Value-Based Purchasing

News & Analysis as of

An Examination of Fee-Splitting Statutes in the Context of Value-Based Health-Care

One of the goals of the Affordable Care Act is to align incentives among provider communities and their patients and partners. This effort to create communities of common interest with mutually beneficial incentives is now a...more

CMS Call: Medicare Acute Care Quality and Reporting Programs (May 12)

On May 12, 2015, CMS is hosting a call that will provide an overview of all Medicare hospital inpatient quality reporting and value-based purchasing programs. Specifically, the call will cover: the Hospital Inpatient Quality...more

CMS Releases Proposed IPPS Rule

On April 17, 2015, CMS released a copy of its proposed changes and updates to the Medicare inpatient prospective payment system (IPPS) for fiscal year 2016. The official version appears in the April 30th Federal Register, and...more

"Cutting-Edge Analysis Can Help Companies Leverage Patent Opportunities, Avoid Risks"

There is no shortage of new developments involving patents these days — from legislative initiatives in Congress to a host of recent U.S. Supreme Court decisions — and making sense of these changes and their impact on patent...more

CMS Proposes FY 2016 Update to SNF PPS Rates, Policies

On April 20, 2015, CMS published its proposed rule updating Medicare skilled nursing facility (SNF) PPS rates and policies for FY 2016. CMS projects that the proposed rule would increase overall payments to SNFs by $500...more

CMS Posts Initial Results for Physician Value-based Payment Modifier

Under the ACA, the Physician Value-Based Modifier (Value Modifier) policy rewards physicians and groups of physicians who provide high quality and cost effective care, while penalizing those who did not meet objectives. ...more

CMS Takes a Measured Approach to Medicare Advantage and Part D Plan Payment Rates and Policy Changes for 2016

Increased Part D Drug Costs Set the Stage for Higher Beneficiary Premiums - The Advance Notice (“Advance Notice”) of Methodological Changes for Calendar Year (“CY”) 2016 for Medicare Advantage (“MA”) Capitation Rates,...more

Shifting to Value-Based Reimbursement

The Blue Cross Blue Shield Association released an interesting survey over the summer (July 2014) that provides further evidence of the change that is now happening in the American healthcare delivery system....more

Early Report on Value-Based Purchasing: Less to It Than Meets the Eye?

Medicare’s Value-Based Purchasing (VBP) program produced no improvement in either quality of care or patient satisfaction during its first nine months of operation. That’s the finding of a study led by Andrew Ryan, of the...more

Oh Baby: Medicare Wants to Focus on Early Elective Deliveries

Deep within the proposed FY 2015 Inpatient Prospective Payment System (IPPS) rule released a few weeks back is an interesting proposed new measure to the Medicare hospital Value-Based Purchasing (VBP) program – elective...more

CMS Outpatient and Physician Payment Rules: Don't Miss the Efficient Quality of Care Reform Forest for the Dollar Trees

The final physician fee schedule (PFS) and hospital outpatient department payment rules for FY 2014 clearly signal the continued intent by the Centers for Medicare and Medicaid Services (CMS) to transform the healthcare...more

CMS Releases CY 2014 Hospital OPPS and ASC Final Rule

CMS has published its Calendar Year (CY) 2014 Final Rule for Medicare policy and payment rates for hospital outpatient prospective payment systems (OPPS) and Ambulatory Surgical Center (ASC) services. This final rule with...more

CMS Announces Bonuses and Penalties for 2014 VBP Program Ranging from +0.88% to -1.14%

CMS posted a list on its website of the 2014 bonuses and penalties applicable to each subsection (d) hospital participating in the value-based purchasing (VBP) program. The posted rate increases or reductions are effective...more

CMS Releases FY 2014 Hospital IPPS Final Rule

On August 2, 2013, CMS released the annual Hospital Inpatient Prospective Payment System Final Rule for FY 2014 (the “Final Rule”), effective for discharges occurring on or after October 1, 2013....more

Homeless Readmissions In Los Angeles – A Community Acts

After years of planning and in response to the reality of cuts from Medicare due to excessive readmissions, more than 30 Southern California hospitals and health systems and other providers gathered on June 10, 2013 to kick...more

CMS Provides Progress Report to Senate Finance Committee on Healthcare Reform Efforts, Highlighting Decrease in Hospital...

On February 28, 2013, the acting principal deputy administrator and director of CMS, Jonathan Blum, provided a progress report to the Senate Finance Committee on CMS’s efforts to reform the healthcare delivery system,...more

What Hospitals Should Know About Payment Changes For 2013

In response to the government’s continued focus on improving quality of care through payment policy, several changes to new and existing regulatory requirements recently came about through the 2013 Inpatient Prospective...more

Medicare Program Issues Proposed Rule for Acute and Long-Term Care Hospital Inpatient Prospective Payment Systems for Fiscal Year...

On May 11, 2012, the Centers for Medicare and Medicaid Services (CMS) published in the Federal Register a proposed rule that would, among other things, update payment policies and rates for acute care hospitals paid under the...more

The Hospital Medical Staff of the Future Webinar Series, Part III: The Jigsaw Puzzle: Credentialing and Privileging Providers in...

In this presentation: - Overview of New Alignment Initiatives - Board of Directors oversight of new Performance Standards - Review Methods for Credentialing/Privileging Providers using New...more

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