An Innovative Solution: LEAN Six Sigma in Healthcare

What happens when you bring wisdom from outside of healthcare into your organization? One New Hampshire CEO is thinking outside of the box and testing this out. Tom Mee, CEO of North Country Healthcare, is standardizing quality of care across the four facilities that make up his healthcare network by standing up a LEAN Six […]

Next Generation ACOs Cut Medicare Spending

Next Generation ACOs (NGACO) have been associated with model-wide reductions in spending without declines in quality, according to a new report from CMS. Based on their first performance year (2016), the participating NGACOS reduced Medicare spending by approximately $100 million.   The savings appeared to be associated with reductions in hospital and skilled nursing facility […]

CMS Proposed Rule Will Cut Medicare Spending by $760 Million

CMS recently released its proposed rule for changes to the Outpatient Prospective Payment System (OPPS) for FY19. In addition to a proposed 1.25 percent increase in hospital OPPS rates for FY19, CMS wants to reduce payment for hospital outpatient clinic visits at off-campus provider-based departments to 40 percent of the OPPS rate.   The “site-neutral” […]

Competition and Value Lead CMS Policy Priorities

The head of CMS outlined the agency’s policy shift to competition and choice in a recent interview.  Seema Verma noted, “Coming incentives will encourage Medicare beneficiaries to shop among providers, with those that have the lowest prices and deliver better-coordinated care gaining a competitive advantage.” (“Public Poll, Verma Reject Single-Payer,” HFMA Compass, July 27, 2018) […]

Advocates Want CMS to Increase APM Options for Clinicians

The recently released “massive” Medicare physician proposed payment rule included a “surprise” projection that alternative payment model (APM) participation may decline. Provider organizations are planning member briefings on the rule. (“Providers Examining Why APMs Are Expected to Stall,” HFMA Weekly News, July 23, 2018)   The proposed rule continues the implementation of revisions to physician […]

An Argument for Growing High-Value Service Lines

Hospitals/systems may be considering the pro’s and con’s of growing their service lines, even as they grapple with cost reduction strategies. Experts have noted the many benefits including increased patient volumes, improved health outcomes, increased market share and improved physician loyalty. If hospitals/systems focus on high-value service lines, a key benefit would be a significant […]

CMS Reveals New Stance on ACO Risk Contracts and Medicaid Limits

No Medicaid lifetime limits and a hard stance on ACO risk contracts highlighted CMS head Seema Verma’s talk at the American Hospital Association’s recent annual meeting.   “We’re determined to make sure that Medicaid remains the safety net for those who need it most,” Verma said. “To that end, we have determined we will not approve […]

Internalizing Enterprise Risk Management

As the healthcare market expands and evolves, the inherent risks also are increasing. These risks include: The shift from volume to value The rise of the consumer and expansion of consumer options New payment models Mobile strategies New entrants An aging population Continued political and regulatory uncertainty   Whereas hospitals/systems have traditionally done well at […]