Recently the Centers for Medicare & Medicaid Services (CMS) published results for the second year of the value-based payment modifier (value modifier). The value modifier was established as one of the pay-for-performance initiatives under the Patient Protection and Affordable Care Act (PPACA). The 2016 value modifier is based on 2014 performance and is applied to physicians in groups with 10 or more eligible professionals (EPs), with all groups being identified by their Medicare-enrolled taxpayer identification number (TIN). 

In autumn 2015, physician groups and solo providers were able to review information on their quality and cost performance in the 2014 annual Quality Resource and Use Reports (QRURs). Payment impacts are based on cost and quality tiering covering a spectrum of low, average, or high cost and low, average, or high quality for TINs with 10 or more EPs. Quality tiering is defined as the methodology used to evaluate a group’s performance on the cost and quality measures used in the value modifier. While the value modifier is currently being phased in, it will apply in 2017 to all physicians (solo practitioners and groups) based on 2015 performance. In 2018 the value modifier will be applied, based on 2016 performance, also to nurse practitioners, physician assistants, clinical nurse specialists, and certified registered nurse anesthetists in groups with two or more EPs. 

The recent CMS announcement indicated that as it pertained to data collected up until Dec. 18, 2015,  a total of 128 physician groups exceeded the value modifier quality and cost efficiency benchmarks, meaning they will receive an increase in their payments under the Medicare physician fee schedule (PFS) of either 15.92 or 31.84 percent. However, 59 groups did not perform well under the value modifier and will see a decrease in their PFS payments of 1 to 2 percent. There were also 8,208 physician groups that met the minimum reporting requirements (or, in some cases, there was insufficient data to calculate their value modifier), and their PFS payments will remain unchanged in 2016. Of note is an additional 5,418 groups that did not meet the minimum reporting requirements and thus will see a 2-percent decrease in their 2016 PFS payments. 

CMS continues to encourage groups and solo practitioners to report the Physician Quality Reporting System (PQRS) data in an accurate, complete, and timely manner to avoid this automatic downward adjustment to PFS payments in the future. Still pending are 1,390 groups awaiting results from PQRS or value modifier informal review as of Dec. 18, 2015. Medicare Administrative Contractors (MACs) were slated to begin paying claims based on the updated payment amounts after March 14, and groups should expect to see claim adjustments within the next six weeks. Additional information on the value modifiers can be found online at


About the Author

Rhonda Taller is VBPmonitor’s legislative correspondent. She has over 30 years of experience with health information technology working within the vendor environment, with roles in product management, management, government affairs, and strategic consulting. Her expertise is on topics related to CMS reimbursement and quality regulations, value-based reimbursement programs, ICD-10, meaningful use, and health reform. Rhonda has held volunteer positions with HIMSS and WEDI, including appointment to the HIMSS Business Systems/Medical Banking Committee (2010-2012), chairing the HIMSS ICD-10 Task Force (2013-2014), and serving as co-chair of WEDI ICD-10 Transition Workgroup.

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This is the fifth article in a series addressing the value proposition of long-term, post-acute care (LTPAC) providers and health IT vendors. The articles focus on five major valued quality of care coordination (VQCC) differentials between LTPAC providers and acute/ambulatory care providers. This series of articles is based on the LTPAC health IT collaborative ONC brief written in May 2015 for Karen B. DeSalvo, national coordinator for health information technology and acting assistant secretary for health with the U.S. Department of Health and Human Services (HHS), titled Health Information Technology Use & Value Delivered by The Long-Term and Post-Acute Care (LTPAC) Sector.

Readers can find the complete ONC brief on the LTPAC HIT Collaborative website.

The following is a summary table of the five VQCC differentials cited in the ONC brief. Articles have been published on the first two differentials (duration and e-assessments).

This article is about what might be the most important VQCC differential: chronic care comorbidities. Why is chronic care the most important of the five differentials? The major reasons are:

An aging population: The fact that the Medicare program has experienced a large influx of new enrollees during recent years isn’t new news. What might be new is the anticipated rapid future growth of the program’s enrollees in their early to mid-80s. Mark Parkinson, MD, president and CEO of the American Health Care Association (AHCA), noted in a recent speech at the Direct Supply DSSI Forum in February that this age group had flat growth from 2012-2015. This caused a census issue in skilled nursing facilities (SNFs). As you can see from the graph, after 2015 and through 2030, the number of people over 80 is projected to increase at a rapid rate. This group includes the elderly, who are most prone to requiring chronic care.




