Value-Based Reimbursement: What You Always Wanted to Know, But Were Afraid to Ask (Part One of Three-Part Series)
At present, the healthcare industry's transition towards value-based reimbursement is in full swing, with providers and payors preparing for significant ties between the quality and efficiency of services and the payment for those services. However, the current emphasis on quality and efficiency stands in stark contrast to previous reimbursement structures utilized by the Centers for Medicare and Medicaid Services. This Health Capital Topics article is the first in a three-part series that will examine the evolution of value-based reimbursement in the United States. This first article in the series will explore the early initiatives that attempted to test the efficacy of paying healthcare practitioners based on the value of the services that they provided in a reimbursement environment dominated by an emphasis on volume. (Read more...)

Telemedicine: The Reimbursement Environment (Part Two of Four-Part Series)
As highlighted in Part One of this four-part series, the Centers for Medicare and Medicaid Services (CMS) is increasingly recognizing the value associated with the provision of telemedicine services. For calendar year 2016, CMS is reimbursing more than 20 different telehealth services, including the practice of telemedicine in pharmacologic management, behavioral neurology, and end-stage renal disease therapy. This trend toward increased reimbursement for telemedicine services is also occurring among commercial payors, for services such as video diagnoses and remote monitoring for chronic conditions. The second installment of this Health Capital Topics four-part series on telemedicine will examine the telemedicine reimbursement environment in light of recent legislative trends and economic conditions impacting healthcare delivery. (Read more...)

ACA's Cadillac Tax Delayed Until 2020
As a sign of the continued evolution of healthcare reform, on December 18, 2015, President Barack Obama signed the Consolidated Appropriations Act, 2016, into law, which delayed the implementation of the excise tax on high-cost employer health benefits packages, known as the "Cadillac Tax," from 2018 until 2020. While many legislators and employers in opposition to this excise tax are seeking to transform the two-year delay on the implementation of this provision of the Patient Protection and Affordable Care Act (ACA) into a full repeal of the law, other market forces may already be driving many employers to reduce the costs associated with their benefits plans, which could affect overall healthcare spending, and ultimately achieve the intended goals behind this controversial ACA provision. This Health Capital Topics article will detail the basics of the Cadillac Tax, examine the reaction of employers and others in the healthcare industry on the provision's two-year delay, and discuss how, even with the implementation delay, employers are nevertheless modifying healthcare benefits packages for their employees, potentially impacting overall healthcare expenditures. (Read more...)

HCA Hit with $400 Million Judgment by Missouri Court
A recent Missouri court decision against the largest for-profit hospital chain in the U.S. has brought new attention to the need of for-profit entities, when acquiring non-profit hospitals, to abide by post-closing covenants related to the provision of charitable care. On December 9, 2015, the state Circuit Court of Jackson County, Missouri at Kansas City, in the case Health Care Foundation of Greater Kansas City (Foundation) v. Health Corporation of America (HCA), found that HCA did not abide by post-closing covenants requiring HCA to spend funds in furtherance of the charitable mission of Health Midwest, a greater Kansas City non-profit health system acquired by HCA in 2003. The ruling, which set forth damages against HCA in the amount of $433,725,593, highlights the importance of a for-profit company's compliance with post-closing covenants related to furthering charitable goals when buying the assets of a non-profit health system. This Health Capital Topics article will detail the facts and rulings of the case, as well as the potential implications of the ruling on the transactional environment for hospitals. (Read more...)