News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel

News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
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Medicare Moves Forward with Bundled Payment Reimbursement as Part of a Trend That Has Major Ramifications for Clinical Pathology Laboratories

Pathologists and clinical laboratory managers can expect that CMS will accelerate the shift from fee-for-service reimbursements to bundled payment models

It is still not widely recognized among clinical laboratory managers and pathologists that Medicare program officials are serious about moving forward to replace fee-for-service provider payment with value-based payment methods. In fact, many medical lab professionals may not have heard the news from earlier this year that one-third of Medicare payments are now value-based.

It is important for all clinical lab executives to be aware of the press release issued by the federal Department of Health and Human Services on January 26, 2015. It was the first time that the Medicare program had published goals for moving away from fee-for-service that were tied into specific dates. (more…)

New Medicare Program Bases Reimbursement for Hip and Knee Replacements on Value-Based Criteria, Now in 67 Regional Markets

Medicare’s latest payment rules for joint replacement surgeries is another step forward on the path toward bundled payments and similar value-based reimbursement models 

By now, most clinical laboratory managers and pathologists know about an ambitious new Medicare program that essentially brings a value-based reimbursement model to joint replacement surgeries. The program has already commenced in a number of regional markets across the United States.

This new program was instituted by the U.S. Department of Health & Human Services (HHS). It is mandatory program and reimburses providers for hip and knee replacements using a reimbursement model that further ties Medicare payments to quality or value metrics. This program was launched in 67 metropolitan areas.

Called the Comprehensive Care for Joint Replacement (CJR) model, it establishes a 90-day episode of care from the date of the replacement procedure. Hospitals remain accountable for all charges related to recovery and rehabilitation within this window.

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New CMS Pilot Intends to Test Viability of a Universal Bundled-Payment Model for Inpatient Care

Nearly 500 healthcare organizations nationwide to participate in payment bundling for 48 Conditions

Medicare’s largest bundled reimbursement project to date is now launching. Clinical laboratory executives and pathologists are watching for clues as to how these bundled payment arrangements will compensate the clinical laboratory testing done on behalf of patients whose care is covered by this latest Medicare initiative.

The Centers for Medicare & Medicaid Services (CMS) will commence implementation of Phase 1 of the Bundled Payments for Care Improvement Initiative. This will be a three-year project that will test the viability of a universal bundled payment system to improve coordination and quality of care and lower costs. It is also the largest bundled-payment pilot to date, with nearly 500 participants, according to a story published by Healthcare Finance News.

One major goal of this Medicare project is to begin moving providers from the current fee-for-payment model to a single, lump-sum payment model. This would be true for all Medicare Part A and Part B services provided during one episode of care. (more…)

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