Nearly One-Third of Traditional Medicare Payments Now Based on Value-Based Reimbursement and Alternative Payment Models

Faster than expected transition from fee-for-service healthcare should grab attention of clinical laboratories and anatomic pathology groups who face financial unknowns under new payment systems Clinical laboratory executives should take note of a key financial fact. The transition from fee-for-service healthcare to value-based reimbursement is occurring at a faster clip than the Department of Health and Human Services (HHS) anticipated last year when federal officials announced a plan to tie...

Even as Medicare ACOs Delivered Mixed Results in 2014, Primary Care Physicians Were Awarded Biggest Share of Bonus Payments

AJMC study shows ACOs that allocate majority of shared savings to primary care providers are more likely to generate savings When it came time to pay bonuses to Medicare’s Pioneer ACOs and Shared Savings Program (MSSP) ACOs based on 2014 results, a substantial proportion of the payments went to primary care physicians compared to hospitals and specialist physicians. Significantly, only a minority of these ACOs qualified for bonus payments. Pathologists and clinical laboratory managers watching...

Experts Say Medicare Accountable Care Organizations (ACOs) Produced Mixed Results in 2014 Even as Enrollment Continues to Grow Significantly

Clinical laboratories and pathology groups can expect to see more growth in the number of patients served by ACOs and that will require labs to have a new pricing strategy Will ACOs be the next big thing in American healthcare? Many people are betting that will be true as the number of ACOs continues to increase. Some reports indicate that as many as 750 Medicare and private ACOs were in operation as of early 2015, compared to about 250 ACOs in 2013. Pathologists and clinical laboratory...

Falling Inpatient Revenues at Many Hospitals Is Sign of Healthcare’s Transition to New Models of Integrated Clinical Care and Changes in Medical Laboratory Test Utilization

Statistics indicate that inpatient admissions and revenues are falling nationally, a development that affects clinical laboratories in hospitals and health systems One important trend that directly impacts the medical laboratories of hospitals and health systems is the falling rate of inpatient registrations seen nationally in recent years. What exacerbates this trend is the fact that many payers are cutting the prices they pay for certain inpatient services. Collectively, these two...

While ACO Care Coordination Holds Promise for Improving Quality and Lowering Healthcare Costs, It’s Still a ‘Work in Progress’

Healthcare Experts Now Exploring New Care Coordination Strategies and Overcoming Gaps in Measuring Performance For many healthcare professionals, the jury is still out as to whether accountable care organizations (ACOs) will prove effective at delivering the two important goals of improved patient outcomes at a lower overall cost of care over an extended period of time. That is why close attention is being given to the experience of Medicare’s Pioneer ACOs, since they were among the first ACOs...