Should I stay or should I go? If I go there will be trouble And if I stay it will be double. -The Clash In the next several months, more than 200 Medicare Shared Savings Program (MSSP) ACOs face a big decision. What had looked like a simple choice to “stay or go” will be […]
As a Zen master might say, “Change must come from within.” Everybody can point to fundamental problems with healthcare delivery, especially for low-income populations. But managed-care rewards and penalties and other efforts have not been enough to transform the delivery system. New York State is working to encourage “change from within” through its Delivery […]
The number of physician-led ACOs is growing faster than the number of hospital-physician ACOs. Increasing numbers of physician groups are evaluating bundled payment arrangements. Payers are working directly with physicians on patient-centered medical homes (PCMHs). It appears that physician-led accountable care initiatives are here to stay. In some markets, physician-led networks may compete successfully by […]
The pilot phase of the Bundled Payment for Care Improvement (BPCI) initiative has attracted 467 participants, according to the Centers for Medicare and Medicaid Innovation (CMMI). The great majority of these organizations will probably continue to participate when the performance period begins around July. BPCI offers these organizations an opportunity to learn how to better […]
If you are like many hospital finance leaders, you are probably still deciding how intensely you want to pursue the many new revenue models—such as ACOs, bundled payments, value-based payments, risk sharing. Even if you are undertaking the complex financial analysis of these contracts, along the lines described in the cover story for the April […]
New value-based payment models, including bundled payments and shared savings ACOs, will affect hospital and health system operating revenues and earnings (see “The Transition to Emerging Revenue Models,” hfm, April 2013). They will also create new demands for capital. It’s not about bricks and mortar; it is all about infrastructure requirements, working capital and […]
One of the biggest risks for healthcare CFOs right now is underestimating the extent to which payer contracting has become intertwined with every aspect of organizational strategy. Life was simpler in the old days. If a hospital CFO could negotiate substantial increases from private payers, and Medicare increases were reasonable, life was good. Sure, there […]
Hospitals have traditionally been unable to share savings with independent physicians for fear of setting off legal alarm bells—Stark, anti-kickback, and private inurement. This concept was so hardwired into the minds of health system executives that when some exceptions became possible through Medicare accountable care and bundled payment programs, everyone was skeptical. Now, the […]
With the first quarter of performance data released for Medicare’s Bundled Payment for Care Improvement (BPCI) initiative, participants are in one of two camps: relieved that they saved money, or wondering if they can really reduce costs of care in the area they selected. Among the organizations we have observed directly, all were able […]
Results have come in for the first performance year of Medicare’s Bundled Payment for Care Improvement (BPCI) program. Providers are taking stock of successes and identifying areas for improvement.