Three Steps for Aligning Cost and Compensation

This post was co-authored by Senior Manager Jamaal Campbell and Manager Chris Franklin.

With Medicare planning to tie more than 50% of payments to value-based care criteria by the end of this year, hospitals and health systems are looking for new ways to lower costs. That’s leading some organizations to pilot an unusual approach – incentivizing physicians to manage costs. Continue reading

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

Rethinking Deficit Funding in AMCs

It is an uncomfortable ritual that occurs in nearly every academic medical center (AMC): specialties unable to meet their department profitability targets find themselves hat in hand, requesting funding to cover budgetary shortfalls. The AMC, committed to providing comprehensive services, is then put in the position of having to find some way to oblige.

This is a tiresome exercise for all parties, and these negotiations often render the relationship between AMCs and faculty group practices (FGPs) as purely transactional, inhibiting a more integrated approach. 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