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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

Pennsylvania helps Highmark and UPMC come to agreement on care of patients after 2015

The ongoing dispute between Highmark and UPMC in Pennsylvania had created considerably concern in the state over what would happen to patients with Highmark health plans who receive care from UPMC after 2015 when the contract between the two organizations ends.

HFMA survey: Strategy now beats competitive advantage as reason to merge

The pressure to control costs and manage risk-based payment systems is changing the reasons why healthcare providers merge finds a new survey of Healthcare Financial Management Association (HFMA) members.

4 factors expected to increase healthcare sector growth in 2015

For 2015, the PricewaterhouseCoopers (PwC) Health Research Institute (HRI) is forecasting an end to the five-year contraction in the $2.8 trillion health industry. It predicts medical cost growth of 6.8 percent, up from the 6.5 percent it projected for 2014.

Merger to create $3.8 billion Michigan healthcare organization moves forward

The three individual boards of Southeast Michigan’s Beaumont Health System, Botsford Health Care and Oakwood Healthcare unanimously approved a merger plan and the three healthcare systems’ leaders signed the definitive merger agreement this week.

Texas health system hits nerve by raising entry-level compensation with money from executive bonuses

When Dallas-based Parkland Health & Hospital System announced last week that it would bump up its entry-level pay to $10.25 per hour using the first pool of funds earned by executives as part of a new pay for performance plan, it tapped into a much larger national debate about executive pay, minimum wage levels and income disparity.

Surgery Partners to acquire Symbion in a $792 million deal that will create one of the nation’s largest ASC operators

The already rapidly changing ambulatory surgery center (ASC) market is getting hotter as Surgery Center Holdings Inc. (which does business as Surgery Partners) will acquire Symbion Holdings Corporation and create a company with roughly 100 healthcare facilities and complementary ancillary services in 27 states that combined treat more than half a million patients a year.

DOJ joins whistleblower suit against national hospitalist company

What makes the suit particularly notable is that it involves alleged upcoding of evaluation and management (E/M) claims, a practice that normally does not generate payment differences large enough to justify the time and effort of the Centers for Medicare and Medicaid Services (CMS) conducting audits on such claims.

Castlight finds wide variation in commodity-type medical services

While the complexity of medicine may never fully allow pure commodity economics in healthcare services, certain services, such as diagnostic imaging and laboratory tests, do lend themselves toward being shopped for as commodities. In theory, this should make such services more sensitive to price pressure. But that is not what San Francisco healthcare technology firm Castlight Health found when it examined four such services: low-back MRI, head CT, lipid panel and preventive primary care visit.

Hospital mergers and profits come under fire in Massachusetts

Massachusetts, the first state to enact a universal health insurance coverage law, may also be among the first to experience the political upheaval that could come with healthcare reform driven changes.

ValleyCare community hospitals to become Stanford affiliates

Academic giant Stanford Medical Center in Stanford, California, and ValleyCare Health System, based in Pleasanton, California, have signed a non-binding letter of intent that would make ValleyCare’s two community hospitals and outpatient facilities part of Stanford Hospital & Clinics.

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