Tag Archives: fee-for-service

New rules govern how health care providers partner with payers

Since the Patient Protection and Affordable Care Act was signed in 2010 there has continued to be some uncertainty about how healthcare reform will evolve. However, most  large health care organizations agree that value-based care is here to stay. They invested in robust technologies and began implementing population health management strategies. The market’s smaller players […]
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Blinkers on: It’s time to move into the value-based care fast lane

Providers and payers are converging and seeing new opportunities to collaborate to improve care quality and control costs under new value-based care models.  Increasingly, providers are evolving to take more accountability for cost of care and patient outcomes—issues historically laid at payers’ feet. However, providers must continue to operate in a fee-for-service environment while transitioning […]
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Analytics provides “one report card” for physicians

In today’s health care, there are a lot of players – and a lot of payers, each with their own standards for evaluating physicians and the care they provide. As Greg Kile, CEO of the analytics firm Populytics, explains in an Optum® video, his company’s top 10 payers have 176 different metrics. Being washed over […]
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MACRA is big for doctors. What about hospitals?

With the Medicare Access and CHIP Reauthorization Act replacing the sustainable growth rate, changes are coming for physicians. But will MACRA impact facility providers? Consultants at Optum say yes. Specifically they say hospitals and health systems should prepare for changes to referral patterns and readmission rates. Jay Hazelrigs, vice president and lead actuary at Optum, […]
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Confirm patients’ medical memories to develop complete health histories

Can you remember what you wore to work last Thursday? How about what you had for lunch yesterday? We humans aren’t particularly great at recalling details. Study after study shows it. Colonoscopy patients don’t remember details of their procedures when more than a year has passed, according to a report in Healio. How about hip […]
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Who should make up the team that directs your move to accountable care?

As the U.S. health care system moves away from reimbursement models that reward volume and toward those that reward care coordination – traditional industry roles are blurring. • New #5in5 video: Fee for value requires revised relationships As this integration accelerates, organizations must build new governance structures that can provide strategic direction and accountability. That […]
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Not perfect, but practice makes progress for ACOs

Recently released results of the Medicare Shared Savings Program (MSSP) highlight the fact that Accountable Care Organizations need to be in it for the long haul. In August, the Centers for Medicare & Medicaid Services issued an update announcing that participating ACOs continue to show improvements in their ability to contain costs. Three hundred and […]
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Understanding a new, mandatory payment model

As the health care industry moves toward population health management, providers and payers are working to determine which value-based reimbursement models show the most promise. The Centers for Medicare and Medicaid Services gave the bundled payments a boost this year by making the model mandatory for a number of hospitals — first for hip and […]
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Monitor these metrics to find revenue leaks

Tracking, explaining and plugging gaps in your revenue cycle is tough enough without the added challenge of practice acquisitions and mergers. Joining two systems means standardizing and streamlining policies that may differ greatly from each other. As consolidation work takes place, health systems can pay close attention to certain metrics to help identify revenue leaks. […]
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Roadmap to partnership: Keys to identifying the best revenue cycle partner for you

After careful scrutiny of productivity, processes and technology costs, many CFOs see the value in partnering with an external company that can take over day-to-day revenue cycle operations. Such a partner is built for revenue cycle management (RCM) and can likely do it better than most hospitals or health systems. For CFOs, it may make […]
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