Reimbursement

Akron Children's Hospital gets half its reimbursement from Medicaid, with all health systems facing a changing payer mix.

Final rule disincentives include hospitals not being able to earn three quarters of the annual market basket increase.

The increase counteracts some of the financial uncertainty caused by the California state budget deficit, CalOptima says.

CMS has paid over $2.5 billion to Part A hospitals and more than $717 million to Part B physicians, suppliers and others.

In traditional FFS, clinicians see one patient, but in value-based care, the provider is responsible for a population of patients and needs to know where else they have received care, which brings in the necessity for interoperability, says Dr. Harm Scherpbier, HealthShare Exchange CMIO.  

The decision comes after CMS lost two court cases, but the agency says it reserves the right to appeal.

Change is needed on Capitol Hill, which is why the Digital Therapeutics Alliance summit was held in D.C., says Andy Molnar, president of the group.  

CMS has been ordered to redetermine the star ratings, which Elevance says should be higher.

The current HHS formula costs hospitals more than a billion dollars each year, says AHA.

"Today's decision is a victory for Tribal self-determination and Tribal sovereignty," says Mark Macarro.