Cost of care: There have been many papers written on the cost of care for the segment of the elderly population that have chronic conditions. Most of these patients have more than one chronic condition and are classified as complex chronic care patients with comorbidities.



Quality of care: As we shift from fee-for-service to value-based care, there are many programs that can be leveraged to harmonize quality measures across the spectrum of care. Most of these deal with single disease states and not quality measures associated with those with multiple chronic conditions with comorbidities. It will be difficult to really measure quality indicators on a complex chronic care patient, as the conditions are interactive, as well as the polypharmacy used in medication management. This means that developers of quality measures (QMs) will have a difficult time measuring metrics for one chronic care patient while referencing another or a segment of the population, especially across the spectrum of care.

Regulations: CMS has recognized the issue of the importance of caring for the chronic care patient with comorbidities, not only for their high costs of episodic care, but for their quality of life. Specifically, the agency noted:

“The Centers for Medicare & Medicaid Services (CMS) recognizes care management as one of the critical components of primary care that contributes to better health and care for individuals, as well as reduced spending.

Beginning Jan. 1, 2015, Medicare pays separately under the Medicare Physician Fee Schedule (PFS) under American Medical Association Current Procedural Terminology (CPT) code 99490 for non-face-to-face care coordination services furnished to Medicare beneficiaries with multiple chronic conditions. (Ref: ).

What does this mean to LTPAC and the VQCC differentials? In other care settings, there is often not enough time and professional support to diagnose, treat, stabilize, maintain, and set up a comprehensive, holistic chronic care plan. In the ONC brief, this is explained:

“VQCC No. 3, LTPAC Chronic Care – Co-Morbidity Care Differential LTPAC Providers, as (some) of the first providers after hospital discharge to coordinate care, have:

  • Coordination of staff and health IT capability to conduct chronic care co-morbidity as well as standard e-assessments;
  • A complete clinical profile of the patient, identifying the diagnostic, care, treatment, and/or maintenance plan; and observation requirements for chronic care and co-morbidities;
  • A person-centric longitudinal care record based on coordinated team care in a controlled environment; and
  • A plan that prepares the patient (and his or her family) for the next level of care or the home of their choice (see Appendix J of the ONC brief for more information).”

LTPAC value proposition: Mainly in skilled nursing facilities and home health agencies, there is an opportunity to develop the chronic care patient’s person-centric electronic longitudinal care record, and to be able to transition this care plan to the next care setting. Assisted living facilities using the clinical model and long-term acute-care hospitals also have an opportunity to develop the chronic care longitudinal care record, as do some of the new care models in which professionals make calls on chronic care patients in their homes. SNFs have been working with the complete chronic care model for years. It has remained in the paper clinical record and there has been very little trending and aggregating, except maybe in the minds of the caregivers. The SNF is the primary care facility that can develop the patient’s first person-centric electronic longitudinal chronic care record. They have the five VQCC differentials, which all build on the care of the patient (including No.1, duration, No. 2, e-assessments, No. 4, medication management, and No. 5, technology). The person-centric electronic longitudinal care plan was defined in a previous article in this series. Basically, it is the electronic aggregation of all the clinical elements of a patient collected over a period of time in order to develop trending, alerts, and the introduction of clinical decision software to get to preventative care and wellness.

The advantage of the chronic care patient with co-morbidities having his or her first transition of care from a hospital episodic incident to rehabilitation could be the development of the person’s first chronic care longitudinal care plan being passed on to the next care site. This is a major value proposition that is currently being ignored as we look at patients in single disease states.


