In April 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law, representing the most sweeping set of changes to Medicare’s physician payment methodology in more than two decades. MACRA largely made headlines for its repeal of the sustainable growth rate (SGR) formula, thereby averting the planned 21% across-the-board cut in Medicare’s provider payments. But perhaps more importantly, it represents for Medicare a dramatic step away from traditional fee-for-service reimbursement and toward value-based payments for physician services. Continue reading
The transformation to value-based care requires an organization to shift its focus from traditional care delivery – characterized by silos of hospital departments, autonomous physician services, and other pre- and post-acute components – to care management and coordination across all of these disparate services.
As part of our ongoing series of conversations about the value-based enterprise, Steve Messinger, President of ECG, shares his thoughts on what it means to be an integrated organization in the era of reform. Continue reading
One of the foremost objectives of a patient-centered medical home (PCMH) is to reduce unnecessary specialty visits through effective management of acute and chronic illnesses. Invariably, though, some conditions require more costly specialty care. Among these conditions, cancer is notable for the extent to which it becomes the primary medical focus immediately upon diagnosis and establishes the context in which all other conditions must be managed. In that sense, PCMHs face particular challenges in managing patients with cancer, because much of their care transitions to specialists and settings that do not share the PCMH’s incentives for coordination, integration, and cost containment. Continue reading
AMCs are increasingly looking to do more with less related to their research enterprises. Competition continues to grow for securing external research funding, recruiting and retaining talented faculty and other researchers, and keeping up with the expensive research infrastructure necessary to conduct cutting-edge science.
Traditional internal sources of support, most notably from clinical activities, are coming under significant pressure and uncertain futures as the healthcare environment shifts toward integration and value. Continue reading
The trend of consolidation in the healthcare industry has enabled many health systems to expand their regional or national footprint and improve patient access. At the same time, these mergers and acquisitions have resulted in clinical congestion for systems that acquire operations with overlapping markets and services. Such redundancy can blunt the very advantages and efficiencies that health systems hope to gain by expanding their enterprises.
An effective rationalization strategy enables a health system to contain costs, maximize resources, and enhance the efficiency of care delivery. That may mean some tough decisions for health executives and Boards of Directors, but becoming an optimally rationalized system calls for leadership to guide their organizations into a new era of value-based care. Continue reading