Recently I had the opportunity to research CMS’ Oncology Care Model (OCM) bundle and to interview a number of c-suite individuals across oncology hospitals and clinics. Below please find eight summary thoughts. Difficulty of bundling oncology. Joint replacements (the focus of CMS’ new mandatory bundled payment program) have a clear beginning and end for the episode […]

Using CMS Limited Data Set (LDS) 2013 claims data, I examined the distribution of all Medicare fee-for-service (FFS) costs. The LDS claims file consist of 100% of all FFS claims for inpatient, outpatient, home health, skilled nursing facilities (SNF), and hospice. However, they include only a 5% sample for claims related to durable medical equipment […]

As a former primary care clinic manager and COO of a medical group engaged in value-based contracts, I was excited to see CMS’ announcement on Comprehensive Primary Care Plus (CPC+). I welcome this shift in Medicare primary care payments away from the quagmire of Fee-For Service (FFS) and into the higher ground of partial capitation, […]