About the Author

John F. Derr, RPh, is CEO of JD & Associates Enterprises, specializing in strategic clinical technology with a focus on person-centric electronic longitudinal medication management and LTPAC. He has over 50 years of top executive-level experience with Squibb, Siemens, Tenet (NME), Kyocera, MediSpan, and EVP of AHCA. He was SVP, CIO, and CTO for Golden Living, LLC. He is a member of corporate boards providing guidance on clinical health IT and medication management. He represents LTPAC and pharmacy as a member of HHS HITECH Committee on Standards. Derr is a graduate of the Purdue School of Pharmacy and a 2006 distinguished Purdue alumnus.

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One of the concepts being used to move the healthcare industry from the current fragmented, episodic delivery-of-care model to a value-based model is the accountable care organization (ACO). In theory, this concept should allow providers to work in a much more collaborative and cohesive manner and provide better quality care at lower costs. What are the early results? The answer may depend on who you ask.

To evaluate this, let’s review some of the associated CMS initiatives and their results.

CMS has expanded the number of ACO models under the Patient Protection and Affordable Care Act in an attempt to improve quality of care, better coordinate care delivery, and bend the cost curve. These models include the Pioneer model, the Medicare Shared Savings Program (MSSP), the Next Generation model, and the Comprehensive ESRD care model.

Currently, in total there are 477 ACOs participating in these programs, covering 8.9 million beneficiaries, and 64 ACOs are in risk-bearing models. In 2014, the 20 ACOs in the Pioneer program and the 333 in the Shared Savings program had a combined level of program savings of $411 million. However, 45 percent pf participants cost Medicare more than projected, and after paying bonuses, the ACO program incurred a $2.6 million net loss to the Medicare trust fund.

From the perspective of CMS, the early results are revealing success, as the agency cites improved care based on common quality metrics when compared to fee-for-service providers. Pioneer ACOs improved in 27 of 33 quality metrics, and Shared Savings participants improved on 26 of 33 quality measures. The Pioneer model was designed for healthcare organizations that have already had experience in coordinating care across settings. There have been three years of results recorded for the Pioneer program, and in Year 3, a total of 11 of the 20 participants received payments for their share of the shared savings, three had to make payments back to CMS, and six were revenue-neutral.

On a gross cost savings basis, as noted above, including both the Pioneer and Shared Savings programs, there was $411 million in savings. And the rate of ACOs generating cost savings has been increasing for those providers that have participated in the program the longest. Of those providers who have been in the program since 2012, a total of 37 percent generated savings, compared to 27 percent and 19 percent for those who entered in 2013 and 2014, respectively. CMS believes this illustrates that with more experience, providers improve performance, and this is a positive long-term trend.

However, when you look beyond the numbers, it’s important to note the following: of the ACOs participating in 2014, there were 196 that saved Medicare money, 157 that cost more than anticipated, but only three that had to repay Medicare for losses.

On the flip side, from the providers’ perspective, there have been mixed results. Providers note that while some ACOs have seen savings, it has been a rather small amount, and when adding in providers’ investments in new data systems, infrastructure, care management protocols, and incentive payments, the net impact has been a loss. There is some speculation that the early results are biased due to the preponderance of large health systems, hospital networks, and large multi-specialty physician groups. Given the large capital expenditures and fixed costs of these organizations and the continuation of the fee-for service payment structure, there is still a volume-based incentive to drive revenue and less emphasis on cost reduction. Another issue affecting performance was that most participating providers were reluctant to assume a higher risk/reward structure, instead opting for a less risky model.

In the short term, Medicare will have to deal with the issue of participation in the program and whether to make the repayment of cost overruns by providers mandatory. This could cause current participants to drop out of the program and limit new participants. However, not implementing repayment may limit the amount of cost savings, since providers will have less incentive to reduce cost.

So in terms of answering the question of whether ACO are the answer to the value-based payment question, it looks like the jury is still out. In order to answer this question more comprehensively, we will need more broad-based participation in the program, a longer period of time for ACOs to fully implement value-based care, and payment models that truly provide incentives to provide quality care at a reasonable cost.

Stay tuned.


