In the 1980s, the United States healthcare system was at a crossroads in understanding how to value and pay for professionals services performed by healthcare providers such as physicians. To help understand this, through a grant, the U.S. government engaged Harvard University with the task. At this point, Dr. William Hsiao enters the picture and forever changes the healthcare landscape. William C. Hsiao is an American economist, is the K.T. Li Research Professor of Economics at the Harvard T.H. Chan School of Public Health in Boston, Massachusetts. He is internationally recognized for his work on health care financing and social insurance.

Among his many contributions to the fields of health care economics, policy, and social insurance was a landmark study called the Resource-Based Relative Value Study or RBRVS which examined the United States system of reimbursing physicians for medical services. RBRVS led to a series of articles published in the New England Journal of Medicine, one of the first times the prestigious journal had devoted an entire issue to articles on one subject. RBRVS led to a revolutionary reordering of physician reimbursement payments under Medicare Part B which was passed by Congress and signed into law in 1989. Today's episode sheds light on this fascinating history.

Join us in this enlightening episode as we dive into the fascinating world of healthcare and insurance with a distinguished guest, Professor Mark Fendrick from the University of Michigan. In this thought-provoking conversation, we explore the innovative concept of Value-Based Insurance Design (VBID) and its potential to revolutionize the way we approach healthcare coverage.

Professor Fendrick, a renowned expert in health policy and economics, delves into the core principles of VBID, discussing how it shifts the focus from traditional "one-size-fits-all" insurance models to a more personalized and effective approach. Through his extensive research and expertise, he unpacks the idea of aligning insurance incentives with clinical value, ensuring that individuals have access to the high-value services and treatments that matter most to their health outcomes.

In this episode of Healthcare Alignment we have a conversation with Harvard Professor Michael Chernew on numerous topics ranging from value based payment models to the physician fee schedule and more. Michael Chernew, PhD, is the Leonard D. Schaeffer Professor of Health Care Policy and the Director of the Healthcare Markets and Regulation (HMR) Lab in the Department of Health Care Policy at Harvard Medical School. In addition, he is currently serving as the Chair of Medicare Payment Advisory Commission (MedPAC) while previously serving as the Vice Chair from 2012-2014 and a Member from 2008-2012. In 2000, 2004 and 2010, he served on technical advisory panels for the Center for Medicare and Medicaid Services (CMS) that reviewed the assumptions used by Medicare actuaries to assess the financial status of Medicare trust funds.

In our first episode, join ⁠Lisa Wilson⁠, Senior Technical Advisor at the Centers for Medicare & Medicaid Services (CMS), ⁠Tim Smith⁠, Principal with TS Healthcare Consulting, and moderator, ⁠Alex Krouse⁠, Associate General Counsel at Parkview Health, in a substantive discussion of fair market value under the Stark regulations. In 2020, CMS issued a much anticipated Final Rule for the Physician Self-Referral Law (Stark). In that Final Rule, CMS spent more time and words discussing fair market value than it had in all prior rulemaking combined. While it has been over two years since publication of the Final Rule, this panel will dive deep into the Stark FMV framework, analyzing key concepts such as precluded reliance, buyer neutrality, unique arrangement factors, survey use, percentile-based rules of thumb, and physician practice losses. Join us for a deep dive into fair market value and physician compensation under the new Stark regulations.

We are extremely excited to announce the launch of the American Association of Provider Compensation Professionals' podcast! The Healthcare Alignment Podcast brings together industry experts for conversations on our healthcare system. Subscribe today!