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An early look at Medicare’s episode payment models22 August 2016 - By Pamela M. Pelizzari - Article

This document outlines the major provisions of the Centers for Medicare and Medicaid Services’ notice of proposed rulemaking, released July 25, 2016, and suggests possible implications for affected providers.

MIPS adjustment overview18 August 2016 - By Mary Margaret Huizinga and Pamela M. Pelizzari - Article

This paper covers the transition from current payment programs to the Merit-Based Incentive Payment System (MIPS), reviews the MIPS inclusion criteria, discusses the Composite Performance Score (CPS), demonstrates how the CPS leads to the determination of the MIPS adjustment factor, and explores the effect of changing practices on both the CPS and MIPS adjustment factor.

Challenges and opportunities with obtaining Qualifying APM Participant status18 August 2016 - By Charlie Mills and Christopher Kunkel and Pamela M. Pelizzari - Article

This paper explores both the challenges and the opportunities associated with participating in an Advanced Alternative Payment Model (APM) and obtaining Qualifying APM Participants status, helping providers understand not only why this status may be desirable, but also what risks they might encounter along the way.

Advanced APMs and Qualifying APM Participant status16 August 2016 - By Lynn F. Dong and Pamela M. Pelizzari - Article

This paper explores the definition of an Advanced Alternative Payment Model (Advanced APM) , how providers can qualify to be paid under the provisions of the Advanced APM track instead of under the Merit-Based Incentive Payment System, and why that might be desirable.

Key MACRA timeframes03 August 2016 - By Mary Margaret Huizinga and Pamela M. Pelizzari and Susan E. Pantely - Article

This paper covers the timeframes associated with the Medicare Access and CHIP Reauthorization Act of 2015 with a focus on the Merit-Based Incentive Payment System and the Advanced Alternative Payment Model.

Cost drivers of cancer care: A retrospective analysis of Medicare and commercially insured population claim data 2004-201414 April 2016 - By Bruce S. Pyenson and Kathryn V. Fitch and Pamela M. Pelizzari - Article
This report identifies trends in the overall and component costs of cancer care, creates comparisons to cost trends in the non-cancer population, and identifies several drivers influencing the rising cost of cancer care.The Comprehensive Care for Joint Replacement model: Balancing risk and opportunity24 March 2016 - By Pamela M. Pelizzari - Article

It is imperative that hospitals fully understand the key constructs underlying the Comprehensive Care for Joint Replacement model, because as of April 1, eligible services provided and managed by post-acute providers will directly affect the hospital’s payment for a lower extremity joint replacement patient.

Integrated benefit programs: The future for dual eligibles04 June 2015 - By and Pamela M. Pelizzari - Article

There is great interest in trying to provide benefits to dual-eligible individuals in a more efficient way.

The high cost of heart failure for the Medicare population: An actuarial cost analysis04 February 2015 - By Bruce S. Pyenson and Kathryn V. Fitch and Pamela M. Pelizzari - Article

Heart failure is becoming increasingly prevalent in the U.S., with its total direct medical cost expected to be $53.1 billion by 2030.


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