About the Author

Greg Adams is the chief strategy officer for Panacea Healthcare Solutions and has over 35 years of experience in the field of healthcare, including 20 years’ experience as a hospital CFO. His experience includes financial operations, managed care contracting, physician practice management, patient accounting, patient access, health information management, materials management, and real estate development. Greg is the past chairman of the Healthcare Financial Management Association (HFMA), having served as the chair of its Board of Directors in 2011-12. In that role he oversaw the services the organization provides to its 40,000 members. Greg speaks extensively on healthcare reform and the transition to a value-based payment system. His speaking engagements include national, regional, and state programs. He previously served as a member of the National Board of Directors for HFMA from 2002-2005 and as president of the New Jersey chapter in 1997-98. He has also served as a member of the Board of Trustees and chairman of the Finance Committee at St. Ann’s Home for the Aged in Jersey City, N.J.

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The transition from fee-for-service to pay-for-value has been referred to as one of the greatest financial challenges the U.S. healthcare system currently faces. Although the change is expected to occur over an extended period of time, it is anticipated there will be an initial phase during which provider revenues may decrease as the industry determines appropriate definitions of bundles and payment levels. At a time when the average hospital operating margin hovers around the 2-percent mark, there is little room for error in understanding the cost of doing business and pricing products and services accordingly. 

With the Centers for Medicare & Medicaid Services (CMS) announcing aggressive goals for transitioning Medicare hospitals and providers from fee-for-service to pay-for-value payment models, and commercial health insurers following suit, HIMSS wondered how well-prepared for the change provider organizations consider themselves to be. This transition will be extremely complicated. Most of the industry’s legacy revenue cycle technology was designed to support a fee-for-service environment and does not include the functionality required to support a value-based payment system. This is a critical point in time, not only to ensure the successful transition from one payment model to another, but, if we are to realize the third goal of the so-called triple aim – reducing healthcare costs – we must consider how we administer this change in the most efficient and cost-effective way.

The first annual HIMSS Healthcare Cost Accounting Survey was designed to check the pulse of provider readiness for value-based payment models and identify ways in which HIMSS and others can help providers manage this major challenge in the most effective, least disruptive ways possible.


In January 2015, U.S. Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell announced that by the end of 2016, a total of 30 percent of all Medicare payments made to hospitals and physicians would be based on pay-for-value payment models – and that by the end of 2018, that number would be increased to 50 percent. In addition, Secretary Burwell said that the remaining fee-for-service payment arrangements would be adjusted so that 85 percent of Medicare hospital payments would be tied to quality or value by the end of 2016, with an increase to 90 percent by the end of 2018. The announcement of these ambitious goals was quickly followed by the creation of the Health Care Payment Learning Action Network (the LAN) and the Health Care Transformation Task Force, national collaborative efforts aimed at expanding the adoption of value-based payment models beyond Medicare and into the private sector. 

The LAN is a private-public partnership with a stated goal of allowing a diverse group of industry stakeholders (including payors, providers, employers, purchasers, states, consumer groups, and others) to discuss, track, and share best practices on how to transition to alternative payment models, including accountable care organizations (ACOs) and bundled payment arrangements. The stated goals of the group are to:

  • Serve as a convening body to facilitate joint implementation of new models of payment and care delivery;
  • Identify areas of agreement around movement toward alternative payment models and define how best to report on these new payment models;
  • Collaborate to generate evidence, share approaches, and remove barriers;
  • Develop common approaches to core issues such as beneficiary attribution, financial models, benchmarking, quality and performance measurement, risk adjustment, and other topics raised for discussion; and
  • Create implementation guides for payors, purchasers, providers and consumers.

The Health Care Transformation Task Force is a private industry effort that includes some of the nation’s largest commercial health insurers, providers, and purchasers. Members of the group have voluntarily committed to having no less than 75 percent of their business operating under value-based payment models by no later than January 2020. The stated focus of the Task Force is to create or enter into contracts that “successfully incentivize and hold providers accountable for the total cost, patient experience, and quality of care for a population of patients, either across an entire population over the course of a year or during (a) defined episode that spans multiple sites of care.” The initial focus will be on ACOs and bundled payment models. Deliverables include: 


  1. Policy recommendations for CMS, focusing initially on improving patient attribution, financial stability, quality measurement, and patient engagement.
  2. Publishing best practices for ACOs, addressing improving patient attribution, financial stability, quality measurement, and patient engagement. 

