The Controversy over the Rules of the Game for the Medicare Shared Savings Program
Ken Perez examines the fundamental disagreement over how MSSP ACO savings are being measured and the potential fallout as participants consider leaving the program.
More than 1,500 Provider Organizations Join New Bundle
Oct. 9—The latest Medicare bundled payment model gained 50 percent more provider organizations than its predecessor.
Transitioning to a New Medicare Benchmarking Paradigm
As commercial health plans adopt a case-rate approach to payment based on Medicare’s MS-DRGs, modifications are needed to account for how health plans’ populations differ from the Medicare population.
Success Factors for Getting High-Cost Drugs Approved
The University of Rochester Medical Center’s high-cost drug manager works to help patients get access to appropriate drugs and mitigates the financial risk associated with buying and administering them.
Ask the Experts: Lesser-Than Provisions
What specific pitfalls should we look for in terms of lesser-than provisions?
The Conscience of the Generic Drug Market
Created to address the high costs and shortages of generic medications, the not-for-profit generic drug manufacturer Civica Rx aims to be a societal asset by providing patients across the nation with affordable access to the medications they need.
Oct. 8-12: ACO Changes Urged for Consideration by Administration, Congress
Oct. 3—Healthcare industry leaders will gather next week at various meetings that will include discussions of high-profile accountable care organization (ACO) programs. The Medicare ACO program particularly needs changes, providers told federal officials this week.
Keeping Up-To-Date on Shifting Medicaid Eligibility Laws
A government affairs expert shares strategies for keeping up with complex Medicaid rules and stay in compliance.
Medicare Shared Savings Program “Pathways to Success” Proposed Rule
This document summarizes the Medicare Shared Savings Program - Pathways to Success proposed rule, published in the August 17, 2018, Federal Register.
Medicare Quality Pay Leads Practice Regulatory Burden
Oct. 2—Although insurance prior authorization and electronic health record (EHR) interoperability have garnered extensive attention as challenges for medical practices, a new survey fingers Medicare quality payment programs as the biggest hindrance.