About Dave Wofford

For almost 20 years, Dave has focused on improving performance and achieving alignment between hospitals, physicians, and other entities. Dave’s clients appreciate his knowledge of the issues related to hospital/physician relationships and affiliations, as well as his understanding of the perspective and value that each party brings. This, in turn, allows him to help parties reach sustainable arrangements. As providers seek opportunities for clinical affiliation and collaboration in an era of shrinking revenue sources and increased competition, Dave works closely with hospitals and medical groups on matters such as physician compensation plan redesign, strategic planning, and the negotiation and development of professional services arrangements. He consults to hospitals and physicians on issues concerning operations, business planning, strategic alignment, and in particular, professional revenue cycle performance turnaround. Recently Dave worked with Children’s Hospital Los Angeles Medical Group, an organization consisting of approximately 500 professionals. He led an effort to improve the group’s revenue cycle performance, which resulted in significant reductions in accounts receivable and IT vendor fees, positioning the organization for enhanced ongoing collections. Prior to joining ECG, Dave served as an officer in the U.S. Army for 8 years, and today his clients value the leadership qualities honed during important international assignments.

MACRA Forces Providers Seeking APM Track to Move Quickly

In the recent proposed rules for MACRA, CMS offered some clarity for providers who are trying to decide whether to participate under the Merit-Based Incentive Payment System (MIPS) or the Alternative Payment Model (APM) track.  In short, it really is not a decision that the provider makes, but rather a determination made by CMS based on the provider’s level of participation – if any – in qualifying APMs (also known as advanced APMs). Continue reading

MACRA Proposed Rules Provide Some Clarity, But Questions Remain

Last week CMS released its much-anticipated proposed rules for the Medicare Access and CHIP Reauthorization Act (MACRA), which was passed by Congress approximately 1 year ago and introduced substantive changes in the way Medicare will reimburse physician services. Readers of previous ECG blog posts and articles may recall that, like the ACA before it, this legislation grants the HHS Secretary great latitude in fleshing out the details through rulemaking. While these are only proposed rules, and CMS is using this as an opportunity to solicit commentary from the public, they do shed light on what we can expect when the rules are finalized in November. Continue reading

MACRA Draft Plan Is Short on Details

On December 18, 2015, CMS released its draft plan for developing the quality measures that will be used within both the MIPS and APM components of MACRA. The purpose of this draft plan and the mandate for the Secretary of HHS, at least theoretically, is to:

  • Address how measures used by private payors and integrated delivery systems could be incorporated into Title XVIII (i.e., Medicare).
  • Describe how coordination across organizations developing such measures might occur.
  • Take into account how clinical best practices and clinical practice guidelines should be used in the development of quality measures.

Continue reading

The Not-So-Obvious Implications of MACRA

With the passage of the Medicare Access and CHIP Reauthorization Act (MACRA) this past April, a couple of things became evident. First, there are some concepts Congress can agree on – like the unpopularity of the sustainable growth rate (SGR). An overwhelming majority in both houses voted for its repeal.

Second, Medicare is moving away from fee-for-service (FFS) reimbursement and toward value-based payments for physician services. Beginning in 2019, providers will have the option of participating in the merit-based incentive payment system (MIPS) – an enhanced version of the current FFS system – or moving into alternative payment models (APMs). Providers who opt for MIPS will see a period of essentially flat reimbursement; those who accept more risk through APMs will have a chance to reap higher rewards.

Regardless of which reimbursement path providers choose, they’ll need to focus on managing the cost of care and demonstrating value to patients and payors. That much is clear. But MACRA will also have implications that are not so obvious. Continue reading

The Divergent Paths of MACRA

“Two roads diverged in a yellow wood/And sorry I could not travel both.”

No federal legislation will ever be mistaken for poetry. For one thing, poetry uses far fewer acronyms. But like the narrator in the famous Robert Frost poem quoted above, today’s providers find themselves staring at a fork in the road. Continue reading