A Hammer, a Chisel and a Bus Token

The news of Dartmouth’s withdrawal from the accountable care organization (ACO) program, as reported in a recent article in The New York Times, caught many by surprise since the ACO model can be traced back to concepts initially proposed by Dartmouth researchers. Citing unsustainable financial results, Dartmouth discontinued its participation in the federal ACO program. More

A Systematic Approach to Caring for the Chronically Ill

Health care spending in the U.S. exceeds $3 trillion per year and 10% of the population – the chronically ill – accounts for approximately 60% of that cost. Those patients are distinguished by their complex medical conditions that often require costly interventions. As noted in a previous Vizient blog, more than two-thirds of Medicare beneficiaries have multiple chronic diseases and a staggering 93% of total Medicare spending goes toward beneficiaries with multiple chronic... More

As Your Mother Might Say ... Elections Have Consequences

Consider this your public service announcement for the day: VOTE! Given the current political climate, I would not presume to enter the debate over which of our presidential candidates should be in the White House come 2017; we could certainly discuss that for hours ... or days ... or for the next four years. However, regardless of anyone’s opinion on our candidates, the fact remains that we will have a new president in less than 60 days and thus, changes are on the way. More

The Hurricane That Never Came

In 1989, the National Weather Service retired its coastal warning display system in favor of electronic communication and other technological advances. For more than 100 years prior, colored pennants, flags and lights were used to warn mariners of impending storms. In the 19th century, those warnings often came as the result of sailors having beaten a path to port ahead of storms they had seen with their own eyes. More

New Episode Payment Model Furthers CMS’ Goal for Provider Alignment

Continuing with the effort to build on value-based payments, the recent announcement by the Centers for Medicare & Medicaid Services (CMS) regarding the new Episode Payment Models (EPM) for acute myocardial infarction (AMI) and coronary artery bypass grafting (CABG) reinforces the their long-held belief that physician alignment is the key component for the transition to value-based care. More

Finding the Signal amid the Noise of Various CMS Payment Models


It is no secret that CMS intends to keep pushing the health care industry toward value-based reimbursement through its evolving payment models. The proposed rule for the Medicare Access and CHIP Reauthorization Act (MACRA) offers a new method of paying clinicians for the value of care they provide. It proposes implementing this change through a framework consisting of two paths: the Merit-based Incentive Payment System (MIPS) or advanced Alternative Payment Models (aAPMs).


A Walk through the Orchard: The Move to Outpatient Surgery

A recent article in Modern Healthcare reported on the enthusiasm over outpatient joint replacement surgery for younger and healthier patients. The arguments in favor of the shift for a subset of carefully selected patients are compelling. Quicker recoveries, faster return to normal activities, and reduced exposure to infections and other risks associated with hospitalization make a strong case for the change of venue. More

Goodbye Fee-for-Service. Hello Cardiac Bundles.

Spurred on by the overwhelming participation rates in the Bundled Payments for Care Improvement Initiative (BPCI) as well as their uncontested ability to impose a mandate on hospitals in selected areas through the Comprehensive Care for Joint Replacement program (CJR), CMS last week announced plans for a more extensive foray into the bundled payments arena.  More

If Sherlock Holmes Investigated Health Care Spending

In The Hound of the Baskervilles, Sir Arthur Conan Doyle’s intrepid sleuth observes that “the world is full of obvious things which nobody by chance ever observes.” Many of us who have spent our professional lives in health care have an intuitive belief that genuine multispecialty medical groups deliver care more efficiently than when physician services are fragmented among multiple, largely independent medical groups. More