Bundled Payments

  1. Conducting an environmental scan of all bundled payment approaches being used in the private and public sectors.
  2. Developing evaluation criteria for measuring the open source and proprietary bundle definitions.
  3. Developing a KLAS-like comparative profile of current bundled payment options.

All of these endeavors have a shared goal of moving the nation toward achieving the Institute of Healthcare Improvement’s Triple Aim of:

  • Improving the patient experience (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per-capita cost of healthcare.

The combination of these efforts demonstrates that much consideration is being given to the requirements and expected outcomes of alternative payment models. However, little attention seems to be being paid to the infrastructure necessary to meet these requirements or effectively demonstrate outcomes. 

A September 2014 report by the Commonwealth Fund found that 25 percent of hospital spending in the U.S. is related to administrative expenses – a whopping $200 billion. Further, the study found that between 2000 and 2011, hospital administrative costs in the U.S. rose 25.3 percent, going from consuming 0.98 percent of our gross domestic product in 2000 to 1.43 percent in 2011. One of the major components of hospital administrative costs in the U.S. is the complexity involved in working with multiple payors with varying payment rates, rules, and documentation requirements. As we consider leveraging alternative payment models to improve the quality of care received in the U.S., we must be mindful of the administrative costs associated with doing so. For example, consider the administrative costs associated with monitoring multiple definitions of “quality” or “value,” or the administrative cost of tracking and billing all of the activities involved in an episode of care when the definition of what is involved in that episode of care is based not on a national standard, but on the entity paying for it.  

Further complicating matters for providers is the potential revenue impact of the move from fee-for-service to pay-for value. According to information released in the 2013 American Hospital Association Annual Survey Data, prepared by Health Catalyst, the years between 1990 and 2010 saw a dramatic shift in revenue mix for hospitals. In 1990, a total of 42 percent of a hospital’s annual revenue was attributed to commercial payors; by 2010, that had dropped to 35 percent. During that same time period, the percentage of revenue from Medicare increased 3 percent: something hospitals expected because of the aging of baby boomers. What hospitals didn’t expect was the shift from commercial payors to Medicaid. In 1990, Medicaid was responsible for only 10 percent of a hospital’s revenue; in 2010 that increased to 16 percent. 

According to Health Catalyst, this trend is expected to continue, driven in part by the Medicaid expansion provided for in the Patient Protection and Affordable Care Act. This change in payment mix has a direct impact on a provider’s bottom line – in 2012, the average Medicare hospital margin was -5.4 percent. During this same period the commercial healthcare market saw a dramatic increase in the number of high-deductible health plans (HDHP) being purchased. According to the National Center for Health Statistics, 37 percent of individuals under the age of 65 who had health insurance in 2014 were enrolled in a HDHP, and only a third of those individuals also had a health savings account. 

Historically, 50 percent of patient financial responsibility goes unpaid. It is unclear how patient financial responsibility will be structured under a pay-for-value benefit plan. What is known is that during this initial stage of pay-for-value, every penny of revenue will count; it will be critical for providers to find a way to collect payment as early in the episode of care as possible. One way to address this will be to offer price transparency at the point of care so conversations may be had early in the process regarding how much the patient will owe and how and when they will pay. Central to these conversations will not only be information about various treatment options, a comparison of their efficacy, and the costs associated with each, but patient access to financial counseling when these costs exceed the patient’s ability to pay.

Adding insult to injury, in 2013 hospitals reported a decrease in their operating margins despite an increase in revenue. Although revenue increased by an average of 5 percent, expenses increased at an average rate of 7 percent, the result of technology upgrades, higher salary and benefit expenses, higher supply and drug costs, and provider taxes to fund the Medicaid fee programs. 

Given these economic conditions, it will be critical for providers participating in alternative payment models to understand their cost structure in complete real-time detail. They will need to be prepared to evaluate their expenses on a frequent basis, looking for every opportunity to reduce costs and improve operating margins. And they will need to have revenue management processes in place that address the increasing role consumers play in their revenue stream to ensure that they are maximizing all payment opportunities. 

