CMS issued a final rule last week that will allow accountable care organizations (ACOs) to benchmark their results to regional Medicare spending, using a phased approach to incorporating regional fee-for-service (FFS) expenditures into calculations for resetting, adjusting, and updating an ACO’s rebased historical benchmark after an initial three-year agreement period. National benchmarks will continue […]
CMS will allow primary care practices in the Medicare Shared Savings Program (MSSP) to participate in the Comprehensive Primary Care Plus (CPC+) initiative. The announcement came in response to stakeholder concerns that a new Medicare primary care payment model could steer physicians away from accountable care organizations. Up to 1,500 eligible primary care practices […]
Note: iProtean editorial staff will be on holiday next week, celebrating Memorial Day. Look for the next blog/newsletter June 1. Enjoy the holiday! The uninsured rated dropped from a high of 16.3 percent in 2010, the year the Affordable Care Act was enacted, to 9.1 percent in 2015, according to data released by the […]
The financial profiles of US not-for-profit hospitals are stronger than they were three years ago, says Moody’s Investors Service vice president Daniel Steingart. In his summary in Healthcare Quarterly, Steingart notes that “stronger financial footing will undoubtedly help hospitals mitigate the headwinds associated with changing and more stringent reimbursement models.” (“Not-For-Profit Hospitals: Financially Stronger as […]
Moody’s Investors Service reported a continuation of “favorable operating performance” for not-for-profit and public hospitals, citing its preliminary FY 2015 medians. “Strong revenue growth and strengthening profitability margins are due to gains in insurance coverage, volume increases, improved revenue cycle, expense management and the stabilizing of changes implemented by the Affordable Care Act (ACA),” […]
Physicians participating in many existing alternative payment models (APMs)—including most Medicare accountable care organizations (ACOs)—will not qualify to receive future Medicare pay increases under proposed rules issued by CMS last week. The proposed rules would implement changes through the unified framework called the Quality Payment Program, which includes two paths: The Merit-based Incentive Payment […]
CMS has issued a proposed rule for FY 2017 that would eliminate a 0.2 percent cut implemented as part of its controversial “two-midnight” policy. “CMS finally saw the light and proposed to terminate their flawed Two Midnight payment cut in the Inpatient Prospective Payment System (IPPS) rule,” said an executive from Premier in a […]
A new alternative payment model featuring public-private payer partnerships was announced last week by CMS. The Comprehensive Primary Care Plus (CPC+) model features Medicare-commercial-state health insurance plans partnerships to support the delivery of advanced primary care. Existing alternative payment models range from pay-for-performance, to bundled payments, to accountable care organizations, to global payments. […]
A 77-bed hospital in Indiana fell victim to a ransomware attack on April 4 via an ordinary looking email sent to a clinical worker’s Outlook inbox. The worker opened the email and inadvertently released the malware. Recognizing something was wrong, the worker notified the IT department which immediately shut down all of the hospital’s computer […]
Continuing our series on excerpts of interviews with iProtean experts, we feature our old friend and new iProtean expert, Jim Rice, Ph.D., FACHE., on governing in an era of population health. We’re moving into an era of population health management that will have profound implications, both challenges and opportunities, for boards of directors. I […]