alternative sources to access healthcare.
Retail health clinics are expected to
number more than 2,800, reaching
capacity for 9 million more patients
by the end of 2017. The expansion of
“telehealth” and urgent care clinics
is driving down prices and creating
additional stress for healthcare providers.
Changes in Reimbursement.
The announcement in 2015 by
the Department of Health and
Human Services (HHS) that it would
fundamentally reform how it pays
providers for treating Medicare
patients in the coming years was a
seismic shift in U.S. healthcare policy.
The intent is to reduce the volume
of unnecessary procedures while
improving patient outcomes. For the
fifth time, the U.S. healthcare system
in 2014 ranked last in quality compared
to 10 other industrialized Western
nations. 5 It continues to be difficult to
explain how and why performance
and patient outcomes continued to
be so underwhelming, even as U.S.
health expenditures per capita ranked
highest among the countries studied.
To improve outcomes, the Centers for
Medicare & Medicaid Services (CMS)
will tie 30 percent of all fee-for-service
(FFS) payments to providers to quality
initiatives through alternative payment
models—particularly accountable care
organizations (ACOs) and bundled
payments—by 2016. This standard will
rise to 50 percent by 2018.6 Another
key goal for HHS is for virtually all
Medicare FFS payments to be tied to
quality and value; at least 85 percent
in 2016 and 90 percent in 2018.7
With alternative payment models,
providers are now accountable for
the quality and cost of care for the
individual patients and populations
of patients they serve. How systems
respond to this broader definition is
increasingly critical under the ACA. It
strongly encourages healthcare delivery
systems, public health agencies, and
to work together to improve health
outcomes in the communities they
serve. Population health dispenses
with the old model that said, “The
more you do, the more you get paid.”
With alternative payment models, providers
are now accountable for the quality and
cost of care for the individual patients and
populations of patients they serve.
BILLIONS OF DOLLARS ARE RECOVERED BY CORPORATIONS IN CLASS ACTION SETTLEMENTS EVERY YEAR.
CALL RON SUSSMAN AT (201) 853-0307
OR MICHAEL EPSTEIN AT (201) 853-0303
Financial Recovery Strategies
RE COVER YOUR AS SE TS
continued on page 14