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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

Team-based approach needs 63% percent capitation to be viable in primary care

Sixty-three percent capitation would needed in order to make population health management, including team- and non-visit-based services, financially viable for a primary care practice.

Hospital spending growth falls to 28-year low

Between June 2016 and June 2017, hospital spending grew by 0.8 percent, according to revised economic indicators data posted by the Altarum Institute.

Tenet selling more hospitals amid discussion of company break-up

Tenet Healthcare announced it will sell eight hospitals in the U.S. and its nine hospitals and clinics in the United Kingdom, yielding up to $1 billion for the company, though breaking up the company’s three main business lines is also a possibility, according to outgoing CEO Trevor Fetter.

Washington hospital sued for allegedly withholding charity care

St. Joseph Medical Center in Tacoma, Washington, has been sued by the state’s attorney general for allegedly instructing employees not to mention the availability of charity care to patients, even when they were “obviously low-income or homeless.”

Insurers can match bargaining power of consolidated providers but consumers don’t benefit

In markets where both insurers and providers have become highly concentrated, insurers had enough bargaining power to reduce prices on hospitalization and certain specialty care. Those savings were not, however, passed onto consumers in the form of lower premiums.

Carolinas HealthCare to merge with UNC Health

Charlotte-based Carolinas HealthCare System, already the largest health system in North Carolina, has announced plans to grow even bigger by creating a joint venture with University of North Carolina (UNC) Health Care.

Advocate 'actively exploring' acquisitions, affiliations after 42% drop in operating income

Second quarter financials for Downers Grove, Illinois-based Advocate Health Care showed a 41.8 percent year-over-year drop in operating income, which fell to $47.4 million.

UnitedHealth buys Advisory Board’s healthcare division as part of $2.6B deal

The Advisory Board Company has announced a $2.6 billion deal which will see UnitedHealth Group’s Optum health services segment take over its healthcare business.

CMS asked to delay cuts to Medicaid DSH payments

The American Hospital Association (AHA) and dozens of doctors and hospitals have asked CMS to delay proposed cuts to Medicaid disproportionate share hospital (DSH) payments, arguing reductions would hamper safety-net hospitals and criticizing how the payments would be calculated.

Northwell Health to shut down its insurance business

The largest hospital system in New York, Northwell Health, announced it will wind down operations of its CareConnect insurance division due to financial losses caused by the Affordable Care Act’s risk adjustment program.

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