Affordable Care Act, Alternative Payment Models (APM)

The MIPS Effect: A Surprise Twist in Estimating Medicare Payments for Clinicians Next Year

McDermott+ on 8/24/2023

As physician groups and other stakeholders work to finalize comment letters on the calendar year (CY) 2024 Physician Fee Schedule (PFS) proposed regulation by September 11, 2023, the Centers for Medicare & Medicaid Services...more

Stark Under the Microscope: Congress and HHS Examine Reform of the Stark Law for a Value-Based System

Bass, Berry & Sims PLC on 7/19/2018

On July 17, 2018, the U.S. House of Representatives' Ways and Means Committee Subcommittee on Health ("Subcommittee") expressed its commitment to modernizing the Stark Law during a hearing in which industry and government...more

Driving Health Care Efficiencies: Consolidate and Innovate, But Proceed with Caution

Brownstein Hyatt Farber Schreck on 3/20/2018

Despite the U.S. substantially outspending peer high-income nations with almost 18 percent of GDP dedicated to health care, on any number of statistical measurements from life expectancy to birth rates to chronic disease, the...more

2017 – The Health Law Year in Review

Bradley Arant Boult Cummings LLP on 1/25/2018

Uncertain. What better word to describe a year in which a new administration came to power and began to chart a new course for health policy, the fate of the Affordable Care Act (ACA) hung in the balance, and courts grappled...more

Manatt on Health: September 2017

Manatt, Phelps & Phillips, LLP on 9/13/2017

1332 Waivers Under Review at CMS - The Trump administration has approved one 1332 waiver to date, but four more are pending, including a sweeping Iowa waiver. Here is where things stand today...more

CMS Proposes QPP Revisions: The Paths for QPP Participation Continue to Evolve

Baker Donelson on 8/5/2017

CMS recently proposed modified policies for continued implementation of the Quality Payment Program (QPP) in the 2017 Proposed Rule. Among other things, the Proposed Rule provides flexibility for clinicians in the second QPP...more

AGG Takeaways from 2017 AHLA Health Care Transactions Conference

Arnall Golden Gregory LLP on 5/9/2017

The annual AHLA Health Care Transactions Conference provides valuable insights into transaction strategies, commercial developments, and legal issues affecting contemporary health care transactions, as well as unique...more

Insiders Say New MACRA Rule Likely as Providers Look to Sec. Price to Ease Burden

Mintz - Health Care Viewpoints on 5/2/2017

The Trump administration is considering releasing a rule to ease the burden that small practices are facing in trying to comply with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), according to a recent...more

Final Rule Implements Quality Payment Program under MACRA

Baker Donelson on 12/30/2016

If you are a physician, mid-level provider, or work with those providers, then you have been bombarded with new acronyms for new programs and promises to remove older acronyms from your Medicare vocabulary. Medicare...more

2016 Health Care Year in Review

Burr & Forman on 12/12/2016

Since I began writing this year-end review in 2013, there have been some common themes – a shift to pay for quality and away from fee-for service, much of which has been brought about by the Affordable Care Act (ACA): efforts...more

Health Update - November 2016

Manatt, Phelps & Phillips, LLP on 11/23/2016

Post-Election Analysis: Healthcare Antitrust in a Trump Administration - In a Republican sweep of all the elected branches of the federal government, Donald Trump won the presidential election and Republicans retained...more

Health Care Reform 2017: Substance, Process, and Timeline

Epstein Becker & Green on 11/23/2016

President-elect Donald J. Trump campaigned on a promise to “repeal and replace” the Affordable Care Act (“ACA”). For several years, the newly reelected Republican majority in Congress has likewise identified ACA repeal as a...more

Promise to Repeal the ACA Poses Threat to MACRA Implementation

Mintz - Health Care Viewpoints on 11/21/2016

Most of the post-election discussion of the ACA has focused on how promises to repeal the law could impact the newly insured. But one priority area of the ACA that has received very little discussion is the federal...more

