Despite the elimination of mandatory bundled payments by the Centers for Medicare and Medicaid (CMS), commercial insurers are investing in this model based upon the positive results they’ve seen from the CMS demonstration models and their own trial experiences. Bundled payment models shift financial and clinical accountability to a single provider-led organization that takes responsibility […]
Commercial payers benefit from bundled pricing
As commercial payers seek strategies to lower costs and improve care quality, they are increasingly paying closer attention to bundled payments. While many payers express concerns about the impact of recent regulatory reversals that removed mandatory requirements for bundled payments, the benefits of bundled pricing still resonate strongly throughout the commercial marketplace. In late 2017, […]
Bundled Pricing: Cost Containment, Better Outcomes Attract Commercial Payers
While mandatory bundled payments have been scaled back by the Centers for Medicare and Medicaid (CMS), commercial insurers are starting to offer bundled reimbursement programs to their customers. Market analysts see government support of voluntary bundles for payment initiatives as a signal that this innovative strategy is here for the long-term. A number of health […]
Demonstrating High Quality Care Becomes Paramount in the Bundled Payment Models
The Centers for Medicare and Medicaid Services’ (CMS) cancellation of the mandatory payment bundles for cardiac care, surgical hip and femur fracture treatment in late 2017 is expected to be replaced in 2018 with a voluntary program, called the Bundled Payments for Care Improvement Advanced (BPCI). CMS also cancelled the cardiac rehabilitation incentive payment model […]
Building an ERM Framework for Value-Focused Health Care
At a Glance The traditional frameworks that healthcare providers used for managing risk in the past under the volume-based payment model are insufficient for managing risk posed by today’s value-based payment models. Under value-based care, a provider can be financially penalized for failing to meet quality standards established for what previously would have been a […]
Choosing The Right Performance Management System For Measuring And Improving Clinical And Financial Performance
To optimize payments and reimbursement in emerging value-based care models, hospitals and health systems need to more proactively measure and improve clinical and financial performance across a myriad of quality and patient safety measures and programs. The inherent challenges to achieving these goals are daunting, expensive and increasingly burdensome to all stakeholders in value-based care: […]
Value-based Purchasing and Reimbursement: The Business Case for Improving Quality and Patient Safety
In the increasingly competitive, transparent and value-based healthcare economy, hospitals and health systems in Western PA and throughout the nation are facing increasing financial pressure from healthcare purchasers and payers to improve patient care outcomes. At the center of value-based purchasing and reimbursement, performance against numerous measures of quality and patient safety performance also heighten […]
Measuring and Improving Healthcare Quality, Safety and Performance Remain Constants
Many skilled nursing and long-term care providers face uncertainty stemming from the heated debates over repeal of the Affordable Care Act and the fate of the Better Care Reconciliation Act.
Patient Monitoring and Alarm Fatigue
Alarm fatigue continues to be a major healthcare concern, ranking third on the ECRI Institute’s Top 10 Health Technology Hazards for 2017. So manufacturers and their customer hospitals persist in exploring ways to reduce the incidence of this patient and clinical staff safety hazard. Mechanical ventilators are often one of the major sources of an […]
CMS Star Ratings Fail to Reflect True Clinical Quality
Hospital executives and other stakeholders should be aware that a new research study1 challenges the idea that CMS hospital star ratings based solely on patient experiences can serve as a reliable indicator for clinical quality. This study follows a wake of industry criticism regarding a recent research letter published in JAMA Internal Medicine based on […]