According to a recent report on the 2016 Medicare Shared Savings Program (MSSP) results, Track 1 ACOs that earned shared savings still incurred a $31 per member per month (PMPM) loss on average, equating to $5.2 million in losses for an average organization. For Track 1 ACOs earning shared savings, the average $27 PMPM savings payment […]
Veralon Views Blog
The Veralon Views blog is an extension of our partnership with leaders who are transforming the healthcare industry. Here, we share expert perspectives from our nationally recognized senior consulting team on issues that are key to the success of your organization.
CMS has proposed an overhaul of the Accountable Care Organization (ACO) program, to take effect July 2019. The Medicare ACO program, called the Medicare Shared Savings Program (MSSP) would have a new name, Pathways to Success. It would require the 561 existing ACOs to switch to one of two tracks and would mandate that they […]
Hospital merger & acquisition (M&A) activity in the second quarter of 2018 decreased by nearly 50 percent from the first quarter according to a M&A tracking company. Analyses by other companies that track M&A activity reported a similar decrease. However, physician practice acquisition remained steady in the second quarter. Irrespective of these numbers, […]
CMS recently released its proposed rule for changes to the Outpatient Prospective Payment System (OPPS) for FY19. In addition to a proposed 1.25 percent increase in hospital OPPS rates for FY19, CMS wants to reduce payment for hospital outpatient clinic visits at off-campus provider-based departments to 40 percent of the OPPS rate. The “site-neutral” […]
The head of CMS outlined the agency’s policy shift to competition and choice in a recent interview. Seema Verma noted, “Coming incentives will encourage Medicare beneficiaries to shop among providers, with those that have the lowest prices and deliver better-coordinated care gaining a competitive advantage.” (“Public Poll, Verma Reject Single-Payer,” HFMA Compass, July 27, 2018) […]
The recently released “massive” Medicare physician proposed payment rule included a “surprise” projection that alternative payment model (APM) participation may decline. Provider organizations are planning member briefings on the rule. (“Providers Examining Why APMs Are Expected to Stall,” HFMA Weekly News, July 23, 2018) The proposed rule continues the implementation of revisions to physician […]
A recent survey of hospital/health system CEOs by a national healthcare consulting company reported that cost control is their top priority. CEOs responding to the survey noted “innovative approaches to expense reduction” as the second leading priority. The survey results supported an April report from Moody’s Investors Service that the median operating cash flow […]
Hospitals/systems may be considering the pro’s and con’s of growing their service lines, even as they grapple with cost reduction strategies. Experts have noted the many benefits including increased patient volumes, improved health outcomes, increased market share and improved physician loyalty. If hospitals/systems focus on high-value service lines, a key benefit would be a significant […]
As hospitals and health systems build their employed medical practices, a large emphasis is often put on compensation arrangements, and little attention is paid to engaging physicians in the successful management of these practices. At the same time, hospitals are experiencing significant operating losses for their employed practices. Losses vary, but hospital-owned practices typically lose […]
Through Congressional direction and previous Administration initiatives, Medicare has implemented incentives to reduce hospital readmissions. One example is the Hospital Readmissions Reduction Program (HRRP), which financially penalizes hospitals with relatively high rates of Medicare readmissions. One of the criticisms of the program has been the anticipation of an increase in the number of observation […]