The highly publicized Bipartisan Budget Act of 2015, approved by the Senate on the morning of October 30, will do more than just raise the nation’s debt ceiling. It also will exclude newly acquired, off-campus hospital outpatient departments (HOPDs) from receiving reimbursement under Medicare’s outpatient hospital prospective payment system (OPPS). Instead, after January 1, 2017, these new off-campus locations would be reimbursed under the Ambulatory Surgical Center Prospective Payment System (ASC PPS) or the Medicare Physician Fee Schedule (PFS). Continue reading
When the Centers for Medicare & Medicaid Services (CMS) launches the Comprehensive Care for Joint Replacement (CCJR) Model on January 1, 2016, it will signify one of the most dramatic steps toward transforming the way healthcare services are reimbursed across the U.S. healthcare system. The CCJR Model will be the first mandatory bundled payment initiative, and success under this new model will require collaboration – among hospitals, physicians, skilled nursing facilities, home health providers, and others. To learn more about the model and how your organization can thrive in this new environment, read John Fink’s article “Mandatory Bundled Payment: Getting into Formation for Value-Based Care” in the October issue of hfm Magazine.
Congratulations to John Fink on receiving the Healthcare Financial Management Association’s Helen Yerger/L. Vann Seawell Best Article Award for 2014-2015! John’s article, “Aligning with Physicians to Regionalize Services,” was published in the November 2014 issue of hfm magazine and can be viewed here.
John joins Kevin Kennedy and Dan Merlino as a recipient of this award, which garners national recognition for ECG’s outstanding thought leadership content.
The U.S. Department of Health & Human Services (HHS) Office of Inspector General (OIG) recently issued Advisory Opinion 12-22 addressing an existing comanagement arrangement between a rural hospital and a cardiology group. Under the arrangement, the group manages the hospital’s four cardiac cath labs; recommends equipment, supplies, and devices; and provides strategic planning, medical direction, staff development, and other services. This is the first OIG opinion that specifically addresses comanagement arrangements. Advisory Opinion 12-22 provides useful guidance for structuring a comanagement arrangement, including compensation parameters and safeguards against the reduction of services and the inducement of referrals. Continue reading
Michael Porter defines value in healthcare as health outcomes achieved per dollar spent. So our goals are to maximize the numerator by achieving optimal outcomes and minimize the denominator by better managing resources. These goals are best accomplished simultaneously; options to do so include:
- Improving case management.
- Optimizing care delivery teams.
- Enhancing outcomes measurement.
- Providing clinicians with real-time access to information.
- Implementing bundled payment systems.
Easier said than done. And the financial implications of improving value are not always clear-cut. CFOs are left to figure out how to make money when Continue reading