Blog

A spike in COVID-19 cases following the loosening of restrictions in some parts of the country is keeping the spotlight on the pandemic, while many in the healthcare industry are alarmed by the dramatic reduction in demand for care for other acute and chronic conditions. Another likely effect of the pandemic is the acceleration of […]

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As DataGen discussed in our recent blog post, “A Change for BPCI Advanced?,” CMS has proposed modifications to its target price methodology to adjust for unforeseen impacts from other policy changes. We noted that we believe a retrospective target adjustment is a good approach, but it should be implemented in ways that increase predictability for […]

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CMS weighing changes to target price methodology BPCI Advanced’s goal is to help practices more effectively deliver high-quality care at lower costs. But, certain policy changes come with unintended confounding factors that make it harder for participants to realize that goal. To ensure the continued viability of BPCI Advanced and other bundled payment programs, CMS […]

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As states begin to open up and our understanding of the coronavirus improves, the end of the pandemic is nowhere in sight. The effects of the crisis on the healthcare industry and ongoing changes in payment and practice policy continue to generate news. The continuing COVID-19 crisis CMS announced preliminary data on COVID-19, through May […]

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The Centers for Medicare and Medicaid Services (CMS) only just announced flexibilities to its bundled payment programs due to COVID-19. As of June 18, CMS made an additional announcement for participants and episode conveners in the Bundled Payments for Care Improvement Advanced (BPCI-A) program. Participants should make their clinical episode decisions with care. Ensuring they […]

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On June 9, the U.S. Department of Health and Human Services announced plans to distribute $10 billion in CARES Act Provider Relief Funds to certain safety net hospitals that serve a disproportionate number of Medicaid patients or provide large amounts of uncompensated care. According to the HHS announcement, hospitals qualifying for this funding pool will […]

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As part of the federal fiscal year 2021 Inpatient Prospective Payment System rule change proposed by CMS, two new hip-related diagnostic groups may be added to the Comprehensive Care for Joint Replacement program. CMS has noted that clinically, effective treatment of patients undergoing hip replacement following hip fractures tends to require more resources than those […]

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CMS proposed five new Medicare Prospective Payment System rules for federal fiscal year 2021 that healthcare providers should understand. In addition to the regular updates to the wage index, marketbasket and quality programs, one of the most significant items in these proposed rules is an update to the Core-Based Statistical Areas for all inpatient, skilled […]

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As the COVID-19 pandemic enters its third month in the U.S., the healthcare industry continues to focus on news related to the crisis. Nevertheless, as the wheels of healthcare policy reform roll on, updates to value-based care policy continue to be announced. The continuing COVID-19 crisis How has the $50 billion Provider Relief Fund portion […]

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Following the payments sent to hospitals as part of the Provider Relief Fund, The Department of Health and Human Services began distribution of the $10 billion in COVID-19 relief to rural providers on May 6. Hospitals, rural health clinics and community health centers will each receive a minimum base payment plus a percent of their […]

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