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Performance in MIPS can affect patient volume


Rita Numerof, in a FierceHealthcare essay,  warns providers that their performance under  the Merit-based Incentive Payment System can influence their overall patient volume.

She notes: “Though the program is not without its challenges and limitations, it does begin to give consumers some information they need to make informed choices and benefit from competition.

“The healthcare industry is in the position of having this transparency imposed upon it via federal action because the providers themselves have been slow to tackle true accountability. A lack of actionable information has led to a situation where the country’s largest payer must provide both carrots and sticks to collect performance information from providers.

“Over the long term, MIPS reporting has the potential to drive patient volume, either directly, through consumer choice, or indirectly, through network selections made by payers. There are significant implications for individual physicians, medical groups and the hospitals whose revenues depend on their referral streams.”

“Many physician groups have raised concerns about administrative burdens under MIPS, and the recent changes to the program were partially intended to address them. But this is still a heavy lift, and providers need to streamline the data collection that supports MIPS wherever possible in order to minimize overhead and ensure data integrity.”

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Hospital physicians jumping into arms of staffing firms


A look at the lure to  hospital-based physician groups of being bought by staffing firms.

Part of the attraction is the buyers may have far more time and skill to negotiate contracts with insurers and help  physicians improve their business practices.

More and more hospital physician groups are being intensely pressured by price pressures from  insurers, the federal push to bundle services — in part to cut pay to physicians and hospitals – new regulations and barriers to expanding.

Jeff Swearingen, co-founder and managing director of Edgemont Capital Partners, told Modern Healthcare that  the healthcare investment-banking firm has counted 62 acquisitions of hospital physician practices this year, after a similarly active 2014. And the ample institutional capital available for purchases is coinciding with a growing desire among physicians to belong to bigger groups.”

More and more physicians, seeing relentless consolidation among insurers and hospitals, see joining bigger organizations as the the most effective  — and perhaps the only — way to counter price pressures against them.




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