Pathways to Success Implementation Offers ACOs Greater Risks and Rewards

Wednesday, February 27, 2019 | by Alex Hartzman

Tags: Accountable Care Organizations, ACOs, Hospitals, Medicare, MSSP

The Medicare Shared Savings Program (MSSP) is undergoing a major overhaul under the Pathways to Success regulation, finalized December 31, 2018. This regulation replaces the existing program participation tracks with an emphasis on increasing downside risk, as well as updates a variety of other program rules. This rule went into effect on January 1, 2019, with most aspects to be implemented fully starting July 1, 2019.

Is It Time for a Mid-Course Correction for Medicaid DSH?

Wednesday, February 27, 2019 | by Joan DaVanzo

Tags: ACA, DSH, Hospitals, Medicaid, Uninsured

The Patient Protection and Affordable Care Act (P.L. 111-148 as amended) required significant reductions to Medicaid payments to hospitals that serve a disproportionate share (DSH) of low-income and vulnerable patients starting in 2014. However, the start of Medicaid DSH payment cuts was delayed several times by policymakers. In 2013, Congress postponed the beginning of payment reductions to 2018, and budget bills in later years continued to postpone the cuts.

BPCI Advanced Grace Period is Coming to a Close

Monday, February 25, 2019 | by Randy Haught

Tags: BPCI Advanced, Bundled Payment

Last August the Centers for Medicare and Medicaid Services (CMS) provided a one-time retroactive opportunity to withdraw in total from the BPCI Advanced program or withdraw selected clinical episodes by March 1, 2019. This grace period allowed participants to “test the waters” between October 2018 and February 2019 before making a final decision. Participants that retroactively withdraw in total or for select clinical episodes will not be held accountable for those episodes. Meaning that any losses incurred relative to the established target prices will not be charged to the bundler.

The Importance of Medicaid DSH Payments

Friday, November 2, 2018 | by Steven Heath, MPA

Tags: DME, DSH, Medicaid

Medicaid DSH provider payments are an important public policy issue as we move through “repeal and replace.” Let me tell you why.

Modification to the Start of BPCI Advanced

Tuesday, July 17, 2018 | by Randy Haught

Tags: BPCI Advanced, Bundled Payment

The BPCI Advanced program is scheduled to begin on October 1, 2018. Initially, hospital and physician group practice applicants were to make a decision by August 1, 2018 as to whether to participate in the program and to select clinical episode ...

Providers Evaluate Proposed Changes to Inpatient Rehab Payment System

Friday, July 6, 2018 | by Alex Hartzman

Tags: Health IT, IRF, Quality

Dobson | DaVanzo staff recently completed analyses to support provider comments to CMS on proposed changes to the Inpatient Rehabilitation Facility (IRF) Prospective Payment System case-mix system. The proposed changes would primarily replace ...

Major Considerations of the BPCI Advanced Program

Monday, June 25, 2018 | by Randy Haught

Tags: BPCI Advanced, Bundled Payment

The BPCI Advanced data provided to applicants by CMS these past several weeks consists of target price workbooks, an episode-level summary data file, and Medicare claims data files by service type (hospital inpatient, hospital outpatient, HHA, SNF, ...

BPCI Advanced Participation Deadline Fast Approaching

Thursday, June 21, 2018 | by Randy Haught

Tags: BPCI Advanced, Bundled Payment

CMS has recently released bundled payment information to acute care hospitals and physician group practices who applied for the program in March of this year, to enable them to decide whether to participate in the new BPCI Advanced program. The ...