Value-based care is being trumpeted as the panacea to cure all of the healthcare systems’ ills, and while it’s picking up momentum, to say there are a lot of different perspectives to this story is a gross understatement.

From medical and political organizations to investors and technology companies, value-based care is the talk of the town.

Value-based care was first introduced by Michael Porter and Elizabeth Olmsted Teisberg in their 2006 book, Redefining Health Care: Creating Value-Based Competition on Results. Since then, it has been embraced by some; criticized by others. Still, after almost 17 years, the discussion continues. In scouring numerous publications from several months, here’s a sampling of the discussions…

December 16, 2022. American Psychological Association

“The National Academies of Science, Engineering, and Medicine issued a report on implementing high-quality primary care stating that we should ‘pay for primary care teams to care for people, not doctors to deliver services.’ The report recommends a shift towards a hybrid model of payment; part fee-for-service and part capitated (per member, per month) as the default method to pay prospectively for interprofessional, integrated, team-based care rather than the fee-based system that undervalues the work reflected in primary care and behavioral health services.” (“APA advocates for value-based payment models.” December 16, 2022. APAServices.org.)

December 16, 2022. McKinsey & Company

“Providers specializing in value-based care have become attractive to investors because of the distinctive quality of care that they can provide and the investable opportunity they present, with a diversity of risk levels and business models. By building on a decade of increasing value-based payment adoption—combined with enhanced value-based capabilities across payers, providers, employers, and other healthcare stakeholders—continued traction in the value-based care market could lead to a valuation of $1 trillion in enterprise value for payers, providers, and investors.” (Abou-Atme, Zahy; Alterman, Rob; Khanna, Gunjan; and Levine, Edward. “Investing in the New Era of Value-Based Care. December 16, 2022. Mckinsey.com.)

February 7, 2023. The Commonwealthfund.org

“Studies of value-based care programs so far suggest that they can reduce costs and improve quality of care, although results have often been mixed and impact modest….Although participation in value-based care programs is on the rise in the U.S., many healthcare providers are still not in one. To encourage participation, future models in both the public and private sector would likely benefit from being more accessible and financially rewarding, particularly to those serving disadvantaged or rural populations. Moreover, further research is needed about how these programs impact patients, providers, and the health care system overall, as well as which factors are associated with success.” (Lewis, Corinne; Horstman, Celli; Blumenthal, David; Abrams, Melinda K. “Value-Based Care: What It Is and Why It’s Needed.” February 7, 2023. Thecommonwealthfund.org.)

Feb 10, 2023. Healthcare Dive

“With 48% of the eligible Medicare population enrolled in Medicare Advantage plans and, the CMS committed to having 100% of enrollees in a value-based care program by 2030, the tailwinds are pushing at-risk arrangements forward in a big way.” (Kirk, Liz. “Tipping point is in sight: Value-based care is driving meaningful financial results.” February 10, 2023. Healthcaredive.com.)

March 14, 2023. BenefitsPro

“Employers and their benefits consultants are increasingly embracing value-based reimbursement models as they – along with provider organizations, commercial payers, and government programs – seek more ways to improve health outcomes while reducing costs.” (Sharma, Rahul and Caroll, Lynn. Implementing value-based health care: Key trends shaping 2023.” March 14, 2023. Benefitspro.com.)

April 10, 2023. Bain.com

“There is still ample headroom for growth in value-based care adoption in the PCP space. As of 2021, nearly 60% of healthcare payments had at least some linkage to quality and value, but less than 20% incorporated two-sided risk (and capitated models are still under 8% of spending)…Our analysis suggests fee-for-value arrangements will capture 15%–20% market share from traditional FFS providers in primary care by 2030, creating strong macro tailwinds and supporting further investment in the space.” (Fry, Sharon; Nierenberg, Dave; Wynn, Grace; Murphy, Kara; and Jain, Nirad. “Value-Based Care: Opportunities Expand.” April 10, 2023. Bain.com.)

