Counsel That Cares Podcast - Value-Based Care and Shifting Away from the Healthcare Fee-for-Service Model
Compliance Perspectives: Changes to the Physician Self-Referral and Anti-Kickback Rules
Value-based health care: compliance infrastructure
The Biggest Obstacle to Value-Based Care
Polsinelli Podcast - Health Care Payment Changes: From Service to Value
The last week of June was a busy one when it comes to news about prior authorization – a major tool used by health plans and the federal government to manage healthcare utilization. The week started with a commitment from...more
On June 27, 2025, the Centers for Medicare & Medicaid Services (“CMS”), through its Innovation Center (“CMMI”), released the Request for Applications (“RFA”) for a new payment and service delivery initiative: the Wasteful and...more
On January 3, 2025, OIG posted the results of an audit that found that Medicare could have saved $7.7 billion if critical access hospitals’ (CAH) payments for swing-bed services were similar to those of the fee-for-service...more
This series explores legal issues related to physician burnout and potential solutions, and here we explore the potential impact of value-based care (“VBC”). Our first post addressed how healthcare organizations can foster...more
Happy Halloween! In the health policy world, there are two things on everyone’s mind this spooky season: the upcoming election and the major calendar year (CY) 2025 Medicare fee-for-service (FFS) final regs that should be...more
Episode 11 – Empowering Physicians & Provider Groups as they Navigate the Transition to Value-Based Care - In this episode of BRight Minds in Healthcare Delivery, host Eric Tower, a partner at Blank Rome, interviews Luis...more
Episode 9: How Value-Based Care Models Affect Physician Practice Valuation - In this episode of BRight Minds in Healthcare Delivery, host Eric Tower interviews Larry Elisco, a partner in Wipfli LLP’s health care practice...more
Meaningful progress has been made in value-based care, but the documented advances in reducing costs and improving patient outcomes have taken place predominately in the primary care sector. Significantly less headway has...more
Medicaid Regs Part 2! Last week, Regs & Eggs took a deep dive into the Ensuring Access to Medicaid Services final reg, one of two regs that the Centers for Medicare & Medicaid Services (CMS) released to add new requirements...more
On April 22, 2024 the Centers for Medicare & Medicaid Services (CMS) published the Medicaid Program; Ensuring Access to Medicaid Services final rule. The rule has a particular focus on home- and community-based services...more
The Medicare program is broken down into four parts. Part A covers the cost of healthcare items and services provided during inpatient hospital stays as well as skilled nursing facility, hospice, and some home health care....more
Is Medicare Advantage really a Disadvantage for seniors and taxpayers? Our nation is graying rapidly. Every day, 10,000 baby boomers, members of one of the largest generations in U.S. history, hit the traditional...more
Seventeen healthcare stakeholder groups have come together to support The Value in Health Care Act, a bill that a bipartisan coalition reintroduced in Congress this summer. The bill supports a shift in the medical care...more
Originally published in Healthcare Michigan, Volume 40, No. 10 - In an age of highly polarized opinions, there is a common consensus to address the rapidly rising health care costs in the United States. Research shows that...more
In this episode of "Counsel That Cares," healthcare attorney Daniel Patten is joined by Susan Dentzer, president and CEO of America's Physician Groups (APG), to discuss the benefits and incentives for healthcare providers to...more
The New York Department of Health (DOH) adopted regulations effective on September 13, 2023, that revised Medicaid Utilization Review for Medicaid fee-for-service benefits. The regulations were initially published on April...more
The Centers for Medicare & Medicaid Services (CMS) announced a new primary care model—the Making Care Primary (MCP) Model—geared towards smaller, independent primary care practices and organizations that want to participate...more
Learning Objectives - Review Proposed Changes for Medicare Advantage Plans in 2024 - Discuss the change from Version 24 to Version 28 and the impact on Risk Adjustment Calculation Methodology - Explain how...more
The Centers for Medicare & Medicaid Services (CMS) proposed on April 23, 2023 two rules that would affect Medicaid managed care: Ensuring Access to Medicaid Services (CMS 2442-P) and Medicaid and Children’s Health Insurance...more
The shift in health care from a retrospective fee for service (“FFS”) model to a value based care (“VBC”) model is growing across our nation’s health system and different specialties, including nephrology. VBC models in...more
In this session, panelists focused on the unique challenges and opportunities facing health systems as they move into value-based care (VBC)...more
In this session from the Value-Based Care Symposium 2023, McDermott Will & Emery Partner Lisa Mazur moderated a panel that explored how digital health tools can support financial and clinical success under value-based care...more
Welcome to the Payor/Provider Convergence Series of the Health Care Law Today blog. This series is dedicated to exploring the intersection between payors and providers in the health care space; in particular, the evolving...more
As many are aware, compliance with price transparency requirements continues to lag. Under the final rule, effective January 1, 2021, hospitals are required to provide clear, accessible pricing information online about the...more
In its March 2023 report to Congress, the Medicare Payment Advisory Commission (MedPAC) recommended adjusting the fee-for-service (FFS) base payment rate for acute care hospitals in 2024 by an amount equaling the current...more