Healthcare

Healthcare providers face $42 billion in cuts in 2018 under Medicare’s traditional fee-for-service program. Those payment rate reductions, which were put in place by the Affordable Care Act, are scheduled to cut deeper with each year—from $53 billion in 2019 to $86 billion in 2022.

The post-acute care (PAC) sector is a target for significant change. Facing criticism of excessive spending, the sector is facing an overhaul of the payment system that, when it finally arrives, could disrupt the healthcare landscape once again.

With health care spending growth still increasing, the Medicare Payment Advisory Commission (MedPAC or the Commission) continues to pursue its mission to advise US Congress on the Medicare program and its costs, which ultimately are borne by all taxpayers.

As high deductibles and escalating costs drive patients to take a more active role in their health care, providers are waking up to the fact that they need to pay attention to what buyers want. But uncovering those consumer insights and using them to drive organizational strategy remains a challenge for most providers.

Consider a small U.S. town that doesn't have local access to a cardiologist. The community can't support one on a full-time basis, so the hospital brings in a cardiologist twice a month. The physician pays to use the hospital's facilities, equipment, support staff and nurses during those two days. Patients are able to access the specialized care they need without having to travel, and the physician pays only for the space and support that he or she needs.

A long time ago (the mid-90’s), there was a television series titled Highlander. It was a sci-fi action series whose main character, Duncan MacLeod, hailed from a race of immortals. The opening voice-over would end with the proclamation, “There can be only one!” You see, these immortals sought each other out until it was the “last man standing.” Duncan was a force for good that battled other immortals of darkness. Each episode featured an epic battle that ended with Duncan annihilating his immortal foe, whose power transferred to Duncan.

Many physicians are subject to participation in the new Merit-Based Incentive Payment System (MIPS) through CMS’s ongoing payment model reform initiatives encouraging providers to deliver better healthcare at lower costs.

CMS is just the tip of the spear. Commercial payers are developing their own pay-for-performance contracts as they slowly transition away from fee-for-service reimbursement. Yet many independent practice physicians and even employed physicians lack a strong strategy to participate in a healthcare environment where the Triple Aim is the ultimate mission.

Rural hospitals have some tough decisions to make about their level of participation in the new CMS Quality Payment Program created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). 

For a number of reasons, the MACRA cards are stacked against small and rural providers. Given the limited number of Advanced Alternative Payment Models (APMs) that are being approved, many providers will start out in the Merit-Based Incentive Payment System (MIPS), and that track offers limited upside potential compared with APMs.

It is important to recognize that the road to long-term success does not end with the implementation of the Merit-based Incentive Payment System (MIPS). In CMS’ own words, MACRA’s final rule was established, in part, to incentivize and promote participation in Advanced Alternative Payment Models (APMs). These incentives include a 5% participation bonus from 2019 to 2024 and a 0.5% annual increase above the MIPS track beginning in 2026.

January 20 is a significant date for healthcare providers—but not necessarily for the reason you think.

Yes, there is the inauguration of the 45^th President of the United States, who has vowed to “repeal and replace” the most significant healthcare legislation in recent history.

But that date has even greater significance for the many providers across the country who are struggling to cover the cost of care of an increasingly high-risk, low-income population.

Virtual healthcare is a godsend to struggling healthcare systems as they try to offer the right care in the right setting. Every day, these systems face enormous pressure to provide both high-quality and cost-effective healthcare to their communities. Their clinics are filled with scheduled patients, while others wait for a “work in.”

A big news item in healthcare is CMS’ recent release of the MACRA Final Rule, which articulates CMS’ future direction for Medicare Part B. With the Final Rule, CMS makes clear the following strategic objectives in developing MACRA’s new Quality Payment Program (QPP):

When Congress passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), “risk” moved front and center as a feature of provider reimbursement models. These days, we’re using terms such as “at risk” and “risk-based” more and more, but what do they really mean? And why should healthcare providers be more concerned with risk now than they have been in years past?