Archive for ACO

 

MedPAC Reports to Congress

MedPAC has submitted its annual report to Congress.

The congressionally mandated report, titled Report to Congress: Medicare and the Health Care Delivery System, consists of seven chapters:

  • Realizing the promise of value-based payment in Medicare: an agenda for change.
    Challenges in maintaining and increasing savings from accountable care organizations (ACOs).
    Replacing the Medicare Advantage quality bonus program.
    Mandated report: Impact of changes in the 21st Century Cures Act to risk adjustment for Medicare Advantage enrollees.
    Realigning incentives in Medicare Part D.
    Separately payable drugs in the hospital outpatient prospective payment system (OPPS).
    Improving Medicare’s end-state renal disease (ESRD) prospective payment system (PPS).

While MedPAC’s recommendations are not binding on Congress or the administration, they are highly respected and often find themselves worked into new law or regulations.

Go here to see MedPAC’s news release accompanying the report and here to find the report itself.…

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues.

The issues on MedPAC’s March agenda were:

  • Addressing Medicare Shared Savings Program vulnerabilities
  • The role of specialists in alternative payment models and accountable care organizations
  • Realigning incentives in Medicare Part D
  • Redesigning the Medicare Advantage quality bonus program
  • Mandated report: Impact of changes in the 21st Century Cures Act to risk adjustment for Medicare Advantage enrollees
  • Improving Medicare’s end-stage renal disease prospective payment system
  • Separately payable drugs in the hospital outpatient prospective payment system

MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.

Go here for links to the policy briefs and presentations that supported MedPAC’s discussion of these issues.…

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues.

The issues on MedPAC’s January agenda were:

  • The Medicare prescription drug program (Part D):  status report and options for restructuring
  • Redesigning the Medicare Advantage quality program:  initial modeling of a value incentive program
  • Hospital inpatient and outpatient payments
  • Physician payments
  • Outpatient dialysis payments
  • Skilled nursing facility, home health, inpatient rehabilitation facility, and long-term-care hospital payments
  • Hospice and ambulatory surgery center payments
  • The 340B program
  • ACO beneficiary assignment

MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.

Go here for links to the policy briefs and presentations that supported MedPAC’s discussion of these issues.…

Mandatory Payment Models Coming to Medicare?

Even as CMS rolls out new, voluntary Medicare alternative payment models, it is contemplating making participation in future models mandatory rather than voluntary, as is currently the case.

Or so Centers for Medicare & Medicaid Services administrator Seema Verma told a gathering in Baltimore last week.

At the heart of the idea, Verma told her audience, is that while CMS is pleased with participation in voluntary accountable care organization models, organizations are choosing to participate in ACO models they think would benefit them most while posing little or no downside financial risk.  The agency may need to move away from that approach to advance its efforts to transform more of Medicare into a value-based payment program.

Learn more in the Fierce Healthcare article “Verma: Trump administration mulling mandatory payment models.”

Adverse Selection May Explain Rising ACO Costs

Hospital ACO costs are rising because of the sicker patients they attract, a new study suggests.

According to researchers at University of Wisconsin Health, patients served by traditional Medicare or by physician-led accountable care organizations often switch to hospital-led Medicare ACOs as they encounter health problems, bringing those hospital-led ACOs sicker patients than those otherwise served by such organizations.  As a result, the per patient costs of hospital-led Medicare ACOs often rise more than those of the costs of traditional Medicare and physician-led ACOs.  Often, these shifts are encouraged by patients’ medical specialists.

Hospital-led Medicare ACOs have been criticized for their failure to control rising costs but this adverse selection may explain that failure, researchers found.

Learn more in the Health Affairs study “Hospital ACO costs are rising because of the sicker patients they attract, a new study suggests.”

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