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 […]
Healthcare system executives are well aware that physician employment agreements must be consistent with Stark and Anti-Kickback legislation requiring that they not pay more than fair market value (FMV) for any services provided or received. However, quantitative benchmarking is only part of the story. As regulatory scrutiny continues to increase, it is imperative that certain […]
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 […]
Proactive collaboration allows AMCs and community counterparts to benefit from each other’s strengths, creating value that wasn’t necessarily sought or derived from more traditional partnering approaches. In Part I of this blog post on partnerships between community hospitals/systems and academic/major teaching centers (“AMCs”) we: Explored changes in AMC rationale for pursuing partnerships and partner attributes […]
Note: iProtean, now part of Veralon 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 […]
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),” […]
Physician engagement is critical to CIN success. True engagement, however, takes vigilance and a long-term commitment; having physicians join your network is just the beginning of the process. Our experience has shown that, despite their best intentions, many CINs lose touch with their physician membership at some point along the road. Effectively engaging physicians in […]
Industry transformation requires major adaptations from healthcare organizations – to increase scale, enhance scope, and achieve differentiation, among others. Partnerships can be a key vehicle to facilitate and pursue these adaptations. Partnerships between academic and community hospitals/health systems are a unique sub-set of healthcare provider partnerships. Academic providers aligning with their community counterparts is, of […]
Your selection of post-acute care (“PAC”) partners can make or break your value-based payment programs and care management initiatives. Even where fee-for-service is still dominant, having the right post-acute care partners can improve economic performance by reducing length of stay and minimizing acute care readmissions. Most health systems and hospitals do not own PAC facilities, […]