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Scott Hodgin

about 

With a Master’s Degree in English from Middle Tennessee State University, and decades of writing experience, Scott Hodgin is a proven contributor for INSIGHT. He has built a reputation as an experienced researcher, who is well-versed in the healthcare environment, and who delivers quality reporting with a dynamic, engaging, and relatable writing style.

latest posts
Fee For Service

What is Fee-for-Service?

By

Scott Hodgin

|

April 9, 2018

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...

Fee For Service

Capitation vs. Fee-for-Service

By

Scott Hodgin

|

April 9, 2018

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...

accountable-care-organization

What Is An Accountable Care Organization (ACO)?

By

Scott Hodgin

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February 19, 2018

The era of traditional, fragmented healthcare is coming to an end, and Accountable Care Organizations (ACOs) are positioned to become the new normal. The fee-for-service (FFS) reimbursement model is yielding to newer value-based payment models that focus on paying providers for quality and value, not volume. Specifically, since the passing of the Affordable Care Act (ACA) in 2010, ACOs have proliferated the healthcare landscape. Although stimulating an...

Value Based

Value-based Purchasing: What is it?

By

Scott Hodgin

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January 26, 2018

Value-based purchasing (VBP) is a methodology of healthcare payment reform that focuses on paying providers for quality and value, not just volume. Sometimes referred to as “pay-for-performance” (P4P), value-based purchasing is becoming the new normal in healthcare, linking provider reimbursements to quality measures and cost-efficiency. The traditional fee-for-service (FFS) payment model is “morphing” into alternative payment models (APMs) that increase provider accountability for both quality and total cost of care, while requiring a greater focus..

Value Based

The Five Conceptual Templates for Value-Based Reimbursement

By

Scott Hodgin

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January 26, 2018

The healthcare industry is in the middle of a payment structure overhaul. The conventional fee-for-service (FFS) reimbursement model is slowly being replaced by an assortment of value-based reimbursement (VBR) models aimed at encouraging healthcare providers to deliver the best quality care at the most reasonable cost, thus improving the overall value of care. In January 2015, the Department of Health and Human Resources (HHS) announced its intention to link 50% of all traditional Medicare payments to value-based reimbursement models by...

accountable-care-organization

The HMO Act of 1973: Objectives Finally Met through ACOs?

By

Scott Hodgin

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February 19, 2018

Signed into law by President Richard M. Nixon on December 29th, the HMO Act of 1973 was ambitious legislation that initiated a long, bumpy, and unsatisfying endeavor to establish a comprehensive healthcare delivery system that lowered medical costs and provided quality care to every American. Senator Edward M. Kennedy favorably described the proposed legislation as “a drastic overhaul of [the] entire way of doing business in the healthcare field” (Brase). The legislation obligated the Federal Government to support the...

Fee For Service

Fee-for-Service Health Care: Three Phenomenon Affecting Success

By

Scott Hodgin

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April 9, 2018

The United States healthcare system is experiencing a major shift in delivery and payment policy to address out-of-control spending and low-quality care. In 2010, the Affordable Care Act (ACA) set in motion a new vision for healthcare delivery and reimbursement—value-based care—aimed at replacing the “broken” traditional fee-for-service (FFS) model. Massive change takes time, yet lawmakers and industry experts are determined to fully replace the..

Medicare Shared Savings Program (MSSP)

The Medicare Shared Savings Program: Risk vs Reward

By

Scott Hodgin

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February 19, 2018

The Medicare Shared Savings Program (MSSP) was created by the Centers for Medicare and Medicaid Services (CMS) as part of the Affordable Care Act (ACA) of 2010. Launched in 2013, the MSSP is CMS’s largest Accountable Care Organization (ACO) program, covering 10.5 million assigned Medicare beneficiaries in 2018. The MSSP is the key component in Medicare payment reform, utilizing ACO models to lead the transformation from fee-for-service (FFS) to value-based health care. It’s no secret that...

Independent Physician Associations

How Independent Physician Associations (IPAs) Win Together

By

Scott Hodgin

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March 26, 2018

Today’s healthcare system is undergoing a complicated transformation, a regulatory restructuring of care coordination and payment reimbursement from fee-for-service (FFS) to value-based care. Payment models and care delivery systems are evolving, and independent physicians are being forced to reexamine their roles and sustainability in this modern approach to health care. With the help of...

accountable-care-organization

Diabetes and Accountable Care Organizations: A Value-based Care Strategy

By

Scott Hodgin

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February 19, 2018

In today’s healthcare system, diabetes, and treatment associated with the disease, continues to be a major contributor to rising healthcare costs. Diabetes remains the 7th leading cause of death in the United States, affecting 30.3 million Americans in 2015, or 9.4% of the U.S. population. In 2012 the total cost of diagnosed diabetes, and prediabetes, in the U.S. was $322 billion. Experts agree that in order to lower the...

