- Pathways to Success: MSSP proposed rule: Assignment changes to identification of E&M Services in skilled nursing facilities
By Anders Larson, Jill S. Herbold | 19 October 2018
This paper discusses the current and proposed rules related to evaluation and management services in the Medicare Shared Savings Program.
- 2019 cost-of-living adjustments for Medicare benefits
By Milliman Employee Benefits Research Group | 17 October 2018
CAB 18-3: The Department of Health and Human Services’ Centers for Medicare and Medicaid Services has announced cost-of-living adjusted figures for Medicare Part A and Part B for 2019.
- Population-based payments (PBPs) open door for ACOs to more effectively manage care
By Noah Champagne, Jason McEwen | 16 October 2018
The Next Generation accountable care organization (ACO) model introduced a provider payment mechanism called population-based payments that allow ACOs to negotiate provider payment rates and may allow more effective management of resource use.
- Impact of Next Generation ACO Model on Medicare spending in 2016
By Hugh Larson, Annie Man, Timothy J. Wilder, Coleen Young | 15 October 2018
This paper combines the aggregate gross impact of each of the Next Generation Accountable Care Organizations (NGACOs) shown in the NORC report with the shared savings/(loss) results of each NGACO to calculate the net impact of each individual NGACO.
- Pathways to Success: MSSP proposed rule: Winners and losers
By Anders Larson, Cory Gusland | 03 October 2018
All accountable care organizations (ACOs) will be affected by the Medicare Shared Savings Program if enacted, and the impact of the rule change will vary by ACO depending on its current situation and unique characteristics.
- Pharma APMs: A learning curve awaits you, pharma
By Maggie Alston, Bruce S. Pyenson | 02 October 2018
There are some valuable lessons for pharmaceutical manufacturers in provider alternative payment models (APMs), but whether pharmaceutical APMs succeed or fail will depend on finding solutions to operational and logistical challenges—some of which are unique to the pharmaceutical industry.
- Pathways to Success: MSSP proposed rule: Beneficiary incentive program
By Carol Bazell, Susan Philip, Laurie Lingefelt | 26 September 2018
This paper explores the beneficiary incentive program proposed in the Medicare Shared Savings Program.
- Medical professional liability in 2018: Major challenges
By Paul A. Greve, Jr., Richard Henderson, Susan J. Forray | 25 September 2018
This article provides an overview of the state of the medical professional liability (MPL) insurance industry through the first half of 2018, focusing on key MPL environmental factors, MPL litigation trends, and MPL industry financials.
- Opportunities for care coordination through innovative technologies
By Susan Philip, Carol Bazell, Laurie Lingefelt | 24 September 2018
This paper discusses how accountable care organizations (ACOs) can increase their use of telehealth and other innovative non-face-to-face services in response to opportunities arising from new CMS policies and/or environmental changes.
- Preference-sensitive surgical procedures for preference-sensitive conditions
By Kathryn V. Fitch, Carol Bazell, Sumudu Dehipawala | 24 September 2018
This paper focuses on 15 preference-sensitive surgical procedures that may be performed to treat certain preference-sensitive conditions that have surgical treatment options.