VBC does not necessarily mean a reduction in all utilization. Rather, it means a rebalancing: fewer avoidable admissions, but possibly more use of home-based care, ambulatory services, and proactive outreach.
This proposal reflects a broader shift toward more restrictive oversight of inpatient utilization. As CMS finalizes this policy, providers should be aware of the immediate compliance and reimbursement risks associated with the phase-out.
Healthcare payments are no longer about transactions. It’s about controlling the revenue cycle. And increasingly, that control is not sitting with ISOs.
The goal of the Two-Midnight Rule, originally introduced under traditional Medicare Part A, was to reduce hospital admissions and to ensure the appropriate use of inpatient versus outpatient observation status. Here are some challenges and best practices.
CMS finalized a rule this week that will boost hospitals’ inpatient payment rates by 2.9%. Hospitals groups are unhappy with this payment update, arguing that it is insufficient and will exacerbate hospitals’ financial challenges.
Mental health-related emergency department visits and inpatient hospital admissions have been rising among U.S. children from 2016-21, according to new research. The report unveiled significant mental health utilization disparities between children covered by Medicaid and commercial insurance plans.
CMS has released its proposed inpatient payment rule for fiscal year 2022, which includes a payment bump that could increase reimbursement for hospitals by $2.5 billion. Further, in a win for hospitals, the proposal aims to repeal a part of the price transparency rule related to Medicare Advantage plans.
By reducing administrative burden and redesigning workflows around human needs, it creates space for what matters most: connection between clinicians and patients.
Patient volumes were uneven in 2020, and a new report shows volumes will likely remain below pre-pandemic levels in 2021. This indicates challenges for hospitals looking to stabilize their finances — but there are some key strategies that can help.
The financial futures of U.S. hospitals remain shaky, as Covid-19 cases and hospitalizations surge with alarming speed nationwide. Though vaccines are being distributed, the coming months will be challenging for hospitals, a new report from Kaufman Hall shows.
As a result of rapid consolidation, the 10 biggest health systems controlled 24% of market share based on patient revenue by 2018. The trend is expected to continue through the next decade, with health systems facing growing financial pressures and an increase in demand for new types of care delivery.
Adoption of telehealth is on the rise since 2017 for inpatient providers though for outpatient providers it has largely remained flat.
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