Archive for June, 2017


ACOs, APMs Proliferate

The number of accountable care organizations and alternative payment models is growing, as is the number of people served by such programs.

According to a new study published on the Health Affairs Blog, there are more than 900 ACOs across the country – a 10 percent increase over a year ago.

32 million Americans are served by ACOs today – 2.2 million more than a year ago.  Among them, 59 percent are served through commercial contracts, 29 percent by Medicare contracts, and 12 percent under Medicaid contracts.  ACO growth is greatest in metropolitan areas, the states with the greatest ACO penetration are Rhode Island and Maine, and the states with the least ACO penetration are Wyoming and West Virginia.

Among alternative payment models, growth is greatest among shared-savings and shared-risk ACOs, include episode-based models and partially- and fully-capitated payments for patient populations.  Today, APMs account for more than 30 percent of Medicare payments, with the greatest number, by far, participating in Medicare’s Comprehensive Primary Care Plus Model, followed by Medicare’s Comprehensive Care for Joint Replacement and Shared Savings Program models.

Learn more about the growth of ACOs and APMs, the current policy environment for such approaches, and possible future …

Denied Hospital Claims Exceed A Quarter of a Trillion Dollars a Year

Insurers deny about $262 billion in hospital inpatient and outpatient claims a year, according to a new study.

That amounts to about nine percent of approximately $3 trillion in claims hospitals file with insurers a year.

Of that rejected $262 billion, roughly 63 percent is recoverable but that costs hospitals $118 per claim, or nearly $9 billion a year in costs associated with that recovery.

Learn more about this analysis produced by Change Healthcare in this Healthcare Finance News article.


HHS Needs to Do More on Physician Training

The federal government needs to do more to ensure an adequate supply of primary care physicians and their deployment in non-urban areas outside of the northeastern U.S.

Or so concludes a new study performed by the U.S. Governor Accountability Office.

According to the GAO report, efforts by the U.S. Department of Health and Human Services have resulted in progress toward meeting both of these goals – but not enough progress.  With the federal government spending $15 billion on graduate medical education, GAO believes, HHS can and should do more to ensure an adequate supply of primary care physicians throughout the country and not just in urban areas.

Learn more about what the GAO found and what it recommended in its new report Physician Workforce: Locations and Types of Graduate Training Were Largely Unchanged, and Federal Efforts May Not Be Sufficient to Meet Needs, which can be found here.…

Elderly Patients Return to Hospitals After Observation Stay

More than one in five Medicare patients who have observation stays in the hospital return to that hospital within 30 days, according to a new study published in The BMJ.

Among those returning to the hospital, 8.4 percent return to the emergency room, 2.9 percent have another observation stay visit, and 11.2 percent are admitted to the hospital.  Another 1.8 percent pass away within 30 days.

The numbers are similar for Medicare patients who only visit the emergency room.

Learn more about the study’s findings and its implications for improving post-discharge care in The BMJ article “Outcomes after observation stays among older adult Medicare beneficiaries in the USA: retrospective cohort study,” which can be found here.


MedPAC to CMS: Speed Up Move to New Post-Acute Payment System

Medicare should adopt a unified system for post-acute-care payments even earlier than its target date of 2024.

Or so the Medicare Payment Advisory Commission told Congress.

MedPAC’s idea?  Implement such a system by 2021 and phase it in over a three-year transition period, the agency said in its annual report and recommendations to Congress

Learn more about what MedPAC recommended and why it recommended it in this McKnight’s Long-Term Care News article.  Find MedPAC’s annual report to Congress here.…