Expecting significant movement to repeal and replace the Affordable Care Act (ACA) early in the next Administration, financial analysts have expressed concern that the proposed changes to Medicaid are likely to have the largest financial impact on hospitals. Since implementation, the ACA marketplaces/exchanges have garnered more media coverage, but hospitals saw more activity from those […]
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.
Many questions have arisen about the future of the Affordable Care Act (ACA) since the election. From providers’ point of view, iProtean, now part of Veralon expert and Veralon Managing Director and CEO Dan Grauman noted the “repeal” of ACA probably will not eliminate alternative payment models (ACOs, bundled payments, etc.). Grauman noted in […]
CMS estimates that the hospital value-based purchasing program (VBP) will have approximately $1.8 billion dollars for value-based incentive payments for FY 2017 hospital discharges. The incentive pool is funded by reducing the base operating Medicare Severity diagnosis-related group (MS-DRG) payment amounts that determine the Medicare payment for each hospital inpatient discharge. For fiscal year […]
CMS will reopen applications for new practices and payers in the Comprehensive Primary Care Plus (CPC+) model and for new participants in the Next Generation Accountable Care Organization (ACO) model for the 2018 performance year. Clinicians in the Oncology Care Model (OCM) with two-sided risk in 2017 will qualify as participants in an advanced alternative […]
Business valuation is as much an art as a science. It not only requires technical knowledge of valuation methodologies, it requires the valuator to have significant judgement and the industry experience to evaluate the entity in the context of a broad understanding of the industry. One area where a valuator must exercise considerable judgement is […]
For your convenience: APMs = Alternative Payment Models MIPS = Merit-based Incentive Payment System QPs = Qualifying APM Participants CEHRT = Certified Electronic Health Record Technology The MACRA rule has introduced a load of new acronyms (see above), but here is another wrinkle. What exactly is an “Advanced” Alternative Payment Model? Luckily, several attorneys […]
For your convenience: MACRA = Medicare Access and CHIP Reauthorization Act QPP = Quality Payment Program APMs = Alternative Models MIPS = Merit-based Incentive Payment System CMS has issued the much-anticipated final rule to implement the controversial Medicare Access and CHIP Reauthorization Act of 2015. MACRA replaced the sustainable growth rate formula for […]
To date, just under one-third of accountable care organizations (ACOs) have been eligible to share in savings. This situation is changing somewhat as ACOs gain experience in managing populations of patients for high quality and low cost healthcare. As of 2016, nearly 50 percent of Medicare lives were covered in non-traditional arrangements, including Medicare Advantage […]
As required by the Affordable Care Act (ACA), the Internal Revenue Service (IRS) reviews hospitals for compliance with Internal Revenue Code 501(r). Through June 30, 2016, 166 of the 692 completed reviews were referred for “field examination” for what appeared to be noncompliance with charity care requirements. Issues for which field examination referrals were […]
A former Medicare official recently spoke about the “irony” of the ACO world, noting that CMS is making the deals as hard as they can be—thereby “starving ACOs.” The official, now a large system president and CEO, said there doesn’t appear to be provider resistance to ACOs; nevertheless, it was time to make some […]