Value Based Payment

Site-neutral payment and the battle for healthcare’s soul

In  a remarkable and surprising show of bipartisanship, the U.S. House of Representatives passed the Lower Costs, More Transparency Act on Dec. 11, 2023, by an overwhelming 320-71 vote. Avoiding hyperbole, the act lives up to its name. It seeks to equalize Medicare payment for the same drugs administered in the same way, whether in…

David W. Johnson May 22, 2024

CMS calls for hospitals to be subject to a new bundled payment model and data-reporting requirements

Notable policies in Medicare’s FY25 proposed rule for inpatient hospital care and long-term care hospitals include the formation of a mandatory bundled payment model and requirements for hospital data reporting. Although the proposed payment rate was the headlining aspect of the rule for hospitals, the policy developments could have a longer-term impact on segments of…

Nick Hut April 16, 2024

Insurers see reasons for concern as CMS keeps the Medicare Advantage purse strings tight for 2025

Medicare Advantage (MA) faces the prospect of constrained revenue and payments for participating stakeholders after CMS finalized what amounts to a small decrease in the 2025 payment rate. Average revenue for MA plans is projected to increase by 3.7%, or more than $16 billion — but that’s primarily because of a prospective increase in the…

Nick Hut April 4, 2024

Responses to a new RFI will help guide regulations addressing consolidation and private equity in healthcare

The Biden administration is ramping up its assessment of how to regulate consolidation and private equity (PE) acquisitions in healthcare, issuing a request for information (RFI) from stakeholders. There is a deadline of May 6 to submit comments on the RFI, which was distributed by HHS, the Department of Justice (DOJ) and the Federal Trade…

Nick Hut March 13, 2024

Most healthcare organizations will embrace two-sided value-based care models in 2024, but many do not have clearly defined protocols to assess new opportunities

Read this article for various lessons and questions to consider before entering a value-based care contract.

HFMA January 30, 2024

Why providers are struggling to succeed under value-based care

An obvious question that has often been overlooked in the rush to promote value-based care (VBC) is whether providers are equipped to navigate the transition from volume to value. Findings of a survey of providers and payers published in September suggest that there are reasons for concern.a Many providers report that capability gaps are negatively…

Richard Jackson January 26, 2024

In Congress, it’s status quo for Medicaid DSH payments and the Medicare physician fee schedule

Yet another short-term federal funding measure from Congress included yet another brief extension of full funding for Medicaid disproportionate share hospital (DSH) payments. With funding for much of the federal government set to expire Jan. 19, Congress agreed on a continuing resolution that keeps all agencies fully operational until March. Medicaid DSH payments are guaranteed…

Nick Hut January 22, 2024

Key Senate committee takes a close look at healthcare waste and prices

The U.S. Senate is intent on finding ways to improve the value of healthcare, according to takeaways from a recent hearing of the Budget Committee. Although other committees and subcommittees in both chambers of Congress have held meaningful hearings about healthcare policy and costs this year, the Budget Committee’s attention to the matter is especially…

Nick Hut December 7, 2023

10 Keys to Restoring Trust in Healthcare

The issue of restoring consumer trust in the U.S. healthcare system encompasses a wide range of concerns. Factors in the perceived loss of trust include anxiety and confusion over costs, entrenched inequity, a glut of misinformation about vaccines and other treatments, and data and privacy breaches. To examine the problem and explore solutions, HFMA’s 16th…

Nick Hut December 7, 2023

Dennis Dahlen: Are states losing patience with the pace of healthcare value transformation?

The pace of state-based regulation and oversight of healthcare providers is accelerating — and it could be an indication that patience is growing thin with federal, payer and provider efforts to improve healthcare value.  Across the nation, we’re seeing a growing number of states adopt healthcare affordability boards. It’s a trend that started to pick…

Dennis E. Dahlen, FHFMA, MBA, CPA October 30, 2023
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