The New Era of Health Care Reform

Locke Lord LLP on 11/16/2016

Welcome to the inaugural edition of The New Era of Health Care Reform which highlights important developments in health care reform under the Trump Administration. A FIRST LOOK AT HEALTH CARE PRIORITIES OF...more

Briefing Points for the Board: The Election and the 2017 Health Policy Agenda

McDermott Will & Emery on 11/15/2016

It is vitally important for the health system board, as well as certain of its key committees, to receive an introductory briefing as soon as possible on the health policy implications of last week’s Presidential and...more

Manatt on Health Reform: Weekly Highlights - November 2016

Manatt, Phelps & Phillips, LLP on 11/2/2016

Minnesota’s Governor and legislators propose financial assistance options for on- and off-Marketplace individual coverage; Vermont receives final federal approval for the country’s first all-payer ACO model; and a report...more

CMS Finalizes Sweeping Changes to Medicare Physician Payments

Holland & Knight LLP on 10/20/2016

The Centers for Medicare & Medicaid Services (CMS) on Oct. 14, 2016, released the highly anticipated Final Rule implementing the Medicare physician payment reforms enacted as part of the Medicare Access and CHIP...more

Corridors - October 2016 - News for North Carolina Hospitals

Poyner Spruill LLP on 10/5/2016

Proposed 2017 Hospital OPPS Rule Would End Medicare Payments to Many Off-Campus Facilities at the Same Levels as Hospital-Based Outpatient Departments - Published on July 14, 2016, CMS’s proposed 2017 Hospital...more

OIG Work Plan: A Roadmap to Identify Health Care Compliance Risk

McDermott Will & Emery on 9/7/2016

Each year, the US Department of Health and Human Services (HHS) Office of Inspector General (OIG) issues a Work Plan that summarizes new and ongoing OIG reviews and areas of focused attention for the coming year and beyond....more

Senate Committee Releases Report on Potential Stark Law Changes, Hearing Scheduled

Mintz - Health Care Viewpoints on 7/8/2016

On June 30, 2016, the Senate Finance Committee’s Republican staff issued a 20-page report discussing comments made by industry stakeholders after a December 2015 round-table on the future of the physician self-referral law,...more

Senate Finance Committee Examines Repeal of the Stark Law

Morgan Lewis on 7/7/2016

A new report suggests that the Stark law is obsolete in new payment models. On June 30, the US Senate Committee on Finance (the Committee) released the report Why Stark, Why Now? Suggestions to Improve the Stark Law to...more

OIG Mid-Year Updated Provides Insight To Its Concerns

Hinshaw & Culbertson LLP on 6/20/2016

The Office of Inspector General (OIG) recently released its mid-year update of its Fiscal Year Work Plan for 2016. The Work Plan summarizes new and ongoing reviews and activities that the OIG plans to pursue. Not...more

APMs, MIPS, and the Final MSSP Rule - The Journey from Volume to Value-Based Reimbursement Continues

Pierce Atwood LLP on 6/20/2016

Since the Affordable Care Act was enacted, many providers have been shifting away from traditional fee-for-service, volume-based reimbursement models to payment mechanisms that take a data-driven approach to managing patients...more

Health Care Update - February 2016

Mintz - ML Strategies on 2/16/2016

Are Lawmakers and Stakeholders Ready for the Silver Tsunami? - Last week, the Congressional Budget Office (CBO) released a projection that shows Medicare enrollment will grow by more than 30 percent in the next decade...more

2015 Health Care Year in Review

Burr & Forman on 12/17/2015

In 2015, ICD-10 finally became a reality, and the dire predictions of problems seem to be wrong. Providers now have codes to describe just about every conceivable (and a few simply bizarre) medical occurrences. If a patient...more

Patient Protection and Affordable Care Act (PPACA) › Alternative Payment Models (APM)

"My best business intelligence, in one easy email…"