Tag Archives: medicare

What’s on the Horizon for 2017?


“Predictions are hard, especially about the future.” Niels Bohr Nobel Laureate in Physics   Some would call it foolish to try to predict how the Trump administration and the 115th Congress will shape health care in 2017, but here it goes anyway! I think it is safe to assume that value-based payment is likely to survive, but it may look different in terms of structure. The HHS secretary-nominee, Dr. Tom Price, is not a fan of mandatory initiatives, such as the Comprehensive Care for Joint Replacement (CJR) bundled payment program which began in April last year. The CMS Innovation Center … Continue reading

Accountable Health Communities Model

Social Deteminants of Health

On January 5, 2016, the Department of Health and Human Services announced $157 million in funding to address the health-related social needs of Medicare beneficiaries and associated referrals to and navigation of community-based services. Called the Accountable Health Communities Model, it is a 5-year program and the first CMS Innovation Center model to focus on health-related social needs of Medicare and Medicaid beneficiaries. For a health care system that has historically focused on funding care that occurs in a clinic, hospital, or nursing facility, this is a significant advancement. It is a novel approach for testing whether screening patients for … Continue reading

Embrace Your Expertise: A Professional’s Approach to Outcomes-Based Reimbursement

outcomes based

Change is hard for most of us. When we are asked to change something we are doing, we must give up security and stability in exchange for volatility and uncertainty. This is not a very appealing proposition on its surface. However, if we look below the surface, there is some good news waiting for us. Your work world, as a health care provider, is undergoing a major change like this right now. The practices and systems that you’ve used to build your career are now being challenged by an increasing amount of data and research that suggests that the results … Continue reading

DISRUPTION! The Rapid Change from Fee-for-Service to Value-Based Reimbursement Models

ahrq expenditures

The transformation from volume to value-based health care is happening at an amazingly fast pace. Consider these facts as evidence. In 2014, Medicare paid providers and physicians $362 billion in the traditional, non-Medicare Advantage program. Earlier this year, HHS Secretary Burwell articulated bold goals of having 85% of all Medicare fee-for-service payments tied to quality or value by 2016, and 90% by 2018. Even more significantly, their goal is to have 30% of Medicare payments tied to quality or value through alternative payment models such as accountable care organizations (ACO), medical homes, and bundled payment arrangements by the end of … Continue reading

Support the Cardin Amendment to Repeal the Therapy Caps – Take Action Now!

Support the Cardin Amendment to Repeal Therapy Caps Take Action! On March 26, the House of Representatives overwhelmingly passed a permanent Sustainable Growth Rate (SGR) repeal package – H.R. 2, the Medicare Access and CHIP Reauthorization Act – by a vote of 392-32. The Senate decided not to vote on H.R. 2 prior to its two-week recess.  So, the next step is for the Senate to vote on and pass H.R. 2, when Senators return from recess on Monday, April 13th. Senator Ben Cardin (D-MD) is considering offering an amendment to H.R. 2 that would permanently repeal Medicare’s Part B outpatient therapy … Continue reading

Ask Congress to Repeal the Therapy Cap – Support H.R. 775

take action NASL

Ask Congress to Repeal the Therapy Cap – Support H.R. 775 Protect Patients Access to Outpatient Therapy Services Take Action! Ask Congress to Repeal the Therapy Cap – Support H.R. 775 With the expiration of the therapy cap exceptions process fast approaching on March 31, Representatives Charles Boustany (R-LA), Xavier Becerra (D-CA), Marsha Blackburn (R-TX) and Lois Capps (D-CA) have introduced a bill, which would protect patients and consumers from arbitrary limits on the Medicare outpatient therapy services.H.R. 775, the Medicare Access to Rehabilitation Services Act would permanently repeal the $1,940 cap imposed on physical therapy and speech-language pathology combined and … Continue reading