Aligning Institutional Research Investment with Clinical Strategy: A Future-Focused Approach

The Centers for Medicare & Medicaid Services (CMS) finalized key updates to the Medicare Hospital Outpatient Prospective Payment System (OPPS), the Ambulatory Surgical Center Payment System (ASCPS), and the Physician Fee Schedule (PFS) that will be effective January 1, 2019, with additional changes to be implemented in 2021.

On October 25, President Trump announced his plan to lower prescription drug prices. Under the plan’s new proposed payment system, the Centers for Medicare & Medicaid Services (CMS) will launch a five-year pilot program—the International Pricing Index (IPI) model—that will allow Medicare to pay less for select Part B drugs when a lower international price is available.

A forward-thinking financial model can help hospital leaders better predict and balance potential gains and losses from incentives, penalties, volume changes, and other factors related to value-based payment.

To thrive in the increasingly disruptive healthcare environment of the future, accountable care organizations (ACOs) will need to develop a strategy that is data driven and consumer focused. It is becoming clear that, to enjoy long-term financial success, ACOs must position themselves to assume greater risk/reward models.

The ECG team has been chosen as a preferred vendor for the MassHealth DSRIP Technical Assistance (TA) Marketplace. The MassHealth TA Marketplace is a product of MassHealth—the Commonwealth of Massachusetts’ Medicaid and Children’s Health Insurance Program—and contractor Abt Associates.

In the final rule for the fiscal year 2019 update to the inpatient prospective payment system, effective August 17, 2018, CMS announced a new round of applications due to the closure of Memorial Hospital of Rhode Island. This is only the 13th round of section 5506 cap space reallocation since passage of the PPACA.

Navigating the proposed program, Pathways to Success, can be daunting for new and existing ACOs. While it will take time before the final rule offers definitive guidance, here are seven important considerations that ACOs should begin to address now.

After a long delay in publishing guidance for the 2019 Medicare Shared Savings Program (MSSP) application cycle, CMS issued a proposed rule on August 9, 2018, featuring significant revisions to the program.

Over the past few months, we’ve examined the timeline for building your BPCI Advanced program and reviewed what to do with the claims data released by CMS in May 2018. Now that you’ve received your data, it is time to further evaluate the opportunity to succeed under the BPCI Advanced program.