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May 31 Deadline for 2018 Medicare Shared Savings Program

An organization interested in participating in the Medicare Shared Savings Program (MSSP) as an accountable care organization (ACO) must file a non-binding Notice of Intent to Apply (NOIA) by 12 Noon EDT on Wednesday, May 31, 2017.  Only those organizations that file a NOIA will be permitted to file an MSSP application, which will be … Continue Reading

MIPS Reporting: Getting Off on the Right Foot

A physician who did not report performance on quality measures to the Physician Quality Reporting System (PQRS) for 2015 now faces a 6% penalty on all Medicare Part B payments.  The same penalty will apply in 2018 for physicians who do not report performance for 2016. In addition to PQRS penalties, a 3% penalty now … Continue Reading

What to Expect from Telehealth in 2017

With the rise of consumerism in healthcare, and with providers and payers seeking greater efficiency, the age of telehealth now is dawning.  Market analysts project the telehealth market will grow from $2.78 billion in 2016 to $9.35 billion in 2021–more than a 333% increase over five years. The term “telehealth” refers to the provision of … Continue Reading

Key Provisions of the 21st Century Cures Act

With the focus on the future of the Affordable Care Act, the most recently enacted federal healthcare law—the 21st Century Cures Act—is getting less attention than it deserves.  The Cures Act, which weighs in at 312 pages, gained passage in both chambers by wide margins (392-26 in the House, 94-5 in the Senate) and was … Continue Reading

Optimizing Your MIPS Score: Quality Measure Benchmarks and Reporting Mechanisms

The Medicare Quality Payment Program has officially launched, meaning most physicians (and most non-physician practitioners) now are in the initial performance period under the Merit-Based Incentive Payment System (MIPS).  With 60% of the MIPS composite score based on quality measures, the selection of the most appropriate measures, and the manner in which to report, is … Continue Reading

Has the ACA Been Trumped? Only Halfway

Presidential candidate Donald Trump promised that “[o]n day one of the Trump Administration, we will ask Congress to immediately deliver a full repeal of Obamacare.”[1]   President-elect Trump now has signaled a willingness to retain a few popular provisions (e.g., coverage for pre-existing conditions), but it seems likely Obamacare will be replaced with some form of … Continue Reading

Our Top Ten PQRS Reporting Readiness Tips

It has been a busy fall for physicians with the publication of the new Quality Payment Program (QPP) Final Rule and the 2017 Medicare Physician Fee Schedule (MPFS) Final Rule, the release of the 2016 Quality Resource Utilization Reports (QRURs), and the announcement of the Physician Compare preview period.  In addition, many physicians now are … Continue Reading

Ambulatory Care Management Programs: New Revenue Opportunity for Specialists

Ambulatory care management programs generally are viewed as services offered by primary care providers.  However, specialists – oncologists, urologists, rheumatologists, cardiologists, pulmonologists, to name a few – caring for patients with chronic conditions should evaluate this opportunity. By providing patient education, performing medication reconciliation, and arranging for support services, clinical staff bring care outside the … Continue Reading

2017 OPPS Proposed Rule: 4 Things to Know and 4 Things to Think About Regarding Site-Neutral Payments

The recently published 2017 Outpatient Prospective Payment System (OPPS) Proposed Rule provides additional information regarding the site-neutral payment provisions included in Section 603 of the Bipartisan Budget Act of 2015. The Proposed Rule explains certain aspects of the provisions that will prohibit newly established off-campus hospital outpatient departments (HOPDs) from billing services and receiving payments … Continue Reading

Strong leaders – and cultures – start with self-awareness

During a session on great leadership at the Becker’s Hospital Review Annual Meeting in Chicago last Friday, four prominent healthcare executives talked about the characteristics of contemporary leaders and how they contribute to a multidisciplinary, team-based culture that is essential for success. Especially notable were insights from Pamela Stoyanoff, executive vice president and COO of … Continue Reading

The dangers of pursuing the “silver bullet”

In her remarks at the ninth annual World Congress on Health Care, Shari M. Ling, MD, deputy chief medical officer of the Centers for Medicare and Medicaid Services wisely pointed out that there is “no silver bullet” to achieve better value. As reported by Fierce Healthcare associate editor Alicia Caramenico, Dr. Ling emphasized, “When we start to talk … Continue Reading

The Ultimate Compliment

It was almost nine o’clock in the evening when I finally arrived at my hotel from a long day of meetings and travel in preparation for the full-day workshop I would lead the next day. I was tired, but I was also hungry. I asked the front-desk clerk as I checked in if there was … Continue Reading

Buy and Employ Transactions – Part 2: Buyer’s Side Due Diligence

As mentioned in my last post, hospitals are increasingly buying physician practices and then entering into productivity based employment arrangements with the individual physicians. These buy and employ transactions generally make good business sense for both the hospital and physician(s) but also include certain risks – especially for the hospital. Accordingly, an appropriately structured “buyer’s … Continue Reading

Buy and Employ Transactions: Part 1

Hospitals are increasingly entering into “buy and employ” transactions with key physicians as part of their strategy to provide high quality patient care and grow market share. This buy and employ model is where the hospital acquires the medical practice and then employs the physician(s) – generally under some type of productivity based compensation arrangement. … Continue Reading
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