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 […]
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 […]
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 […]
The 2015 medians showed that the largest 50 and smallest 50 hospitals and healthcare systems, measured by total revenues, experienced similar financial trends of improving revenue growth and stable-to-improving financial performance, according to a report on medians issued by Moody’s Investors Service in early September. In the last two newsletters we highlighted key findings […]
When you consider the medians of the hospitals/systems at the two ends of the rating scale—Aa and speculative grade—there is greater dispersion of minimum, maximum, mean and standard deviation in the FY2015 not-for-profit healthcare medians. Moody’s Investors Service analysts noted in one of its recent reports on healthcare medians that “continued consolidation and the aim […]
This is the first of three newsletters based on Moody’s Investors Service medians reports for FY 2015. Next week we will cover consolidation/size and wide statistical variances, followed by revenue growth for the largest and smallest hospitals. “Not-for-profit and public healthcare revenue growth rebounded to levels not seen since fiscal year (FY) 2008 and […]
Medicare Advantage (MA) plans paid hospitals 8 percent less than traditional Medicare between 2009 and 2012, Stanford University researchers recently reported in Health Affairs. The discrepancy between MA plans and private insurance was even greater. According to the researchers’ study, MA plans paid hospitals about 91.5 percent of what FFS Medicare paid in 2012, […]