HIMSS Healthcare Cose Accounting Survey

The responses to the Survey clearly indicate that although hospitals and provider organizations are willing to embrace value-based payment models, few believe that their organization is well-prepared to do so. Nearly 50 percent of respondents currently participate in an alternative payment model, but only 3 percent believe their organization is really ready to make the change. Healthcare providers and delivery systems are looking to HIMSS and other professional associations and industry groups to help them develop a consistent approach to the terminology/definitions and business processes and tools used to support these new payment models and to help build the technical infrastructure necessary to facilitate the underlying activities. They are specifically interested in:

  • Tools to track and evaluate quality of care;
  • Better communication between disparate providers;
  • Consistent definition of quality by specific type of disease; and
  • A consistent approach to:
    • Cost accounting;
    • Establishing price;
    • Sharing pricing information with patients; and
    • Managing the exchange of clinical and financial information between all entities involved in a particular episode of care.


Over the next several months, HIMSS will prioritize provider needs according to the results of the survey, share our findings with policymakers and healthcare officials, and collaborate with strategic partners to support these needs. This summer HIMSS will launch a task force aimed at understanding and supporting the development of tools and infrastructure to support emerging alternative payment models. The task force will publish thought leadership articles, deliver educational sessions, and gauge the progression of industry readiness for pay-for-value through annual surveys that update and trend the HIMSS Cost Accounting Survey data referenced in this year’s report. If you or someone you know would be interested in participating in these efforts, please contact Pam Jodock, senior director of HIMSS, at This email address is being protected from spambots. You need JavaScript enabled to view it.

Providing this level of leadership and support to those being held accountable for achieving the goals of payment reform – improved quality of care for specific populations, reduced per-capita healthcare costs, and improving the patient experience – will ensure a smoother transition and greater opportunity for success. Adopting a consistent approach to clinical requirements, business processes, and rules of engagement will guarantee that cost savings achieved on the clinical side are not negated by additional expenses being incurred on the administrative side. 

About the Author

Pam Jodock has more than 30 years of health care experience.  As the Senior Director of Health Business Solutions for HIMSS, she is responsible for the overall management and strategy development for HIMSS Health Business Solutions initiatives, which include Revenue Cycle Improvement; ICD-10 Implementation/Operationalizing; Clinical and Administrative Implementation of Alternative Payment Models; Clinical and Business Intelligence; Administrative Simplification; and Coding Integrity.  Pam is a graduate of Eastern Oregon University with a BS in Politics, Philosophy and Economics.

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The style at the HIMSS 16 Conference & Exhibition in Las Vegas last week was provided by none other than keynote speaker and recent Super Bowl champ Peyton Manning of the Denver Broncos.

The substance was provided by those speaking on the pressing issues of population health, revenue cycle, and quality.

Matters associated with the healthcare industry’s massive swing toward value-based care grabbed the spotlight at the Conference – with the exception of Manning’s time spent on stage – as an estimated crowd of more than 40,000 gathered to share stories, sentiments, and best practices., one of VBPmonitor’s sister monitors, via its weekly live internet broadcast Monitor Mondays offered wall-to-wall coverage of the festivities, starting with comments by HIMSS Director of Payer and Life Services Shelley Price, who spoke about shifting from a fee-for-service (FFS) mentality to fee-for-value (FFV).

“Our current FFS system focuses on care delivery that is volume-based. It addresses the individual, it is reactive, and typically in the acute-care setting. Payment for FFS care is based on numbers of procedures, actions taken, and orders made. The more activities, the more the reimbursement,” Price said. “A FFV focus looks at the group. It is proactive, preventive in nature, and addresses wellness and chronic care management. Payment for FFV care is based on health and wellness, is outcomes-oriented, and rewards quality of outcomes as compared to a baseline of health for a group.”

Price estimated that 15 percent of care nationwide is currently being delivered under an FFV model. She noted that the U.S. Department of Health and Human Services (the county’s largest payor) has set a goal of getting that number up to 30 percent as it pertains to reimbursed care by the end of 2016, and 50 percent by the end of 2018.

“Many provider organizations are turning to population health management programs to produce the clinical results that will enable them to financially succeed under value-based reimbursement. These initiatives aim to enhance outcomes for an entire group of individuals, instead of merely looking to improve health on a one-to-one basis,” Price said. “However, population health and population health management does not look and feel the same for every organization or collaborator involved.”  

