Unbiased Analysis of Today's Healthcare Issues

Did BPCI work?

BPCI is Medicare’s Bundled Payments for Care Improvement initiative.  For selected conditions, hospitals receive bundled payments that can include concurrent physician payments, post acute-care or other arrangements. The question is, does this payment approach improve quality and reduce cost? A study by Dummit et al. (2016) looked at lower extremity joint replacement at a BPCI-participating hospital.  They found the […]

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Who is participating in BPCI?

In 2013, Medicare launched the Bundled Payments for Care Improvement (BPCI) initiative.  There were 4 models included in the program: Model 1 (least comprehensive): includes Part A services for the index hospitalization alone, and thus most closely resembles current fee-for-service payment. Model 2 (most comprehensive): encompasses Part A and Part B services for the index hospitalization, readmissions, and all other post […]

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Why don’t payers adopt my technology?

Why don’t payers adopt innovative approaches to treat mental illness? For instance, crisis intervention programs, recovery-focused consumer education programs, telehealth programs, and on-line treatment programs have sometimes have had problems receiving reimbursement from payers. Monica Oss of OpenMinds takes the payers’ perspective: Often, the organization proposing the new program comes to the table with an […]

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Reducing Cancer Treatment Costs

Cancer is the second leading cause of death in the United States. Reducing mortality and morbidity from many types of cancer would be an enormous breakthrough. Although the benefits from high-quality cancer care are clear, cancer care is expensive. GoozNews reports that a UnitedHealthcare official stated that reimbursement for cancer care now accounts for 12 […]

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Effect of Outpatient PPS on Medicare Volume

Implemented on August 1, 2000, Medicare’s Outpatient Prospective Payment System (OPPS) classifies hospital outpatient services into approximately 800 ambulatory payment classifications (APCs) based on clinical and cost similarity. Medicare reimburses the hospital the same amount for each APC–with adjustments for local labor costs, certain hospitals, and outlier cases–regardless of the mix of services provided. How […]

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How Health Reform will affect Hospital’s Business Strategy

For many years, fee for service payment was the status quo. FFS model encourages hospitals to adopt the following strategies to maximize market share and profits: Centered on short-term acute care Focused on specialist alignment Driven by a volume-based service-line strategy Using expensive medical equipment purchases to encourage physician referrals Attracting patients with new construction […]

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