Tag Archives: fee-for-service

Calculating Medicare Advantage/Fee-For-Service Price Differences Is Harder Than It Looks

The fundamental problem is that payments to hospitals from fee-for-service have Indirect Medical Education included in them, but payments from Medicare Advantage plans do not.

November 28, 2016

Making Dental Care A Part Of ACOs

The Affordable Care Act offers new opportunities to bring medical and dental care delivery closer together to improve, integrate, and coordinate care via accountable care organizations or other kinds of clinically integrated networks.

September 7, 2016

Value Based Reimbursement: The Rock Thrown Into The Health Care Pond

The current direction of reimbursement policy is clear and we can see its ripples spreading across the health care pond. Rather than paying for standard, piecemeal work, providers and clinicians seeking economic success will have to deliver value through high-quality services.

July 8, 2016

Paying For Value: Perspective From The Front Lines

The concept of value-based health care is rapidly gaining traction in the U.S., yet implementation remains a significant challenge. We propose that in a true pay-for-value system, a national payment rate should be established and rooted in reality and adjusted for three factors.

May 24, 2016

When Health Policy Gets Personal

How does a health policy professional understand the flaws with our system and the need for genuinely promising approaches to innovation in health care, yet, find instances where he does not practice what he preaches?

March 21, 2016

The Economics Of Paying For Value

A Symposium On Health Law. The belief that payment should be tied to value has led to a proliferation of value-based payment programs in both public and private sectors. Thus, it is useful to explore what economics may say about this change in the American health care system.

March 15, 2016

Supplemental Benefits Under Medicare Advantage

Policymakers have long been aware of the general categories of supplemental benefits available to enrollees under Medicare Advantage, but little has thus far been done to quantify their specific extent, scope, and availability.

January 21, 2016

Synchronizing Medicare Advantage And ACOs To Support The Secretary’s Quality And Value Payment Goals

In January 2015, HHS Secretary Sylvia Burwell announced the Department will tie an increasing percentage of Medicare reimbursement to quality or value. The Secretary's goals, however, exclude Medicare Advantage, which is expected to double its enrollment to 22 million beneficiaries between 2010...

December 28, 2015

Medicare ACOs Continue To Show Care Improvements — And More Savings Are Possible

This August, CMS released financial and quality performance data for its Pioneer and Medicare Shared Savings Program ACOs. We provide further analysis of the latest Pioneer and MSSP results and then discuss some implications for the future of Medicare’s accountable-care programs.

November 4, 2015

Measuring What Matters In Primary Care

Efforts to measure primary care have too often not focused on five key characteristics nor captured the performance of primary care practices on their components. We examine the flaws in current primary care metrics and the advantages of refocusing quality indicators on the key primary care...

October 6, 2015