With that, Price pointed to the HIMSS Population Health Knowledge Center: a special three-day, 30-session feature of the Conference intended to help providers learn how to employ interventions and solutions that leverage technologies, processes, and connected health strategies to improve health and quality outcomes while aligning organizational strategy to deliver sustainable practice efficiency, productivity, and positive economic value through population health management (for more information, go online to (

“I think this is a very exciting time of change and transformation in our healthcare system. But it is not easy for anyone, for any stakeholder, including the patient and consumer,” Price said. “There will be bumps in the road and continuing challenges. We are all in this together, and as such, culture, attitudes, roles and responsibilities, and trust will need to adjust to this new course.”

Another prominent voice within HIMSS, Revenue Cycle Improvement Task Force Chairman Stuart Hanson, offered perspective on the activities of a group organized for the purpose of creating a vision for the next generation of revenue cycle management tools and processes that recognize the impact changing payment models, increased direct patient financial responsibility, and consumerism.

“We are committed to developing and promoting an approach that keeps administrative cost containment, interoperability, and consumer engagement front and center,” Hanson said. “The work of the Task Force is underpinned by a specific set of guiding principles that include ensuring the approach we recommend is patient-centered and involves solutions that are standards-based, leverage existing and emerging technologies, and are designed with the full revenue cycle business process flow in mind.”

In 2015, Hanson explained, the Task Force applied these principles to the development of an overarching vision for the patient financial experience of the future; this vision was shared in a white paper, Rethinking Revenue Cycle Management, and articulated in an infographic that illustrated the Task Force’s vision for a simple, pre-planned office visit.

In 2016, the group has applied its vision to a more complex scenario involving an unplanned episode of care with multiple providers in a variety of healthcare delivery settings. The scenario is played out in a microsite that demonstrates how all of these activities will be coordinated in the patient financial experience of the future and incorporate consideration of patient financial responsibility along the way. 

Lastly, Peyton wasn’t the only award recipient highlighted during the Conference – HIMSS lauded the four winners of its Nicholas E. Davies Award, created to recognize hospitals, ambulatory practices, clinics, community health organizations, and public health entities that use electronic health records and information technology to generate sustainable value and improve clinical and financial outcomes.

Award Enterprise Committee Chair Janis Curtis announced the winners from among a pool of applicants that were asked to provide a minimum of 12 months of trended data clearly illustrating improved outcomes; to demonstrate that the improvements were a product of data addressing specific workflow protocols; and to reflect a replicable and actionable blueprint for using health information technology to improve care quality and/or business outcomes.

One winner, Centura Health, demonstrated that it had reduced heart failure patient readmissions by 17.48 percent, COPD patient readmissions by 16.02 percent, and diabetes patient readmissions by 10.22 percent. Another Award recipient, MetroHealth, significantly improved care outcomes for its diabetic population as determined through composite measures consisting of smoking, body mass index, optimal glycemic control, and blood pressure.

HealthNet of Indianapolis, the third recipient, increased first trimester entry into prenatal care to 71 percent and decreased low birth weight deliveries to 6.8 percent. And lastly, Ontario Shores increased adherence to polypharmacy, metabolic monitoring, and referral to cognitive behavioral therapy for psychosis (CBT-P) by 5.8 percent, 51.0 percent, and 74.8 percent, respectively, reducing incidence of cardiovascular disease and type 2 diabetes.

All of the winners have the following characteristics, Curtis noted:

  • Collaborative teamwork that involved active engagement of clinicians and non-clinicians;
  • Baseline and continuous data collection and analysis to ensure progress towards the intended goal; and
  • Strong support organizational executive leadership.

Submission for the next round of Davies submissions are being accepted now, Curtis added; the submission period runs from Jan. 1 through July 1, 2016. To review case study templates or to acquire more information, email This email address is being protected from spambots. You need JavaScript enabled to view it..

To listen to our streaming podcasts of LIVE from HIMSS 2016 produced by Monitor Mondays please click here. And stay tuned for announcements and registration for VBPmonitor’s weekly broadcast “Thought Leader Thursday” scheduled to begin this summer.

Mark Spivey is a national correspondent for He can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it..

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