Top Predictions for Healthcare 2020

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Price Transparency Lawsuit

As expected, the American Hospital Association (AHA) and others have sued the federal government for the price transparency requirement. This lawsuit was filed regarding the upcoming mandate for hospitals to disclose their private negotiated rates with commercial payers. The Centers for Medicare & Medicaid Services (CMS) has made their goal clear—to allow patients to be …

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Final Rule is Out

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Medical waste is a target for sustainability

A new study published in Modern Healthcare found that medical waste accounts for roughly one quarter of all U.S. healthcare spending accounting for approximately $760-$935 billion annually. This is precisely why the government is focused on value-based care, transparency, and alternative payment models. The report highlights the data the government has been using to drive their quality and value …

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Appropriate Use Criteria

Commencing Jan. 1, 2020 the Protecting Access to Medicare Act (PAMA) requires referring providers to consult Appropriate Use Criteria (AUC) prior to ordering Advanced Diagnostic Imaging Services (ADIS), CT, MR, Nuclear Medicine and PET, for Medicare patients. The Appropriate Use Criteria will apply to services furnished in a hospital outpatient department, physician’s office, or an …

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OPPS Transparency Webinar

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Value-Based Care, Transparency, Value, Data and Alternative Payment Models

The Final Rule, Alternative Payment Model (APM) proposals, and transparency mandates have made it clear that healthcare will be permanently changing. The goal is to standardize quality and value of healthcare while decreasing cost. In theory this sounds acceptable, but the implementation will require practical applications and buy-in from all those in healthcare. In addition, …

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The new age of revenue process management and opportunity

Technology continues to advance rapidly, allowing us to best serve our patients and make quality healthcare more readily available. For hospital operations, we are just now beginning to embrace the opportunities of technology. “Technology investment,” is the fastest-growing opportunity (that many will miss) with the most significant impact at a time where we are seeing: …

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Patients Over Paperwork Initiative Update

The Patients Over Paperwork initiative recently celebrated its two-year anniversary. Seema Verma and several others provided updates on the progress of the program on October 30th, 2019. This has been a top priority for CMS Administrator Seema Verma. The goal is to ensure quality care while removing much of the redundant and duplicative “red tape.” CMS has actively …

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