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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

Annual IT costs as high as $19,000 per doctor for some practices

In 2016, physician-owned practices spent between $2,000 and $4,000 more on IT expenses per full-time-equivalent (FTE) physician, according to Medical Group Management Association’s (MGMA) annual DataDive Cost and Revenue Survey.

Q&A: Avalere finds most ACOs would benefit from taking on downside risk with APM bonus

If the 5 percent bonus payment in the Advanced Alternative Payment Model (APMs) track was available in 2015, accountable care organizations (ACOs) would’ve earned additional net payments of $886 million if they had assumed downside risk under the Medicare Shared Savings Program (MSSP).

M&A activity increased among larger systems in 2nd quarter

Thirty-one partnership transactions among hospitals and health systems were announced in the second quarter of 2017, and 58 have been announced so far this year, according to an analysis on merger and acquisition (M&A) activity by Skokie, Ill.-based consulting firm Kaufman Hall.

Physician compensation up nearly 3%; productivity, collections flat as costs rise

Most doctors saw a similar increase in compensation last year as they had in 2015, with an average raise of 2.9 percent across all specialties reported in the American Medical Group Association’s (AMGA) annual medical group compensation and productivity survey. Productivity, however, remained flat, and the move to value-based incentives in compensation continues to be slower than anticipated.

Urgent care operator American Family Care lands $1B investment

Private equity and real estate firm American Development Partners has agreed to invest $1 billion into American Family Care, the largest operator of urgent care centers in the U.S, to accelerate its expansion plans.

Recognizing Medicare Advantage as Advanced APM supported by members of Congress

24 members of the U.S. House of Representatives have written CMS asking the agency to include risk-based Medicare Advantage (MA) arrangements to count towards requirements for Advanced Alternative Payment Models (APMs) under the Quality Payment Program (QPP).

5 things to know about 2018 physician fee schedule, OPPS proposed rules

CMS has released its proposed rules for the 2018 Physician Fee Schedule (PFS), Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System, with the biggest change being halving the Medicare reimbursement for off-campus services.

House’s HHS budget defies Trump on NIH funding, keeps ONC cuts

President Donald Trump had proposed a 16 percent cut across HHS in his budget blueprint for fiscal year 2018, but the Republican majority on the House Appropriations Committee added $14.5 billion over his request in its own budget proposal released on July 12.

Q&A with Experian exec: Embrace payment plans before going to collections

Jason Considine, senior vice president of patient collections and engagement at Experian Health, argued at the Healthcare Financial Management Association (HFMA) conference in Orlando that providers should first rely on leveraging data and crafting flexible payment options before paying any contingency fees to collectors. He spoke with HealthExec about mistakes providers are making with their collection practices and what data they need to improve the process.

Insurers see record earnings on ACA exchange plans in Q1 2017

Insurance companies earned an average of $298 per member in plans offered on the Affordable Care Act (ACA) marketplace in the first quarter of 2017, the best first quarter performance since the exchanges opened.

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