You are here

Finance

 

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

HFMA 2017: Affiliations, not acquisitions, may be path to value-based care

Transitioning to value-based care and taking on risk is often cited as one of the drivers of the consolidation trend throughout healthcare. Some systems, however, are beginning to look at partnerships more “holistically,” according to Kaufman Hall managing director Anu Singh, MBA, by pursuing creative affiliations to enhance their capabilities rather than a merger or acquisition.

HFMA 2017: Experian’s Nicole Rogas says systems risk ‘financial distress’ if married to old RCM ways

An ever-changing world of reimbursement can be frustrating for those involved in revenue cycle management (RCM). Being too set in your ways to change, however, is one of the most common strategic mistakes seen by Nicole Rogas, MBA, senior vice president of sales at Experian Health.

HFMA 2017: Patientco’s Alan Nalle on how predictive modeling can improve patient billing

Predictive modeling has been shown to help providers assess patient risk for a variety of conditions—which is how the vast majority of hospitals and health systems have been utilizing it.

The hot topics of HFMA 2017

In a year with new payment tracks for Medicare, additional bumps in the road on the path to value-based care and—potentially—an overhaul of health insurance coverage coming through Congress, what are healthcare finance leaders going to be focused on at this year’s conference?

AHCA could lead to 725,000 fewer healthcare jobs

The Republican-sponsored American Health Care Act (AHCA) could “trigger an economic downturn in nearly every state,” according to a new report from George Washington University’s Milken Institute School of Public Health and the Commonwealth Fund, with the majority of the job losses coming from the healthcare industry.

AMA 2017: Outpatient services to drive profitable growth for health systems

Health systems looking for ways to grow profits should focus on sites of care and know what kind of insurance plans their patients may be utilizing, with much of the growth being seen in outpatient services.

10 costliest claims conditions account for $1.3B from 2013 to 2016

Sun Life has released its fifth annual “Sun Life Stop-Loss Research Report," outlining the top 10 catastrophic claims conditions. The report provides data from 53,000 claimants and $4.5 billion in stop-loss reimbursements to project changes over time in costs of medical conditions.

Med groups to CMS: Include Medicare Advantage patients under Advanced APMs

Ten healthcare industry groups, including the American Medical Association, have asked CMS to allow Medicare Advantage (MA) patients to count towards the threshold requirements to qualify as an Advanced Alternative Payment Model (APM).

New York public hospitals eliminating 476 positions

The largest public health system in the U.S., NYC Health + Hospitals, announced on June 2 it will lay off 396 managers and eliminate 80 currently unfilled positions as it faces a projected budget of $6 billion through 2020.

Insurers favor value-based contracts, but few are available

The majority of health plans responding to a Avalere Health survey said they have favorable attitudes towards value-based contracts, though smaller numbers of insurers are actually pursuing or have entered into those agreements.

Pages