How Physician Compare’s New Five-Star Ratings Will Impact Clinicians and Healthcare Organizations

In late 2017, the Centers for Medicare and Medicaid Services (CMS) will implement a new benchmark and five-star quality rating system for clinicians and group practices on Physician Compare, the website mandated by the Affordable Care Act (ACA) to help patients, families and caregivers make more informed choices regarding healthcare services. The c...
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CHRONIC Care Act Proposes Big Boost in Home, Telehealth Services

On May 18th, the Senate Finance Committee unanimously approved a bill designed to improve care for Medicare beneficiaries with chronic conditions. The Creating High-Quality Results and Outcomes Necessary to Improve CHRONIC Care Act (CCA) of 2017 would increase access to telehealth services for Medicare beneficiaries with chronic illnesses—including...
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Feds Take Aim at Medicare Advantage Insurers - Physicians Should Also Take Heed

Medicare Advantage (MA) insurers have gotten themselves into hot water lately with the federal government. The U.S. Justice Department (DOJ) is suing UnitedHealth Group (UHG), accusing the nation's largest MA provider of exploiting the program by providing inaccurate information about the health of its enrollees. DOJ alleges the practices have led ...
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Cybersecurity News and Best Practices for Healthcare Providers

Do the names WannaCrypt or WannaCry mean anything to you? They well might, by now. In a global cyberattack that began on May 12, 2017, this aggressive form of ransomware infected more than 300,000 Windows PCs in 150 countries across Europe, Latin America and Asia.Of special note for hospitals and healthcare professionals—the malware attack wreaked ...
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Studies Shed Light on Provider Readiness for Value-Based Care

The shift from traditional fee-for-service (FFS) models to value-based payments is of growing concern to all healthcare providers. Various types of value-based models are described in the news on a regular basis, with no shortage of opinions as to how quickly this transition will occur and frequent calls to action by those who would like to help yo...
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Survey Debunks Perception That Medicaid Offers Lesser Levels of Care

​Healthcare in America is expensive. The share of the U.S. economy devoted to healthcare spending is currently 17.5 percent, and the Centers for Medicare & Medicaid Services (CMS) projects it will reach 19.6 percent by 2024. Estimates put total U.S. spending on healthcare at more than $5.4 trillion by that point, with both the private and publi...
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Attitudes About Aging and End-of-Life Care: Kaiser Survey

U.S. Census Bureau projections indicate that Americans 65 and older will make up 24 percent of the U.S. population by 2060. A majority of adults in the U.S. say that the government is "not too prepared" or "not at all prepared" to deal with the aging population, according to a recent survey conducted by the Kaiser Family Foundation in partnership w...
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A Snapshot of Risk Management in 2017: 20 Top Concerns for Hospitals

Healthcare's frenetic pace of change—catalyzed by the Affordable Care Act, and more recently, by efforts to repeal and replace that landmark legislation—have expanded the scope and complexity of regulatory compliance and the importance of comprehensive risk management efforts on the part of hospitals and healthcare systems. However, the barrage of ...
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The Administrative Burden of EHRs Opens Doors to Medical Scribes

A physician's responsibility is to provide the best possible care for sick patients. A key for delivering quality healthcare is open communication between the physician and patient to discuss issues and develop a care plan. Today, providing quality care is becoming more difficult due to increasing patient loads and administrative challenges. This d...
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CMS Aims to Simplify with Proposed Inpatient Payment Rule

On April 14, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would update 2018 Medicare inpatient payment and polices. The proposed rule aims to relieve regulatory burdens for providers; supports the patient-doctor relationship in healthcare; and promotes transparency, flexibility and innovation in the deliver...
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Patient Satisfaction is The Next Competitive Battleground

IntroductionPatient satisfaction and the patient experience have always been important to providers. In today's era of value-based care reimbursement models, it has become one of the top three priorities facing healthcare executives, according to a 2013 study conducted by HealthLeaders Media.Measuring patient satisfaction has become an important dr...
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The MACRA MIPS Composite Score: A Guide for Providers

The Medicare Access & Chip Reauthorization Act of 2015 (MACRA) marked the end of Medicare payment's fee-for-service model and the beginning of a performance-based payment system, the Quality Payment Program (QPP). Understanding how participation in the QPP will impact payments begins with understanding the scoring system.Scoring in the QPP is i...
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CMS Delays Bundled Payment Programs

As noted in our eAlert issued March 16, 2016, bundled payments have long been a part of the healthcare reform debate as a strategy for reducing healthcare costs, but while there has been significant discussion and research relating to alternative payment methods, most healthcare spending is still based on a fee-for-service framework. Despite recent...
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An Overview of the American Health Care Act

The House proposal to "repeal and replace" the Affordable Care Act (ACA), the landmark and controversial legislation that is a signature of President Barack Obama's administration, indicates that the nation's healthcare system could be heading for yet another upheaval. March 21, 2017 marked the seventh anniversary of the ACA. Although there is stil...
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Growing Medical Debt Requires New Collection Approaches

The Affordable Care Act (ACA) and new payment models such as high deductible health plans are contributing to a growth in patient liability. This emerging trend has put pressure on providers to collect more from patients while better managing their financial relationship.Increases in patient liability and the responsibility of collecting it are for...
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11 Building Blocks of a Solid Safety Culture

The fact that 125,000 fewer patients died due to hospital-acquired conditions in 2010-2015, resulting in a cost savings of more than $28 billion, shows healthcare's capacity to make strides in improving safety. But despite encouraging results like these, hospitals and health systems still face a daunting array of hurdles, ranging from the growth of...
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ACOs: Who Will Lead the Way?

We are in the midst of a period that economists call "creative destruction" of our fragmented fee-for-service healthcare delivery system. The hope is that it will evolve into a higher-quality, more productive system with strong incentives for efficient, coordinated care. In any case, the transformation will have profound implications regarding hosp...
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Understanding OIG Compliance

BackgroundOn October 15, 1976, President Ford signed into law legislation creating an Office of Inspector General (OIG) at the Department of Health, Education and Welfare (HEW). HEW OIG would become HHS-OIG in 1980 when the Department was redesignated as the Department of Health and Human Services (HHS).The OIG and HHS oversee various segments of t...
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Coalition Targets Root Causes of Health Disparities

The notion that healthcare needs are human needs is gaining ground within the healthcare sector. So is the view of hospitals as important economic anchors that must address these human factors as well as the medical needs of the communities they serve, because the two sets of needs are inextricably linked.A chief catalyst for this broadened view of...
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National Health Expenditures and Federal Funding of Medicaid

2015 National Health Expenditures SummaryIn December 2016, the Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS) issued a study of 2015 National Health Expenditures (NHE). According to the study, overall health spending grew by 5.8 percent in 2015 to $3.2 trillion or about $10,000 per U.S. citizen, and accounted for 17.8...
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