This week, I’m looking back at the year 2019, in two parts. In this blog, I’ll look at policy; in my second blog in this series, I’ll look at “everything else”—fully recognizing, of course, that policy and “everything else” are completely interconnected; but I needed to divide up this year in review conceptually, so that’s…
Although legislative pressure to transition to value-based care began several years ago, movement to alternative payment models (APMs) and changes to healthcare reimbursement have been slow, according to CHIME HealthCare’s Most Wired report. The report, recently made public, was based on responses to CHIME’s 2019 Most Wired survey. CHIME (the College of Healthcare Information Management Executives) conducts…
The majority of physicians now participate in an accountable care organization (ACO), the American Medical Association (AMA) recently reported. Overall, 53.8 percent of physicians polled in September 2018 for the AMA’s Physician Practice Benchmark Survey reported participating in at least one ACO type that year. The percentage is up from 44.0 percent in 2016, the recently…
When asked why he robbed banks, Willie Sutton, the infamous US bank robber, responded “because that’s where the money is.” This quote is the inspiration for “Sutton’s Law,” which recommends prioritizing those diagnostic tests that are most likely to yield a definitive diagnosis and quickly lead to a treatment recommendation. While Sutton’s Law has been…
Download Slides Has your Medicare Shared Savings Program (MSSP) ACO taken full advantage of the many waivers of federal fraud and abuse laws, such as the Stark Law and the Anti-Kickback Statute? During the webinar we will discuss the different types of waivers, what they are, which ones matter to you, how to use…
Health care spending is projected to grow to 19.4 percent of gross domestic product (GDP) by 2027, and big gaps in quality and access to care persist. This has motivated payers and providers to implement alternative payment models (APMs) to enable higher-value care. There is bipartisan agreement, reflected in the Medicare Access and CHIP Reauthorization Act (MACRA)…
Executive Summary Alternative payment models (APMs) are central to the efforts to reduce the growth in healthcare costs and improve outcomes for patients. Yet some stakeholders remain skeptical of their potential. This is understandable, because APMs have shown mixed results. We have identified seven characteristics of well-designed models that yield meaningful savings for payers, improve…
The move to value-based care is not happening a year from now, or in a month, or even tomorrow. It’s happening as we speak. Why do I say that? An analysis from the Health Care Payment Learning & Action Network (HCP-LAN) in October 2018 revealed that 34% of healthcare dollars of 2017 flowed in from Alternative Payment…
The reason CMS Alternative Payment Models (APMs) are failing to significantly reduce spending in Medicare is that none of the major APMs meets the majority of the eight criteria for a successful APM. The Problems with Medicare’s Alternative Payment Models and How to Fix Them details the serious weaknesses in the six major Advanced APMs that have…
CMS issued a final rule Dec. 21 that makes sweeping changes to the Medicare Shared Savings Program, including overhauling the way ACOs share in risks and rewards. Here are seven takeaways from the final rule: 1. There are currently four MSSP tracks. The final rule streamlines the program by discontinuing Track 1, a one-sided risk model,…