April 29, 2023. The American Journal of Managed Care

“…there have been many iterations of value-based programs sponsored by both government insurers and private companies… Among other challenges, a main issue that arises in value-based care surrounds attribution, meaning a patient is attributed to a provider and that provider is reimbursed based on the contract. But what is attribution? If a patient sees 2 primary care providers within a year, which provider is paid for their care?” (McNulty, Rose. “Value-Based Care: Is It Possible for All Providers to Succeed?” April 29, 2023. AJMC.)

May 8, 2023. The New York Times

“Large health insurers and other companies are especially keen on doctors’ groups that care for patients in private Medicare plans…Now, nearly seven in 10 of all doctors are either employed by a hospital or a corporation, according to a recent analysis from the Physicians Advocacy Institute…Insurers say their purchase of medical practices is a step toward what is called value-based care…” (Abelson, Reed. “Corporate Giants Buy Up Primary Care Practices at Rapid Pace.” May 8, 2023. NYtimes.com.)

May 23, 2024. Beckers ASC Review

“Three key driving forces behind the shift to value-based care are government programs and incentives, advancements in technology, and the use of data to gather information. The model has piqued the interest of companies such as CVS Health, Optum, and Amazon, as well as physician groups…Though value-based care’s popularity is growing, just 14 percent of physicians participate in the payment model, according to Medscape’s 2023 ‘Physician Compensation Report.’ The fee-for-service model is still the most popular payment model by a long shot, with 46 percent of physicians participating in it.”  (Hatton, Riz. “How value-based care is squeezing its way into every corner of healthcare.” May 23, 2024. Bekersasc.com.)

June 8, 2023. Center for Medicare and Medicaid Services

“Today, the Centers for Medicare & Medicaid Services (CMS) announced a new primary care model – the Making Care Primary (MCP) Model – that will be tested under the Center for Medicare and Medicaid Innovation in eight states… Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, and Washington.” (“CMS Announces Multi-State Initiative to Strengthen Primary Care.” June 8, 2023. CMS.gov.)

No doubt, this discussion is to be continued. While you are following the latest headlines shaping the future of healthcare in America, you can count on RBT CPAs to take care of your accounting, tax, audit, and advisory needs with the highest ethical and professional standards. To learn more, give us a call today.

RBT CPAs does not outsource work to any other country. All of our work is prepared in the U.S.A. 

In today’s media, it’s hard to tell the difference between news and marketing. Take 5G and healthcare as an example. Talk of the revolutionary nature of this next generation of wireless technology has been around for years, but in truth the uptake has been slow. So, I set out to see what I could learn about whether and how 5G is transforming health care. Here’s what I found…

First, what is 5G? It stands for the fifth generation of cellular wireless technology (1G allowed for voice; 2G – digital voice; 3G – data; 4G – streaming; and 4GLTE encompasses everything up to 4G, faster and better than ever).  5G will transmit data 20x faster than 4G; handle 100x more traffic so more devices can be connected and work more reliably; support wireless operations; speed up how quick data can be uploaded and transported; and dramatically increase the amount of data available for decision-making.

While Wi-Fi doesn’t have the bandwidth to support all of the leading-edge technologies – like the IoMT, edge computing, robots, augmented and virtual reality (AR/VR), and more – 5G can. It’s expected to transform how work gets done, driving productivity, competitiveness, quality, cost savings, profitability, smart decision-making, data security, and more.

As reported by ManagedHealthcareExecutive.com, the Cleveland Clinic Mentor Hospital – scheduled to open its doors to patients on July 11 – is the first U.S. hospital built with a private 5G network via a partnership with Verizon Communications, providing “an opportunity to explore how private 5G networks can help enable digital transformations in hospital settings.”

According to InsiderIntelligence.com, the Cleveland Clinic is already ranked fourth by Newsweek’s World’s Best Smart Hospitals 2023 (Mayo Clinic, Massachusetts General and John Hopkins take the top three spots). With 5G at Mentor Hospital, the clinic will be exploring potential use cases for asset tracking, digital displays, entertainment, check-in kiosks, AR/VR for education/assisted surgery/imaging, and more.

While looking forward to the learnings that will come from Mentor Hospital’s 5G capabilities, Samsung Medical Center (SMC) in Seoul, South Korea is already experiencing the benefits of integrating 5G with digital pathology.

