Recent Articles

For Making Value Based Choices

6 minutes
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What are the Primary Drivers of Healthcare Costs?

The United States healthcare system is the most expensive in the world, reaching $3.5 trillion in 2017 ($10,739 per person) and comprising 17.9% of the country’s gross domestic product (GDP). Expected to reach 19.7% GDP (or $5.7 trillion) by 2026, healthcare costs are reaching unsustainable levels, jeopardizing America’s international competitiveness, burdening U.S. families, and weakening the...

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The Physician Quality Reporting System (PQRS): What is it and Where Did it Go?

The Physician Quality Reporting System (PQRS) is one phase of an evolving history of long-term U.S. programs created to assess and facilitate high-quality care across the healthcare system. Developed by the Centers for Medicare and Medicaid Services (CMS), PQRS is a “legacy” public reporting program, established in 2006 and ending in 2016, designed to collect data submitted by Eligible Professionals (EPs) on quality measures for...

5 minutes
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MSSP Redesign Means ‘Pathways to Success’ for ACOs

The Affordable Care Act of 2010 introduced a new era in healthcare payment reform, focused on shifting the environment of health care from fee-for-service (FFS) to value-based care. The Centers for Medicaid and Medicare Services (CMS) introduced the Accountable Care Organization (ACO) as an alternative payment model (APM) designed to encourage voluntary networks of...

6 minutes
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What Is The Physician Payments Sunshine Act?

The Physician Payments Sunshine Act (PPSA) was introduced in the United States Congress on September 6th, 2007 by Senators Charles Grassley (R-IA) and Herb Kohl (D-WI). The goal of the bill was to “shed light” on the nature and extent of financial relationships between physicians and teaching hospitals and the applicable manufacturers and group purchasing organizations (GPOs) they interact with. The expectations were that the bill would reveal the potential overall effect that these relationships have...

7 minutes
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What is Fee-for-Service?

Fee-for-service (FFS) is health care’s most traditional payment model where physicians and healthcare providers are paid by government agencies and insurance companies (third-party payers), or individuals, based on the number of services provided, or the number of procedures ordered. Payments are unbundled, so services are billed and paid for separately. In other words, every time a...

6 minutes
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Capitation vs. Fee-for-Service

As the current U.S. healthcare environment trends toward value-based care, the fee-for-service (FFS) reimbursement model is under intense scrutiny, often labeled as an antiquated payment model that promotes over-utilization by physicians and patients, while creating fragmentation among healthcare service...