Nontraditional partnerships explicitly form to manage accountable care organizations and clinically integrated networks. Shared governance is typical in these types of partnerships. Other nontraditional partnerships include insurance companies, retailers and pharmacy companies. Accountable care organizations and clinically integrated networks both collaborate among hospitals and physicians to manage large groups of patients to reduce the […]
In several of our courses we have covered the trend toward hospitals entering nontraditional businesses such as health insurance or retail operations as a means to absorb the impact of value-based reimbursement. Several of our experts have discussed mechanisms for such businesses: collaboration with existing companies, joint ventures with varying degrees of control, acquisition of […]
Moody’s Investors Service sees the outlook for the not-for-profit and public hospital sector as stable, reflecting its expectations for the fundamental business conditions in the sector over the next 12 to 18 months. Operating cash flow growth will continue to grow but at slower rates than over the last two years. Growth of about […]
Amid speculation about the outcome, The Department of Justice (DOJ), joined by a number of states, filed complaints on July 21 in federal district court challenging the mergers of health insurance giants Anthem and Cigna and Aetna and Humana. Attorney General Loretta Lynch announced the filing and noted that these deals would eliminate competition at […]
The healthcare industry has less than six months to prepare for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). But according to a recent survey by Deloitte, it may be an uphill battle. According to Deloitte’s 2016 Survey of US Physicians, “half of surveyed physicians have never heard of MACRA, and most […]
Hospitals have been adding services to their outpatient departments in recent years as a means of reducing utilization in costlier inpatient settings as they move to population-based payment models. Medicare’s Outpatient Prospective Payment System (OPPS) proposed rule issued this week might negatively affect this trend, according to finance experts. The proposed rule would disqualify […]
Physician movement and competition for top talent has caused an “upward spike” in physician payment, according to Merritt Hawkins, a healthcare recruitment firm. The firm’s data from April 1, 2015 to March 31, 2016 show a surge in compensation increases among 19 of 20 specialties it tracks. Merritt Hawkins has conducted an annual review […]
Smaller accountable care organization (ACO) officials wrote comments to CMS noting that some provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) could hurt the viability of smaller ACOs. The proposed rule, MACRA, will split physicians into those paid under the Merit-based Incentive Payment System (MIPS) and those paid annual […]
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 […]