CMS announced its latest push towards value-based care in the spring with the Transforming Episode Accountability Model (TEAM). TEAM is a bundled payment program focused on five surgical episodes of care and is mandatory in selected markets. Now that the 2025 IPPS final rule is in place, we can start to assess the impact of […]
There is a new kid on the block in the CMS alphabet soup of value-based payment models. The Transforming Episode Accountability Model (TEAM) pushes hospitals and health systems to better manage five surgical episodes of care for the initial admission and the thirty-days following. TEAM is a mandatory model for selected markets launching January 2026. […]
CMS continues to authorize voluntary and mandatory alternative payment models (APMs) to shift risk to providers. Beyond choosing which models offer the best opportunity, providers must evaluate the impact of participating in multiple APMs simultaneously. Overlapping APMs can be synergistic or self-defeating. Where simultaneous participation is an option, overlapping incentives are complicated and may not […]
One of the most impactful final rules released by CMS in recent months is the CY 2021 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS-1736-FC). This rule includes several important policy changes, most notably the elimination of the Inpatient Only List on a phased schedule through CY2024 (when […]
CMS is launching a Radiation Oncology Alternative Payment Model (“RO Model”) that will profoundly affect radiation oncology economics, with a target start date of January 1, 2022. The RO Model will apply (or at least test) a bundled payment methodology affecting about 30% of eligible radiation oncology episodes. Revenue reductions may be as high as […]
What is the Primary Care First Program (PCF)? PCF is a voluntary 5-year CMS Advanced Alternative Payment Model (APM) with two care models—one for “Advanced” primary care and one for high-need, seriously ill Medicare beneficiaries (Seriously Ill Population, or SIP). The latter is aimed primarily at providers who typically provide hospice or palliative services. Practices […]
The move toward value-based contracts is happening “in small doses,” a 2018 MGMA survey found. While nearly three out of five hospitals participate in value-based contracts, just 34 percent of healthcare reimbursement is tied to value. This presents healthcare leaders with a dilemma: How can we engage physicians in value-based payment models when so little […]
CMS has opened applications for a second cohort of BPCI Advanced (Bundled Payment for Care Improvement-Advanced) participants in April. This initial application step gets you valuable data, and time to decide whether to pursue participation. Advantages of applying include: No obligation to participate. You have time (likely until fall 2019) to decide whether to sign […]
Supercharging claims analysis capabilities empowers healthcare organizations to zero in on opportunities to improve care and reduce costs. The most successful organizations typically elevate their performance under value-based contracts by using claims analysis to drive engagement and improvement. Achieving next-level claims analysis status requires a multifaceted approach. To gain the most value from claims analysis, […]
Many hospitals and health systems may benefit from participation in the Bundled Payments for Care Improvements Advanced program, but there are many points that organizations should address before pursuing this option. When the Center for Medicare and Medicaid Innovation (CMMI) created Bundled Payments for Care Improvements (BPCI), the benefits of participation were straightforward. The program […]