Interactions of Medicare Alternative Payment Models

by John Harris, Director
and Amanda Brown, Manager

Open PDF file >

CMS continues to authorize voluntary and mandatory alternative payment models (APMs) to shift risk to providers. Beyond choosing which models offer the best opportunity, providers must evaluate the impact of participating in multiple APMs simultaneously. Overlapping APMs can be synergistic or self-defeating. Where simultaneous participation is an option, overlapping incentives are complicated and may not […]

3 Questions Every System Should Answer Following the Medicare Hospital Outpatient Prospective and ASC Payment System Final Rule

by Lynda Mischel, Principal
and Meredith Inniger, Manager

Open PDF file >

One of the most impactful final rules released by CMS in recent months is the CY 2021 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS-1736-FC). This rule includes several important policy changes, most notably the elimination of the Inpatient Only List on a phased schedule through CY2024 (when […]

Radiation Oncology Alternative Payment Model: 3 Things to Do Now

by Lynda Mischel, Principal
and Scott Stuecher, Manager

Open PDF file >

CMS is launching a Radiation Oncology Alternative Payment Model (“RO Model”) that will profoundly affect radiation oncology economics, with a target start date of January 1, 2022. The RO Model will apply (or at least test) a bundled payment methodology affecting about 30% of eligible radiation oncology episodes. Revenue reductions may be as high as […]

Primary Care First: Frequently Asked Questions

by John Harris, Director
Amanda Brown, Manager

Open PDF file >

What is the Primary Care First Program (PCF)? PCF is a voluntary 5-year CMS Advanced Alternative Payment Model (APM) with two care models—one for “Advanced” primary care and one for high-need, seriously ill Medicare beneficiaries (Seriously Ill Population, or SIP). The latter is aimed primarily at providers who typically provide hospice or palliative services. Practices […]

5 Strategies for Aligning Physician Compensation with Value-Based Performance

by Amanda Brown, MHA

The move toward value-based contracts is happening “in small doses,” a 2018 MGMA survey found. While nearly three out of five hospitals participate in value-based contracts, just 34 percent of healthcare reimbursement is tied to value. This presents healthcare leaders with a dilemma: How can we engage physicians in value-based payment models when so little […]

BPCI Advanced: Apply Now,
Decide Later

by Amanda Brown, Manager, and Amanda Kueh, Analyst

CMS has opened applications for a second cohort of BPCI Advanced (Bundled Payment for Care Improvement-Advanced) participants in April. This initial application step gets you valuable data, and time to decide whether to pursue participation. Advantages of applying include: No obligation to participate. You have time (likely until fall 2019) to decide whether to sign […]

Top 5 Ways to Supercharge Your Claims Analysis Capabilities

by Amanda Brown, MHA

Supercharging claims analysis capabilities empowers healthcare organizations to zero in on opportunities to improve care and reduce costs. The most successful organizations typically elevate their performance under value-based contracts by using claims analysis to drive engagement and improvement. Achieving next-level claims analysis status requires a multifaceted approach. To gain the most value from claims analysis, […]

5 Critical Issues for BPCI-A

by John Harris, MBA, Molly Johnson, MHSA, Amanda Brown, MHA
HFM Magazine
June 2018

Open PDF file >

Many hospitals and health systems may benefit from participation in the Bundled Payments for Care Improvements Advanced program, but there are many points that organizations should address before pursuing this option. When the Center for Medicare and Medicaid Innovation (CMMI) created Bundled Payments for Care Improvements (BPCI), the benefits of participation were straightforward. The program […]

Engaging Primary Care Physicians in Value-Based Payment

by Rudd Kierstead, MBA, MPP
Becker's Hospital Review
May 2018

  It’s one thing to sit down with a payer and negotiate incentivized goals in a value-based payment contract. It’s a different thing entirely to change the behavior of the practitioners in your medical group in order to meet those goals. Physicians who choose to sell their practice and become employees are typically relieved to […]

BPCI Advanced: Ten Key Differences From Original BPCI

by Amanda Brown, MHA, Molly Johnson, MHSA and Amanda Kueh
Becker's Hospital Review
March 2018

  What CMS bundled payment initiative are we on? It can be hard to keep track. First there was the Bundled Payments for Care Improvement (“BPCI”) model, a voluntary bundled payment program beginning in 2013. Then in 2016, CMS introduced the CJR (Comprehensive Joint Replacement) bundled payment model, which was initially mandatory in 67 MSAs […]