News & Analysis as of

Alternative Payment Models (APM)

CMS Releases Innovation Center New Direction RFI Feedback and Issues New RFI for Direct Provider Contracting

Last fall, the Centers for Medicare & Medicaid Services (CMS) announced a new direction for its Center for Medicare & Medicaid Innovation, CMS’s platform for testing innovative models for delivering high-quality care at lower...more

Direct Provider Contract Alternative Payment Model - CMS/CMMI Issues Request for Information

by Foley & Lardner LLP on

On April 23, 2018, the Center for Medicare and Medicaid Innovation issued a Request for Information (the RFI) on a direct provider contracting model for primary care. The RFI seeks input on how direct provider contracting...more

Direct Primary Care Legislation Continues its Roll Across the Country: Florida Governor Rick Scott signs Florida House Bill 37,...

Direct Primary Care. Direct primary care (DPC) is a style of clinical practice in which a healthcare provider (usually a physician or a physician group) offers primary care services to patients who pay a monthly membership...more

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

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

6 Key Takeaways for Providers on BPCI-Advanced (Value-Based Medicare Payment)

by Foley & Lardner LLP on

Despite some initial difficulty in gaining momentum, the use of value-based payment methodologies will likely increase across all provider niches. This change is partly a function of cost savings driven by margin compression...more

Post-Acute Care Providers Ponder Role in BPCI Advanced

by Baker Ober Health Law on

As CMS's approach to Alternative Payment Models continues to evolve, most recently with the release of BPCI Advanced, post-acute care providers may be left scratching their heads as they try to determine where they fit. An...more

MACRA: Rolled Out and Still Rolling

by Burr & Forman on

Most physicians have, by this point, gained some familiarity with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The name of this law has appeared frequently in commentary over the past several years, and...more

2017 – The Health Law Year in Review

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

CMS Announces an Advanced Alternative Payment Model - BPCI Advanced

by Foley & Lardner LLP on

On January 9, 2018, The Centers for Medicare & Medicaid Services (CMS) announced a new voluntary bundled payment model program – Bundled Payment for Care Improvement Advanced (BPCI Advanced). The episode payment model, which...more

CMS Proposes New Voluntary Bundled Payment Model

by Holland & Knight LLP on

On January 9, the Centers for Medicare and Medicaid Services (CMS) announced a new voluntary bundled-payment demonstration program, also known as Bundled Payments for Care Improvement (BPCI) Advanced. The new model will test...more

CMS Announces First Advanced Alternative Payment Model Under MACRA: Bundled Payments for Care Improvement Advanced

On January 9, 2018, the Centers for Medicare & Medicaid (CMS) Center for Medicare and Medicaid Innovation announced a new voluntary bundled payment model called Bundled Payments for Care Improvement Advanced (BPCI Advanced). ...more

CMS Publishes Final Rule to Cancel Medicare Episode Payment and Cardiac Rehab Incentive Payment Models, and to Cut Back Joint...

by Seyfarth Shaw LLP on

This is the first in a series of alerts from Seyfarth’s Health Law practice highlighting significant changes in health care regulations and policy as providers and other industry participants enter 2018. ...more

CMS Quality Payment Program: Are you ready for round two?

by Bricker & Eckler LLP on

2018 marks the commencement of the second performance year for the Medicare Quality Payment Program (QPP), implemented under the Medicare Access and CHIP Reauthorization Act of 2015 (otherwise known as MACRA). ...more

MACRA Final Rule Continues Gradual Transition and Provider Flexibility for 2018

by Baker Donelson on

On November 2, the Centers for Medicare and Medicaid Services (CMS) released the final rule implementing policies for Year 2 (2018) of the Quality Payment Program established under the Medicare Access and CHIP Reauthorization...more

“We’re Listening” – CMS Issues Final Rule For Year 2 Of The Quality Payment Program And Highlights Efforts To Continue...

by Pierce Atwood LLP on

On November 2, 2017, CMS issued the final rule with comment for the second year (2018) of the Quality Payment Program as well as an interim final rule. Continuing with its theme of a CMS that is “listening to feedback,” CMS...more

Year 2 in the QPP: A Regulatory Update

by Polsinelli on

On November 2, 2017, the Centers for Medicare and Medicaid Services (CMS) released the 2018 Quality Payment Program (QPP) Final Rule. The Final Rule contains notable changes that may affect smaller practices participating in...more

Health Care Weekly Preview from ML Strategies – November 2017

Following House passage of a CHIP reauthorization package, the bill heads to the Senate where it faces an uncertain path forward. First, there’s no indication the Senate is ready to give the House package real consideration....more

CMS Addresses Lingering Uncertainties and Raises Others via MACRA Information Blocking Guidance

The Centers for Medicare & Medicaid Services (CMS) recently issued guidance intended to help clinicians eligible for the Merit-based Incentive Payment System (MIPS) navigate an attestation required thereunder concerning the...more

CMMI Requests Ideas to Spur Innovation and Reduce Burden

by Polsinelli on

The Center for Medicare & Medicaid Innovation (CMMI) is seeking ideas on how to better drive change and reduce regulatory burden. CMMI solicited ideas to shape the agency’s future activities through a September 2017 “request...more

Value-Based Contracting for Prescription Drugs and Medical Devices: An Innovative Solution Impaired by Outdated Regulations

by Pepper Hamilton LLP on

Often lost in the cacophony of headlines surrounding rising health care costs is the promise that value-based contracting offers as a possible solution. In contrast to the traditional fee-for-service model, value-based...more

CMS Proposes Cancellation of Bundled Payment Initiatives

by Arnall Golden Gregory LLP on

On August 15, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule (the “Proposed Rule”) that, if finalized, would (A) cancel the mandatory Episode Payment Models (“EPM Models”) and Cardiac...more

Manatt on Health: September 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

MACRA Update: How to Prepare for Changes in MIPS

As we reported last month, CMS’ proposed rule updating MACRA’s Quality Payment Program (“QPP”) for CY 2018 would extend and expand exceptions that would allow many practitioners to avoid participating in its Merit-based...more

[Event] Legal Pricing Masterclass - October 24 & 25, Atlanta, Ga

by LawVision Group LLC on

Please join Colin Jasper to learn how to get greater value from your clients by improving your pricing strategy, positioning and conversations. Colin is a world leading consultant on this topic and LawVision and the Legal...more

Final Rule for MACRA's Second Year (2018) Expected in November 2017

by Baker Donelson on

On June 20, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule entitled, "Medicare Program; CY 2018 Updates to the Quality Payment Program." CMS proposed changes for the second year (2018) of the...more

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