Value Based

Quality Over Quantity: What Value-based Care Means for Providers

By

Scott Hodgin

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January 26, 2018

The age of value-based healthcare is here, and the Centers for Medicare and Medicaid Services (CMS) has taken the lead in healthcare delivery and reimbursement reform. The strategy is driven by a three-part aim to offer better quality health, to improve patient healthcare experiences, and to deliver services at lower costs. CMS has designed an array of care programs and payment models that are meant to shift the focus of healthcare from volume-based care to value-based care, to change the mindset of providers in today’s healthcare system to focus on quality over quantity. However, this change is not a “light switch” type of adjustment, where providers can...

Shared Savings

How Quality Affects Shared Savings

By

Scott Hodgin

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February 26, 2018

The Medicare Shared Savings Program (MSSP), or Shared Savings Program, was created by the Centers for Medicare and Medicaid Services (CMS) as part of the Affordable Care Act (ACA) of 2010. Launched in 2012, the MSSP has become a key component in Medicare delivery payment reform, utilizing Accountable Care Organizations (ACOs) to lead the transformation from fee-for-service (FFS) to value-based health care. Now in its sixth year, the MSSP has grown...

Independent Practice Associations

IPAs and ACOs: Complementary Roles in Value-based Care

By

Scott Hodgin

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April 5, 2018

Today’s healthcare landscape is in the middle of a complicated reorganization, a changing regulatory structure of care coordination and payment reimbursement from fee-for-service (FFS) to volume-based care. Payment and healthcare delivery models are evolving...

Medicare Shared Savings Program (MSSP)

ACO'S & the Medicare Shared Savings Program (MSSP): How They Strategize Together Towards Value

By

Scott Hodgin

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February 19, 2018

The Affordable Care Act (ACA) of 2010 introduced a new era in healthcare payment reform. The Centers for Medicare and Medicaid Services (CMS) was tasked to create a number of Alternative Payment Models (APMs) designed to accommodate the multiplicity of healthcare disorders and patient population scenarios, while shifting the environment of health care from fee-for-service (FFS) to value-based care. CMS introduced the Accountable Care Organization (ACO) as an APM designed to encourage voluntary networks of physician...

accountable-care-organization

ACOs vs HMOs: Here’s How They’re Different

By

Scott Hodgin

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February 19, 2018

Health systems and managed health care are inventions of the early 20th century, but it wasn’t until the early 1970s that Health Maintenance Organizations (HMOs) were defined as such and considered solutions for dangerously high healthcare costs. Although prevalent throughout the 1980s and 90s, HMOs for various reasons...

MACRA

Understanding the Advanced Alternative Payment Model

By

Scott Hodgin

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January 26, 2018

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 began a reformation of modern healthcare from fee-for-service (FFS) to value-based care. Among other policies, MACRA legislation repealed the Medicare Part B Sustainable Growth Rate (SGR) reimbursement methodology, and it initialized a phasing out...

Value Based

Value-based Care vs Fee-for-Service

By

Scott Hodgin

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January 26, 2018

The healthcare industry is experiencing a transformation involving reimbursement payment models. The conventional fee-for-service (FFS) reimbursement model is slowly being replaced by the concept of value-based care, a reimbursement methodology that challenges the “volume-based care” associated with fee-for-service...

MACRA

MACRA Made Easy

By

Scott Hodgin

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January 26, 2018

MACRA is one of the most significant pieces of healthcare legislation in over a decade. Known as the Medicare Access and CHIP Reauthorization Act of 2015, this bi-partisan legislation was signed into law on April 16th, 2015, setting the course for a modern-day healthcare reformation. Whereas MACRA’s predecessor the...

MIPS

The Ultimate Guide To MIPS

By

Scott Hodgin

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February 19, 2018

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 began a reformation of modern healthcare from fee-for-service (FFS) to value-based care. Among other policies, MACRA legislation repealed the Medicare Part B Sustainable...

Shared Savings

Cracking The Shared Savings Code

By

Scott Hodgin

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February 26, 2018

In the traditional healthcare environment, physicians are reimbursed based on the number of services they provide, or the number of procedures they order. This is known as the “fee-for-service” (FFS) reimbursement model. This system of payment is considered...

Value Based

How Value Based Care Differs From Traditional Care

By

Scott Hodgin

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January 26, 2018

With the proposal and implementation of the Affordable Care Act in 2010, lawmakers searched for ways to reduce the national deficit. Baby boomers would soon be entering retirement age, and the costs of caring for the elderly and disabled Americans were expected to soar. Medicare became...

accountable-care-organization

Why Accountable Care Organizations Succeed

By

Scott Hodgin

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February 19, 2018

Under the Affordable Care Act in 2010, ACO’s were established by the Center for Medicare and Medicaid Services (CMS) with the goal to provide better care for individuals, better health for populations, and lower growth in expenditures (DHHS 67803). It’s important to note that as lawmakers searched for ways to reduce...

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featured posts
Fee For Service

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...

Protected Health Information (PHI)

How Compliance Relates To PHI (Protected Health Information) In an Office Setting

And there are several of the most common violations for this. There's a list of them. And most offices don't realize that they may be out of compliance...

Value Based

Value-based Care vs Fee-for-Service

The healthcare industry is experiencing a transformation involving reimbursement payment models. The conventional fee-for-service (FFS) reimbursement model is slowly being replaced by the concept of value-based care, a reimbursement methodology that challenges the “volume-based care” associated with fee-for-service...