HealthcareITNews.com reports 5G is helping to cut pathology time at SMC in half. They have three diagnostic reading rooms that received numerous “requests for frozen section tests.” It would take 15 to 20 minutes for someone to get to the rooms, until a scanner, analysis and interpretation software, a desktop computer, and 5G enabled access via mobile devices, reducing response time to 10 minutes. The result is quicker diagnosis and fewer surgical delays.

In April, The Wall Street Journal reported on how another hospital in Seoul is using AR technology to promote precision during surgery thanks to its private 5G network which can upload and transmit tremendous amounts of data without lags. The Ewha Womans University Mokdong Hospital’s 5G-enabled AR technology helps surgeons see the exact location of tissues and tumors when a tablet is placed above a patient’s chest. This replaces a surgeon making incisions based on CT scans.

The hospital also tested the system for a recent surgery where surgeons in different locations were able to join a procedure and exchange advice, setting the stage for remote surgeries and even physician training.

(FYI: The AR technology was developed by SKIA Co. which is applying for regulatory approval in South Korea for widespread use and subsequently plans to apply for approval from the U.S. Food and Drug Administration.)

No doubt, this is just the beginning. As The Wall Street Journal reported, “The 5G healthcare market—encompassing 5G-supported augmented-reality and virtual-reality technology services, virtual consultations, remote patient monitoring and more—was valued at $2.5 billion in 2021 and is expected to grow an average of more than 35% annually from 2022 to 2030, according to Global Market Insights, a market research firm.”

While you may be thinking about where and how 5G will impact your healthcare organization’s future strategy, please know that RBT CPAs can help free you up by handling all of your accounting, tax, audit, and business advisory needs. To learn more, visit us at RBTCPAs.com or give us a call today.

March 10 was the deadline for businesses to file an Abandoned Property Law Annual Report. Not filing potentially increases risk of an audit, but so does filing. What’s a business to do?

Healthcare organizations may be particularly vulnerable, considering the complexities surrounding costs, who is responsible payment, and more. Whether it’s a payment to a vendor that went out of business or a duplicative payment from a patient and insurance company for the same claim, the state where the property’s owner resides may have dibs on this and other types of found money including payroll checks, direct deposits, customer credit balances, and more.

The New York State Fiscal Year 2021-2022 Annual Report of the Office of Unclaimed Funds (OUF) explains the OUF is responsible for implementing the state’s Abandoned Property Law by ensuring abandoned funds are remitted to the state; conducting audits to recover funds; increasing public awareness of the funds; and protecting the rights of owners until funds are returned.

During FY 2021-2022, the OUF collected $980 million. The Voluntary Compliance Program resulted in $8 million being found. Audit collections totaled $93 million. $404 million was returned to rightful owners. $560 million was transferred to the state’s General Fund (the state holds over $17.5 billion in unclaimed funds dating back to 1943. The Hudson Valley had the third highest amount of funds paid (following NYC and Long Island), totaling $33 million.

As reported by TaxExecutive.org, “The importance of knowing and understanding unclaimed property laws has grown in recent years, because unclaimed property is now a significant revenue source for certain states…As a result, states now actively enforce these laws to capture unclaimed property in audits, voluntary disclosure programs, and litigation or through legislation.”

Audits can result in significant assessments, interest, and penalties. Voluntary compliance programs and agreements give companies a way to avoid interest and penalties in most states. That sounds good until you consider if your company doesn’t have records for the look back period, it must use the state’s mandated methodology to estimate liability. What’s more, you’ll still need agreement from a state appointed administrator or audit firm. Even after all of that, your firm can still be referred for an audit.  In recent years, more “holders” of unfound money have turned to litigation and increasingly found support.

If your company needs help understanding the laws, how they’re enforced, and your options for responding, RBT CPAs tax professionals can help. With state and auditing firms’ outreach efforts growing to uncover additional sources of potential revenue, should you receive any type of communication asking for self-disclosure or the like, be sure to give your RBT CPAs contact a call.

NOTE: RBT CPAs is providing this content for informational purposes only. It should not be construed as advice or direction. Should you need advice or direction, it’s in your best interest to talk to a tax professional (like those at RBT CPAs) or to contact your legal counsel.