Archive for Alternative payment models

 

MedPAC Issues Annual Report to Congress

The Medicare Payment Advisory Commission has sent its mandatory annual report to Congress.

Included in the report are sections on:

  • Beneficiary enrollment in Medicare: eligibility notification, enrollment process, and Part B late enrollment penalties.
  • Restructuring Medicare Part D for the era of specialty drugs.
  • Medicare payment strategies to improve price competition and value for Part B drugs.
  • MedPAC’s mandated report to Congress on clinician payments.
  • Issues in Medicare beneficiaries’ access to primary care.
  • Assessment of the Medicare Shared Savings Program’s effect on Medicare spending.
  • Ensuring the accuracy and completeness of Medicare Advantage encounter data.
  • Redesigning the Medicare Advantage quality bonus program.
  • Payment issues in post-acute care.
  • MedPAC’s mandated report to Congress on changes in post-acute and hospice care after implementation of the long-term care hospital dual payment rate structure.
  • Options for slowing the growth of Medicare fee-for-service spending for emergency department services.
  • Promoting integration in dual-eligible special needs plans.

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.

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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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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 April agenda were:

  • Expanding the use of value-based payment in Medicare
  • Medicare Shared Savings Program performance
  • Redesigning the Medicare Advantage quality bonus program
  • Increasing the accuracy and completeness of Medicare Advantage encounter data
  • Evaluating patient functional assessment data reported by post-acute-care providers
  • Options for slowing the growth of Medicare fee-for-service spending for emergency department services
  • Options to increase the affordability of specialty drugs and biologics in Medicare Part D
  • Improving payment for low-volume and isolated outpatient dialysis facilities

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.

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Mixed Verdict: Home Health Leads to More Readmissions But Lower Costs

Readmission rates are greater for patients discharged from hospitals to home health care than they are for those discharged to skilled nursing facilities but home health services cost so much less than nursing homes that home health saves money even with the higher numbers of hospital readmissions.

This is one of the major findings of a new study comparing differences in outcomes for patients who are admitted to skilled nursing facilities upon discharge from the hospital to those for patients who go direct home and receive home health services.

The study also found no meaningful differences in patient mortality or functional outcomes.

Readmissions from home health are 5.6 percent greater than those from skilled nursing facilities but with the much lower cost of home health services, Medicare saves, on average, more than $5400 over the first 60 days after discharge when patients are discharged to home health services rather than nursing homes.

Hospitals, it appears, prefer to discharge patients to nursing homes – perhaps, the study’s authors suggest, because of concern for their own readmission rates, which are subject to review and penalty under Medicare’s hospital readmissions reduction program.  Also, relatively few hospitals participate in alternative payment models that encompass …