It’s one thing to sit down with a payer and negotiate incentivized goals in a value-based payment contract. It’s a different thing entirely to change the behavior of the practitioners in your medical group in order to meet those goals. Physicians who choose to sell their practice and become employees are typically relieved to […]
What CMS bundled payment initiative are we on? It can be hard to keep track. First there was the Bundled Payments for Care Improvement (“BPCI”) model, a voluntary bundled payment program beginning in 2013. Then in 2016, CMS introduced the CJR (Comprehensive Joint Replacement) bundled payment model, which was initially mandatory in 67 MSAs […]
The choice of payment model under MACRA should be informed by an in-depth assessment of the various potential financial impacts of each model that constitutes a viable option.
Just one year ago, the Centers for Medicare & Medicaid Services (CMS) announced the creation of a mandatory bundled payment program for major joint replacement: Comprehensive Care for Joint Replacement (CJR). Now, CMS has proposed regulations that add cardiac episodes as well as “other hip and femur procedures” to the list of mandatory bundles for […]
CMS wants more physicians to participate in ACOs and other alternative payment models (APMs). It’s best if they are risk-taking ACOs, but any ACO seems to be better than none. At least, that is what the incentives in MACRA seem to indicate. Prior to the passage of MACRA (the Medicare Access and CHIP Reauthorization Act […]
John M. Harris and Craig E. Holm describe howimplementation of MACRA bring significant strategic implications for hospitals and health systems as well and physicians.
Your selection of post-acute care (“PAC”) partners can make or break your value-based payment programs and care management initiatives. Even where fee-for-service is still dominant, having the right post-acute care partners can improve economic performance by reducing length of stay and minimizing acute care readmissions. Most health systems and hospitals do not own PAC facilities, […]
Many new revenue models—including accountable care organizations, bundled payments, and pay for performance—are intended to generate a pool of surplus/incentive funds. Often, this pool will be split between a hospital or hospitals and physicians, and then the physicians’ pool will be allocated among participating physicians. Part of developing a program under any new revenue model […]