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A bonus of up to 10 percent has been proposed for using an upgraded electronic health record (EHR) system for reporting in the Merit-based Incentive Payment System (MIPS) in 2018, but speakers at two recent industry conventions warned it’s likely not a worthwhile investment for providers.

When the previous administration at CMS finalized rules on mandatory bundled payment models for cardiac and orthopedic care late in 2016, 221 public comments were received. The cancellation of those same bundles, however, drew only 85 official comments as of Oct. 18.

Four accountable care organization (ACO) models generated more in gross savings in 2016, but unlike in previous years, CMS hasn’t publicly touted the results as it re-examines payment models created under the Centers for Medicare and Medicaid Innovation (CMMI).

The U.S. Department of Justice (DOJ) has abandoned a lawsuit against UnitedHealth over allegations the insurer submitted false claims in its Medicare Advantage plans, though a similar case remains active.

Private investors are becoming increasingly active in healthcare acquisitions, which may maximize the purchase price when practices decide to sell, but there are downsides to these transactions compared to be absorbed into a hospital or health system.

 

Recent Headlines

Moody’s: Despite ACA uncertainty, health insurers’ outlook stable

U.S. health insurers maintained a stable outlook in the latest report from Moody’s Investor Service, with the rating agency expecting insurance companies “will continue generating solid results owing to disciplined medical management and moderate medical cost trends.”

UPMC buys 50% stake in Rome hospital

University of Pittsburgh Medical Center (UPMC) has expanded its operations in Italy, buying a 50 percent stake in the 75-bed Salvator Mundi International Hospital in Rome and taking over clinical operations.

What states would lose under Graham-Cassidy ACA repeal

If the Graham-Cassidy proposal is passed by the Senate, most states would lose funding compared to what they be paid under the Affordable Care Act (ACA) in 2020, as the ACA’s insurance subsidies and Medicaid expansion funding would be turned into a fixed block grant. Over a 20-year period, healthcare funding to states will be reduced by $4 trillion, according to Avalere Health.

Anthem to buy Medicare Advantage insurer HealthSun

Insurance giant Anthem has announced it will acquire Florida Medicare Advantage plan HealthSun, which could add 40,000 members from the Miami metropolitan area to Anthem’s affiliated Medicare and Medicaid plans in the state.

University of Texas, Ardent Health to acquire 10-hospital system in joint venture

The East Texas Medical Center (ETMC) Regional Healthcare System will be acquired by a new joint venture between Nashville-based Ardent Health System and the University of Texas (UT) System, the two announced in a Sept. 13 press release, with Ardent assuming control of day-to-day operations.

5 reactions to proposed 2018 Physician Fee Schedule

The comment period for the proposed Medicare Physician Fee Schedule (PFS) has closed, with policy and payment updates drawing a typically mixed reaction from stakeholders within the industry.

Centene buying New York’s Fidelis Care for $3.75B

Health insurer Centene announced on Sept. 12 it had entered into a definitive agreement to buy Fidelis Care, the leading Medicaid managed care insurer in New York, for $3.75 billion.

1 in 6 practices paying fees for receiving electronic payments

One-sixth (17 percent) of physician practices responding to a Medical Group Management Association (MGMA) poll said they’re paying fees from 2 to 5 percent for receiving payments electronically—a practice the MGMA wants CMS to prohibit.

UnitedHealth in talks to buy Chilean insurer Banmedica

UnitedHealth Group, the largest health insurer in the U.S., is considering acquiring Banmedica, an insurer based in Chile, for an undisclosed amount.

UPMC credit downgraded on risk of PinnacleHealth acquisition

The University of Pittsburgh Medical Center (UPMC) saw its credit rating downgraded by Moody’s Investor Service, along with maintaining a negative outlook on the system, citing its “accelerated expansion and high execution risk” with the acquisition of the seven-hospital PinnacleHealth System.

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