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On Jan. 19, the Office of Management and Budget requested public comment on recommendations for changes to OMB’s metropolitan and micropolitan statistical area standards. The recommendations, made by the Metropolitan and Micropolitan Statistical Area Standards Review Committee, included increasing the minimum urban area population to qualify a metropolitan statistical area from 50,000 to 100,000. The […]

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In November 2020, CMS announced a nationwide model that aims to reduce spending on Medicare Part B drug payments without impacting the quality of care. Called the Most Favored Nation model, the program endeavors to lower prescription drug costs by “paying no more for 50 high-cost Medicare Part B drugs and biologicals than the lowest […]

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Background:  After months of anticipation, CMS is planning to go forward with the mandatory Radiation Oncology Model. This bundled payment model, which was first announced in a proposed rule on July 10, 2019, with an anticipated start in January or April 2020, is notable for being one of the first mandatory models the industry has […]

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The COVID-19 public health emergency has resulted in numerous federal policy and program changes. Comprehensive Care for Joint Replacement program participants need to be aware of and prepared for several program changes in one of the most recent, CMS’ Additional Policy and Regulatory Revisions in Response to the COVID-19 PHE, released Oct. 28. First, the […]

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The COVID-19 pandemic has impacted every aspect of our healthcare system. That’s true for participants in the Oncology Care Model and Bundled Payments for Care Improvement Advanced programs. Organizations in these programs had to make important decisions regarding the overlap of their program performance periods with the COVID-19 public health emergency. Several trends have begun […]

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Six months after the initial lockdowns, COVID-19 continues to exert its grip on the country and the world. Amid this unprecedented crisis, the economy and human behavior are changing rapidly — and that holds true for the healthcare industry as well. Here are some updates from the past month that reflect an industry in the […]

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In response to the COVID-19 pandemic, CMS has implemented several policy amendments and changes to value-based care program methodologies. In June, CMS released new COVID-19-related payment methodology and data reporting flexibilities for Oncology Care Model participants impacting performance periods 7-9, along with establishing two new voluntary performance periods in 2021. The deadline for electing to […]

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Last week, the Centers for Medicare and Medicaid Services announced sweeping changes for Model Year 4 of the Bundled Payments for Care Improvement Advanced program. CMS’ own research has revealed that as it currently stands, BCPIA will cause CMS to lose $2 billion over the course of the program. As a result, CMS is making […]

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With each month, we learn more about how COVID-19 is transmitted and the effects of this pernicious disease on those who contract it — as well as the effects of the pandemic on the U.S. economy and the healthcare industry. Taking the pandemic into consideration, CMS continues to adjust its models to support hospitals and […]

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The Centers for Medicare and Medicaid Services is implementing new alternative payment models to address patient care areas that are likely to benefit from more value-based services. In addition to the Kidney Care First model, CMS is rolling out the Primary Care First model, targeted at primary care practices with advanced primary care capabilities. Building […]

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