​Healthcare has experienced a meteoric rise in the use of quality measures to determine payment through the Hospital Value-Based Purchasing Program (HVBP), the Merit-Based Incentive Payment System (MIPS) and other programs. An article in Health Affairs argues that what are missing from these programs are measures and payment incentives tied to one ...

A new Office of Inspector General (OIG) audit report indicates that Medicare made as much as $25.8 million in overpayments to hospitals for intensity-modulated radiation therapy (IMRT) planning services during 2013 through 2015.IMRT is an advanced radiation procedure used to treat difficult-to-reach tumors. Payment for the computer-based planning r...

August 15, 2018As of June 2017, the Medicare appeals backlog stood at an astonishing 607,402 pending cases at the administrative law judge level. Estimates indicate that it will soar to 950,520 cases by the end of the 2021 fiscal year.To help tackle the overwhelming glut of appeals, a federal judge asked the American Hospital Association (AHA) this...

Despite the fact that most health insurance companies now provide a price transparency tool for beneficiaries, only a tiny minority of patients choose to shop for healthcare services or review provider prices before accessing services, a new study by the National Bureau of Economic Research has found.Researchers analyzed data from a large private i...

When it comes to reducing the risk of opioid abuse and the over-prescribing of opioid medications, medical practices should think in terms of communication, technology and referral management, a new report from the Medical Group Management Association (MGMA) advises.Titled Combating the Opioid Epidemic: Effective Policies and Communication Strategi...

Updates to the Quality Payment Program (QPP), significant revisions regarding documentation and payment for Evaluation & Management (E&M) services, a slight increase in the conversion factor from $35.99 to $36.05, and numerous proposals to streamline reporting and other requirements for eligible clinicians (ECs) are among the highlights of ...

Among emerging technologies, blockchain technology probably ranks somewhere near artificial intelligence and machine learning in the level of discussion being generated about its potential to revolutionize health information technology and the sector itself. An IBM survey reported that 16 percent of 200 surveyed healthcare executives had plans to i...

The depersonalization, emotional exhaustion and reduced feelings of accomplishment that characterize the phenomenon known as physician burnout—and that remain endemic in healthcare—call for a combination of organizational and individual interventions, a review published in June issue of the Journal of Internal Medicine reports."Both individual‐focu...

In what the House Energy and Commerce Committee has described as "the most significant congressional effort against a single drug crisis in history," the House of Representatives has passed, by an overwhelming majority, the bipartisan SUPPORT for Patients and Communities Act (H.R. 6) to curb the growing opioid crisis. The bill will serve as the veh...

The Centers for Medicare and Medicaid Services (CMS) has postponed an update, originally slated for July, of the Overall Hospital Quality Star Ratings on its Hospital Compare website. The website is designed to serve as an information and decision-making tool for consumers, and is used as a resource by payers and providers as well.CMS said it has d...

Among other things, the CHRONIC Care Act of 2017 will allow Medicare Advantage (MA) plans to offer chronically ill beneficiaries a broader range of services and supports. One of its main purposes is to integrate medical care with non-medical long-term services and supports (LTSS), which could include everything from vision and hearing aids, transpo...

The $1.6 billion reduction in the federal 340B Drug Discount Program that went into effect in 2018 could negatively impact the operating performance of many participating non-profit hospitals, credit research firm S&P Global Ratings has reported. The Centers for Medicare & Medicaid Services (CMS) has reduced 340B payments by about 30 percen...

The Centers for Medicare and Medicaid Services (CMS) is testing the waters on a new alternative payment model (APM) through which the agency would pay participating primary care practices a monthly per-beneficiary fee for certain services, such as office visits and some office-based procedures. As with other APMs, the proposed direct provider contr...

A recent survey of 1,000 physicians by the American Medical Association (AMA) found that 92 percent believe prior authorizations (requirements by payers to approve a medical service, treatment plan, medication or piece of durable medical equipment [DME] before it is provided) have a negative impact on clinical outcomes. And the American Academy of ...

As mandated in executive orders from the current administration, the Department of Health and Human Services (HHS) is zeroing in on ways to streamline reporting and administrative requirements for clinicians, hospitals and health systems as part of an overall effort to "reduce administrative burden" and free providers from tasks that take time away...

When it comes to complying with the requirements of the Healthcare Information Portability and Accountability Act (HIPAA) regarding electronic protected health information (ePHI), don't confuse a gap analysis with a risk analysis, the Office of Civil Rights reminds healthcare providers in a recent bulletin.A gap analysis can help providers identify...

In keeping with the current administration's emphasis on increasing price transparency in healthcare (see our March 28, 2018 eAlert), the fiscal year 2019 Inpatient Prospective Payment System (IPPS) proposed rule of the Centers for Medicare and Medicaid Services (CMS), issued on April 24, 2018, proposes that hospitals begin publishing their standar...

The secured email protocols and other measures designed to protect sensitive patient information that hospitals and billing companies have implemented during the past few years can seem like a hindrance, but they're necessary in the age of instant access to information—and cybercrime. They're also required by law. With the threat of penalties and f...

It's no secret that the United States population is aging. In just over a decade, the number of Americans in the 65-and-older age bracket will have mushroomed by 50 percent. Not as widely known is the fact that this aging population is likely to impact physician supply as well, because one-third of all currently practicing physicians will be older ...

Howard A. Green, MDDermatology Associates, PA, Palm Beach, FLThere's nothing new about 'population health.' Physicians practicing medicine (notice I didn't say practitioners practicing healthcare) have utilized population health studies or 'clinical studies' for the better part of two centuries. Physicians practicing medicine with patients observed...