Joint Replacement (CJR). Participation in this model will be mandatory for 791 hospitals in 67 geographic regions. It will begin April 1, 2016. These hospitals will be accountable for the quality and cost of care provided to Medicare fee-for-service […]
The challenges faced by the healthcare industry require healthcare organizations to reduce costs. Yet many organizations are determined to grow, and doing both simultaneously may seem counterintuitive. Yet the two imperatives are not necessarily at odds. Growth is typically seen as the product of investment. And reducing costs can itself require the investment of organizational […]
When rural healthcare organizations ask us to review physician compensation from a fair market value (FMV) perspective, management often makes the case that they need to pay more to attract physicians. They cite a smattering of studies[1] showing that rural physicians have higher average compensation than their urban counterparts, with one January 2005 study showing […]
Board members overseeing risk management and compliance can now view the chief healthcare regulatory agency’s 2016 Work Plan, a blueprint of projected investigations over the coming year. The Department of Health and Human Services Office of Inspector General (OIG) issued its work plan in early November and noted that it “will expand its focus […]
Both policy makers and providers expected a movement of patients from inpatient to outpatient settings due to payment redesign and other cost-cutting initiatives in the years since the Affordable Care Act was signed into law. However, both inpatient and outpatient utilization fell among pre-Medicare-age enrollees in employer-sponsored plans in 2014, according to a new report […]
The most noteworthy of the healthcare provisions in the budget approved by Congress last week would bar acquired physician practices from billing Medicare at hospital outpatient rates. Congress worked with the White House to pass a two-year bipartisan budget agreement last week; several issues must be resolved before it is signed into law, but […]
Hospital-physician practice integration has been shown to increase outpatient prices in some metropolitan statistical areas (MSAs) according to a national analysis of the effect of such deals over several years. The results were published in JAMA Internal Medicine in mid October. The study comprised practices in 240 MSAs with seven million enrollees in preferred […]
Local governments want not-for-profit hospitals to provide financial support to help them meet their rapidly increasing fixed costs. Reluctant to increase tax rates, municipalities want not-for-profit hospitals to make payments in lieu of taxes (PILOTs) or, in some cases, to pay property taxes, according to a recent Sector-in-Depth report from Moody’s Investors Service. The […]
An emerging trend among not-for-profit hospitals positions them well for population health management but also carries significant credit risks, say Moody’s Investors Service analysts in a recent report. The trend is to enter the commercial health insurance business to both improve care management and gain market share, the analysts wrote. The effect on credit […]