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 New Cardiac & Orthopedic Payment Models

On January 3, 2017, the Centers for Medicare and Medicaid Services (CMS) published a final rule creating new bundled payment models for services provided during three (3) care episodes: (1) acute myocardial infarction; (2) coronary artery bypass graft; and, (3) surgical hip/femur fracture. Under the final rule, CMS will conduct a five-year test, starting on July 1, 2017, as to whether these episode payment models (EPMs), which combine payments to all providers across the continuum of care involved in the treatment of the patient for a particular condition, "improve the quality of care provided to [Medicare] beneficiaries in an applicable episode while reducing episode spending through financial accountability."Additionally, the final rule creates an incentive program related to cardiac rehabilitation treatments, and modifies certain provisions of the Comprehensive Care for Joint Replacement Model. Together, the final rule expands the scope of CMS bundled payment initiatives to the context of cardiovascular care, and reflect CMS's emphasis on using EPMs to drive the shift from fee-for-service payment to value-based reimbursement (VBR). This Health Capital Topics article will discuss the provisions of this final rule, and how the rule continues the shift toward VBR in healthcare delivery.

On January 3, 2017, the Centers for Medicare and Medicaid Services (CMS) published a final rule creating new bundled payment models for services provided during three (3) care episodes: (1) acute myocardial infarction; (2) coronary artery bypass graft; and, (3) surgical hip/femur fracture. Under the final rule, CMS will conduct a five-year test, starting on July 1, 2017, as to whether these episode payment models (EPMs), which combine payments to all providers across the continuum of care involved in the treatment of the patient for a particular condition, "improve the quality of care provided to [Medicare] beneficiaries in an applicable episode while reducing episode spending through financial accountability." Additionally, the final rule creates an incentive program related to cardiac rehabilitation treatments, and modifies certain provisions of the Comprehensive Care for Joint Replacement Model. Together, the final rule expands the scope of CMS bundled payment initiatives to the context of cardiovascular care, and reflect CMS's emphasis on using EPMs to drive the shift from fee-for-service payment to value-based reimbursement (VBR). This Health Capital Topics article will discuss the provisions of this final rule, and how the rule continues the shift toward VBR in healthcare delivery. (Read more...) 
On December 13, 2016, 38 days before leaving office, President Obama signed into law the 21st Century Cures Act. The law, considered by legal experts to be the "most comprehensive healthcare legislation to be enacted since the Patient Protection and Affordable Care Act [ACA] of 2010," covers a wide variety of topics related to healthcare delivery, administration, and research, including: (1) Mental Health Treatment; (2) Biomedical Research; (3) Opioid Addiction Treatment; (4) Billing for Off-Campus Hospital Outpatient Departments; (5) ACA Health Insurance Exchanges; and, (6) The Hospital Readmissions Reduction Program. The law is expected to impact providers in a multitude of ways, including the delivery of mental health services and modifications to certain quality programs and site-of-service requirements. However, the ultimate effect of the law on healthcare delivery is still unclear, as Congress delegated implementation of numerous aspects of the law to various federal agencies. This Health Capital Topics article will summarize the important provisions of the 21st Century Cures Act as it relates to healthcare providers and discuss the potential benefits, as well as stated criticisms, of the legislation. (Read more...) 
In November 2016, the Office of Inspector General (OIG) of the U.S. Department of Health & Human Services (HHS) released its yearly Work Plan (WP) for 2017. The OIG prepares this document by assessing the relative risks in HHS programs and operations, and consequently prioritizing the sequence and proportion of resources allocated. The 2017 WP describes new or revised OIG audits and evaluations that are underway or have been planned since April 2016, and removes items from the 2016 WP that have been completed, postponed, or canceled. It further discusses certain legal and investigative initiatives within the OIG and among its affiliated departments. The OIG stated in its WP that developing the plan is an ongoing process that may be updated throughout the coming year whenever necessary, meaning that the priorities of the OIG could change from what they have currently listed. This Health Capital Topics article will highlight the key changes in the plan and continued areas of focus for the OIG, as well as identify particular areas of concern for healthcare organizations in developing and maintaining regulatory compliance, especially with regard to issues of compensation, billing, and funding. (Read more...)
In 1999, the federal tax case Gross v. Commissioner of Internal Revenue, brought the issue of the impact of taxes on the value of a subchapter S corporations (S-corporations) to the forefront of consideration within the valuation community, with the Federal Tax Court's rejection of "tax affecting" (i.e., "allowing a deduction for taxes on corporate earnings") for S-corporations. The case spawned much debate in the valuation profession, including the development of four (4) models to utilize in valuing interests in S-corporations (by Roger J. Grabowski, FASA; Z. Christopher Mercer, FASA, CRA, ABAR; Chris D. Treharne, ASA, MBA, BVAL; and, Daniel R. Van Vleet, ASA).  Recently, the Tax Court has once again taken up the issue of valuing S-corporations in the pending case Cecil v. Commissioner of Internal Revenue, which involves a bequest of shares in the Biltmore Company, the operator of the historic Biltmore estate in North Carolina. The case provides another opportunity to resolve differences in the valuation community regarding tax affecting S-corporations, and may serve to address the validity of the models utilized to value interests in these entities. This Health Capital Topics article on the valuation of gifted common stocks for S-corporations will briefly discuss the debate surrounding tax affecting S-corporations, as well as how the Cecil case may impact the resolution of this issue. (Read more...)
ANNOUNCING

Advanced Distance Education to Launch in 2017

The Institute for Healthcare Valuation (IHV) & Consultants' Training Institute (CTI) are pleased to announce premier healthcare valuation training through a distance education program, the Certificate of Educational Achievement (CEA) for Advanced Education in Healthcare Valuation. The program will launch in the summer of 2017 and will bridge the interdisciplinary nature of healthcare valuation to include: the Four Pillars of Healthcare (regulatory, reimbursement, competition, and technology); the market forces shaping the U.S. healthcare industry; and the valuation of healthcare enterprises, assets, and services. Legal professionals and healthcare providers, as well as those wishing to expand their scope of activities in healthcare valuation engagements and those seeking to enhance their current healthcare valuation service lines, will gain comprehensive knowledge through completing the expansive program. The program has been developed and is being presented by industry thought leaders Robert James Cimasi, MHA, ASA, MCBA, FRICS, CVA, CM&AA, Chief Executive Officer, and Todd A. Zigrang, MBA, MHA, FACHE, ASA, President of Health Capital Consultants, alongside a blockbuster faculty of healthcare subject matter experts from the legal, federal regulatory, and valuation professions.

HCC CEO Bob Cimasi Recognized as a "Pioneer of the Profession" 
under NACVA's "Industry Titans" Awards

HCC CEO Robert James Cimasi, MHA, ASA, FRICS, MCBA, CVA, CM&AA
, has been named a "Pioneer of the Profession," by the National Association of Certified Valuators and Analysts (NACVA) and Consultants Training Institute (CTI) as part of their Silver Anniversary recognition luncheon of valuation "Industry Titans," which distinguishes those whom have had the greatest impact on the profession.  Mr. Cimasi joins valuation profession luminaries, including: Dr. Shannon P. Pratt, Chris Mercer, James R. Hitchner, Roger J. Grabowski, Richard Wise, Jay E. Fishman, Nancy Fannon, Honorable Judge David Laro, Howard Lewis, and Mel H. Abraham, along with fourteen others, in receiving this honor. Congratulations to Bob Cimasi and his fellow "Pioneer of the Profession" honorees from the HCC Team and Topics Staff!