What happens when you bring wisdom from outside of healthcare into your organization? One New Hampshire CEO is thinking outside of the box and testing this out. Tom Mee, CEO of North Country Healthcare, is standardizing quality of care across the four facilities that make up his healthcare network by standing up a LEAN Six […]
Next Generation ACOs (NGACO) have been associated with model-wide reductions in spending without declines in quality, according to a new report from CMS. Based on their first performance year (2016), the participating NGACOS reduced Medicare spending by approximately $100 million. The savings appeared to be associated with reductions in hospital and skilled nursing facility […]
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 […]
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 […]
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 […]
No Medicaid lifetime limits and a hard stance on ACO risk contracts highlighted CMS head Seema Verma’s talk at the American Hospital Association’s recent annual meeting. “We’re determined to make sure that Medicaid remains the safety net for those who need it most,” Verma said. “To that end, we have determined we will not approve […]
As the healthcare market expands and evolves, the inherent risks also are increasing. These risks include: The shift from volume to value The rise of the consumer and expansion of consumer options New payment models Mobile strategies New entrants An aging population Continued political and regulatory uncertainty Whereas hospitals/systems have traditionally done well at […]
Continuing with excerpts from recent interviews with our experts, Marian Jennings and Nate Kaufman talked about moving from volume to value, and what that means to them. Interviewer: What is Value? Nate Kaufman: Value relates to the fact that the benefits being provided are worth the cost. The question that a healthcare provider […]