Blog

On Friday, July 14, the Centers for Medicare and Medicaid Services (CMS) released the 2018 Outpatient Prospective Payment System (OPPS) proposed rule. While some of the contents aren’t surprising, there is a key issue at stake that could fundamentally alter the way the Comprehensive Care for Joint Replacement (CJR) bundled payment model functions. The proposed […]

Read More...

What can you do while CMS decides how to handle the mandatory program? As the healthcare community continues its march away from fee-for-service models, bundled payment initiatives have risen in popularity—thanks in no small part to their ability to fuel cost savings and significantly improve care outcomes. The Centers for Medicare and Medicaid Services (CMS) […]

Read More...

Another round of major healthcare financial cuts is possible—and their impact could be devastating. As healthcare policymakers and analysts try to mitigate the high cost of healthcare in the United States, payment reform is already making an impact on the way provider organizations do business. DataGen recently released projections revealing the impact of cuts made […]

Read More...

As we look ahead to 2017—a year that’s sure to bring changes to the way healthcare is delivered under the new Trump Administration—Kelly Price, DataGen’s Vice President and Chief of Healthcare Data Analytics, sat down with Stephanie Kovalick, Chief Strategy Officer at Sage Growth Partners, to provide expert perspective on the current and future states […]

Read More...

For 30 years, Medicare’s hospital Inpatient Prospective Payment System has used Diagnosis Related Groups (DRGs) to account—or risk adjust—for the differences in the cost of care for clinically complex patients. By creating a direct link between reimbursement and outcomes, pay-for-performance adds a new layer to the issue of risk adjustment. Myriad quality metrics are currently […]

Read More...

Two hospitals recently reached out to the DataGen/Singletrack Analytics team regarding their strategies for success under the Medicare Bundled Payment for Care Improvement (BPCI) initiative.  These conversations revealed a contrast in decision points between the two hospitals, both of which are participating in the “Major Joint Replacement” episode family.  Because of the differences in their […]

Read More...

Considerable discussion has taken place during the Centers for Medicare and Medicaid Services (CMS) resource calls about which process to use when computing episode payment rates for low-volume Diagnosis Related Groups (DRGs).  This is an issue because Bundled Payment for Care Improvement (BPCI) applicants are required to participate for all DRG severity levels within a […]

Read More...

The Centers for Medicare and Medicaid Services’ (CMS) responses to applications for the Bundled Payment Care Improvement (BPCI) demonstration program have raised more questions than they answered.  While we understand the government’s need to reign in the myriad bundle definitions, the degree to which CMS has gone from “define your own” to non-negotiable specifics raises some […]

Read More...