Reimbursement
'One nut that we haven't really cracked is how we effectively engage patients,' says bundled payment expert.
AMCs show higher cost per case statistics and were hit with more penalties from value-based programs, survey says.
Starting in 2019, insurers may use step therapy to choose the least expensive drug first before moving on to another prescription.
The agreement will drive down costs through the monitoring of chronic conditions, preventative screenings, a connected EHR and virtual visit options.
Patient care is expected to improve, and as more people join the MA plans, costs are expected to go down.
CMS is finalizing the elimination the 25 percent threshold that reduces reimbursement for long-term hospitals.
Hospices that fail to meet quality reporting requirements receive a 2 percent reduction to their payments.
Consumers who rely on short-term plans for an extended period could face high medical bills when their care isn't covered, AHIP says.
Only a small number of consumers use price transparency tools, and physicians have narrow referral networks, which essentially steers patients toward high-priced testing facilities.
New skilled nursing payment model is slated to save providers an estimated $2 billion over the next ten years, CMS says.