The U.S. healthcare industry continues to inch toward value-based care (VBC) and away from a fee-for-service system. Over the past eight years, the number of U.S. states and territories that implement VBC programs has spiked––rising from three states in 2011 to 48 as of 2018. To stay abreast of this movement, in August, Definitive Healthcare, a…
The Medicare ACO program covers close to a third of total Medicare Beneficiaries, and in 2018, it was comprised of 548 individual organizations. Out of the total ACO cohort, 66% saved Medicare money using benchmarking methods, and another 37% saved Medicare money but didn’t save enough to achieve shared savings. That means that 2018 has had…
A new study found waste accounts for roughly one-quarter of all U.S. healthcare spending, an estimate that’s in the same ballpark as its predecessors. The cost of waste in the U.S. healthcare system ranges from $760 billion to $935 billion annually, according to a JAMA review of 54 peer-reviewed studies, government reports and other information,…
Medicare Shared Savings Program ACOs generated $739.4 million in net savings for the Medicare program across 548 ACOs in 2018, CMS Administrator Seema Verma announced in Health Affairs Sept. 30. The 2018 data shows quality improvement continued, and many of the previously observed cost trends continued. Top performers on spending tend to be in two-sided risk contracts,…
Patient Attribution Code Annual Wellness Visit (AWV) billing codes are attribution codes for an ACO. This means the more AWVs completed, the more likely a patient will remain attributed to your ACO. HCC Coding Point of Care One of the most important tasks for an ACO at the point of care is for the care…
The notion that hospitals can reduce readmissions, and that punishing them for “excess” readmissions will get them to do that, became conventional wisdom during the 2000s on the basis of very little evidence. The Medicare Payment Advisory Commission (MedPAC) urged Congress to enact the Hospital Readmissions Reduction Program (HRRP) beginning in 2007, and in 2010…
The CMS achieved savings from the Medicare Shared Savings Program last year, marking the second year in a row the agency turned a profit from the program. About 66% of the 548 Medicare accountable organizations produced a total of $1.7 billion in savings in 2018 and the CMS scored a $739.4 million gain, according to new agency…
With Medicare’s main trust fund projected to run out in just seven years, the Trump Administration is working hard to lower health care costs and increase quality to protect the Medicare program for all Americans who depend on it. The Medicare Shared Savings Program (Shared Savings Program), established by Congress, promotes accountability for a patient…
If you are part of an ACO or a clinically integrated network (CIN), you have begun the value-based care journey. As payment models continue to change, the question of how and when to increase appropriate risk and reward requires careful consideration. With the release of the final rule for Pathways to Success, CMS is increasingly…
The notion that hospital readmission rates are a “quality” measure reached the status of conventional wisdom by the late 2000s. In their 2007 and 2008 reports to Congress, the Medicare Payment Advisory Commission (MedPAC) recommended that Congress authorize a program that would punish hospitals for “excess readmissions” of Medicare fee-for-service (FFS) enrollees. In 2010, Congress…