Archive for ACO

 

MedPAC Issues 2018 Report to Congress

The non-partisan legislative branch agency that advises Congress and the administration on Medicare payment policies has submitted its mandatory annual report to Congress.

Among the findings included in the report by the Medicare Payment Advisory Commission are:

  • Medicare’s hospital readmissions reduction program has not resulted in increases in emergency room visits or hospital observation stays.
  • Many Medicare accountable care organizations, while maintaining or improving quality, are producing more modest savings than predicted.
  • MedPAC approves of Medicare’s proposals to redesign the case-mix classification system for skilled nursing facilities.
  • MedPAC supports changes Medicare has proposed for patient assessment and therapy requirements for skilled nursing facilities.

MedPAC’s recommendations include:

  • Authorizing outpatient-only hospitals in isolated rural communities to ensure access to emergency care.
  • Reducing payments to off-campus emergency departments in certain urban areas.
  • Rebalancing Medicare’s physician fee schedule to increase payments for ambulatory evaluation and management services while reducing payments for procedures, imaging, and tests.
  • Paying for sequential stays in a unified prospective payment system for post-acute care.
  • Establishing new ways to help patients, families, and hospitals identify higher-quality post-acute care providers for their patients.
  • Establishing new principles for measuring quality that address both population-based measures and quality incentives.
  • Encouraging the development of managed

ACOs Moving Into Medicaid

Accountable care organizations, one of the centerpieces of recent Medicare efforts to test new ways to deliver care more effectively and at less cost, are finding their way into state Medicaid programs as well.

Today, a dozen states employ Medicaid ACOs and another ten are planning to do so.

Learn more about Medicaid ACOs, and how one state (Minnesota), in particular, is using them, in this Kaiser Health News report.…

MedPAC Meets

Last week the Medicare Payment Advisory Commission held two days of public meetings in Washington, D.C.

During the sessions MedPAC, a non-partisan legislative branch agency that advises Congress on Medicare payment issues, addressed the following subjects:

  • a Medicare Advantage status report
  • a Medicare prescription drug program (Part D) status report
  • hospital inpatient and outpatient payments
  • physician payments
  • ambulatory surgical center, dialysis center, and hospice payments
  • post-acute care facility payments
  • the hospital readmissions reduction program
  • telehealth
  • accountable care organizations

Go here to see the issue briefs and presentations used during the meetings.…

Reduced Hospitalizations and Improved Care for High-Risk Patients Not Driving ACO Savings

Medicare savings reported in the early years of the Medicare Shared Savings Program are not coming from reduced hospitalizations of high-risk Medicare patients or even through better coordination of care for those patients.

Instead, Medicare accountable care organization savings are coming mostly from better and more coordinated care for low-risks Medicare ACO participants.

These surprising findings are reported in the article “Medicare ACO Program Savings Not Tied To Preventable Hospitalizations Or Concentrated Among High-Risk Patients,” which can be found in the December 2017 edition of the journal Health Affairs.  Find a link to that article here.…

Medicare ACOs Showing Promise

Medicare’s Shared Savings Program and its accountable care organizations are showing promise as a means of reducing Medicare spending and improving the quality or care.

Or so concludes the U.S. Department of Health and Human Services’ Office of the Inspector General.

According to a new OIG report,

Over the first 3 years of the program, 428 participating Shared Savings Program ACOs served 9.7 million beneficiaries. During that time, most of these ACOs reduced Medicare spending compared to their benchmarks, achieving a net spending reduction of nearly $1 billion. At the same time, ACOs generally improved the quality of care they provided, based on CMS data on quality measures. In the first 3 years, ACOs improved their performance on most (82 percent) of the individual quality measures. ACOs also outperformed fee-for-service providers on most (81 percent) of the quality measures. Further, a small subset of ACOs showed substantial reductions in Medicare spending while providing high-quality care. These high-performing ACOs reduced spending by an average of $673 per beneficiary for key Medicare services during the review period. In contrast, other Shared Savings Program ACOs and the national average for fee-for-service providers showed an increase in per beneficiary spending for key