Blog

Redesigned MSSP program The Medicare Shared Savings Program, one of Medicare’s largest alternative payment models, allows providers and suppliers the opportunity to form an Accountable Care Organization. It was redesigned in 2018, establishing “Pathways to Success” as a way to restructure participation and encourage ACOs to transition to two-sided risk models.  As part of this […]

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On April 29, CMS issued a final rule to extend the Comprehensive Care for Joint Replacement model by an additional three performance years. A number of modifications effective in the extension period aim to improve the model and reflect Medicare policy changes over the last several years. CMS anticipates that CJR will save the Medicare […]

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The initial cohort of the Primary Care First model went live on Jan. 1.  Cohort 1, represented by 847 practices and 14 payer partners, is offered in 26 regions across the country. Over the six-year PCF demonstration period, CMS will test whether advanced primary care practices can improve patient experience and quality, reduce total cost […]

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DataGen has completed its analysis of enacted Medicare cuts, the results of which are shared here. Please note that this analysis is intended for advocacy purposes only and should be used as an indication of the extent to which hospital providers nationwide have been impacted by existing Medicare provider payment cuts. These cuts were enacted […]

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It’s been a year: a year since the first lockdowns and a year since the landscape of healthcare in the U.S. changed forever. While we’re still evaluating the impacts of the pandemic on healthcare policy, we now have seen enough data to assess the effect of the past year on alternative payments models and how […]

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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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