Sheer madness, indeed. Broken, outdated and unsustainable are other words that come to mind. In a payment system that: • Values fee for service over connection to quality and outcomes. See more patients, do more with less and create the provider burn out inferno we now see. • Extends no inflationary update in reimbursement. Every year, providers take a pay cut due to inflation alone. From 2002 to 2023, providers are operating at 26% below its accompanying inflation rate. • Requires budget neutrality. Every year there are winners and losers and everyone get a turn on both sides but nobody ever comes out ahead. • Creates uneven payment advantages through an outdated RVU system. All healthcare is not created equal in the eyes of the RVU system. It’s no wonder why every year the great MPFS debate starts in the summer and everyone holds their breath for the Final Rule each November. Real change starts at the foundation, through alternative payment models and outdated provisions and legislation being lifted and revised to confront the reality of CMS spending. #medicare #healthcarefinance #hfma
Jennifer M Worthy, MBA’s Post
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This should be a major RED FLAG 🚩 for all providers! However, it also creates a significant leverage point for providers who know how to use it at the negotiating table. Payers need broad networks to maintain MA market share and profits. Providers can use that to their advantage at the bargaining table…payers need you more than you need them when it comes to MA. Remember, seniors don’t change doctors, and if forced to decide between keeping an insurer or their provider, 99.9% will change insurers….ask any broker! Learn how to leverage MA with Payers to increase reimbursements. 👉 https://lnkd.in/gRB3rMw3 #EllsworthConsulting #HealthcareInnovation #ConsultingServices #HealthcareLeadership #PayerNegotiations #HealthcareConsulting
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Site-neutral payment reforms have emerged as a rare point of bipartisan agreement in health care. Last week, with support from Arnold Ventures, Paragon Health Institute hosted Medicare Site-Neutral Payments: A Commonsense, Bipartisan Reform. The clear takeaway for me: it’s a “no-brainer” for Congress to enact site neutral payment policies this year. The event united former Department of Health and Human Services Secretaries Alex Azar and Kathleen Sebelius in making a strong case for site neutral payment, which was echoed by a terrific panel of experts from the Center for American Progress, American Enterprise Institute, The Brookings Institution, and Paragon. Right now, patients pay up to 4X more for routine health care services when they’re delivered in a hospital-owned facility instead of a doctor’s office. The current payment policy fuels consolidation by large hospital systems that can buy up smaller physician practices, change the name on the door, and charge more. This drives up spending in Medicare and the commercial market and means patients, employers, and taxpayers pay more. But as the secretaries noted and the panelists all agreed, these increased prices are not leading to better, safer care. There continues to be momentum behind site-neutral payments, offering Congress the opportunity to save money for patients and taxpayers while also reducing incentives for harmful consolidation. With such broad bipartisan support, it’s time to get this done. Watch the panel: https://lnkd.in/eAwTZuNu #SiteNeutralPayment #HealthCare #Costs
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It takes a long time to change #physician's mindset from fee-for-services to value-based care. That's why the U.S. healthcare spending is out of control. #CMS should be more patient and committed to let #MedicareAdvantage programs show their benefits. Otherwise, it would discourage physicians from doing #VBC. #primarycare #PCP #VBP #primarycareprovider https://lnkd.in/ekDfrvNV
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Medicare's underpayment of doctors and hospitals is a significant flaw in our healthcare systems that requires system-level solutions that address the root cause instead of slapping a band-aid on a scratch. Simply cutting costs by paying providers less doesn't fix the issues like inefficiency, misaligned incentives, and lack of transparency. #Medicare #HealthcareReimbursement #HealthcareRegulatoryEnforcement #PhysicianPayments
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Under the CY 2025 Medicare Physician Fee Schedule (PFS) proposed rule, CMS proposes several modifications to the Medicare Shared Savings Program (MSSP) that would become effective in performance year 2025. CMS also proposed finalizing certain amendments to the existing regulations for Medicare Parts A, B, C, and D regarding the standard for reporting and returning identified overpayments under the 60-day rule. This article summarizes key proposed changes to the MSSP and the 60-day rule and discuss their potential implications. Comments on the Proposed Rule are due on September 9, 2024. Read more: https://lnkd.in/e_ribceU
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As Medicare Advantage (MA) continues its rapid growth, hospitals face mounting financial challenges. According to S&P Global, hospitals are at risk of seeing pressure due to strict cost control measures like prior authorizations and slower payments from MA plans. This trend is forcing some hospitals, like Scripps Health, to reconsider their participation in these plans, potentially impacting patient access to care. With rural hospitals being especially vulnerable, the expansion of MA could be a "bad omen" for many healthcare providers. 😔 #Sandiola #ClinicalDocumentationIntegrity #CDI #DRGoptimization #InpatientAcuityCaptureExperts #RuralHospitals https://lnkd.in/deMeyhRW
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As CMS prepares to finalize its rule for 2025, Beth Mitchell and I wrote a piece for Medical Economics that urges CMS to reconsider the proposed reduction to physician payments. We argue the year-over-year cuts do not create a sustainable financial environment for physicians to be successful nor for patients to receive the best care. #CMS #reimbursement #Medicare #PFS https://lnkd.in/ehexW268
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https://lnkd.in/gf93qkzQ CMS is proposing a 2.23% increase in Medicare Advantage benchmark payments for 2025, translating to an estimated $21 billion boost for the program. This could have major implications for payers and providers operating in the MA space. The proposal aims to ensure the program's continued growth and stability while addressing concerns about payment accuracy. What are your thoughts on the potential impact of this increase? #MedicareAdvantage #CMS #HealthcarePayments #Payers #Providers
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Strategic negotiations with Medicare Advantage plans are more critical than ever. MA plans continue to grow in influence, making it essential for healthcare providers to stay ahead by understanding the nuances of contract terms, reimbursement rates, and performance metrics. It’s not just about reaching an agreement, it’s about leveraging these negotiations to drive sustainable growth and improve patient outcomes. #HealthcareFinance #MedicareAdvantage #PayerNegotiations #ValueBasedCare #HealthcareLeadership
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