Assessing Equity to Drive Health Care Improvements: Learnings from the CMS Innovation Center

July 6, 2023acoNo CommentsCMMI, CMS

Background: The Center for Medicare & Medicaid Services’ Center for Medicare & Medicaid Innovation tests service delivery models designed to improve care quality and patient outcomes while reducing or maintaining program costs. Historically, Innovation Center models were not explicitly designed to serve underserved populations, and most evaluations have not focused on health equity-related outcomes. In…

Medicare Advantage Bundled Payment Model Tied to Less Skilled Nursing Facility Use

July 3, 2023acoACOs, CMS, nursing homes, SNFs

A Medicare Advantage bundled payment model for hip and knee replacements offered by Humana (NYSE: HUM) was associated with reduced skilled nursing facility use. These bundled payments were also linked to reduced spending overall for lower extremity joint replacements (LEJR) – while maintaining quality of care, according to a study published in JAMA Network. Of…

Risk for Reward: Strategies Every Provider Should Adopt in Value-Based Arrangements

February 28, 2023acoCMS, CMS APMs, EMR

It’s no secret that something needs to be done in order to curb the unsustainable increase in Medicare spending. In 2021, overall Medicare cost grew 8.4%, or 21% of total national health expenditure, greatly exceeding the pace of economic expansion and in turn threatening the long-term financial viability of the program. The Centers for Medicare & Medicaid…

CMS releases three initiatives to grow Medicare ACO participation

January 18, 2023acoCMS, healthcare, healthcare providers, hospital, Medicare, MSSP

To advance its goal of having 100% of people in traditional Medicare in an accountable care relationship in seven years, the Centers for Medicare and Medicaid Services has announced three initiatives in the Medicare Shared Savings Program and the ACO REACH and Kidney Care Choices models. More than 700,000 healthcare providers and organizations will participate…

AHCA CEO: Value-Based Care ‘Most Exciting’ Development of His 30-Year Skilled Nursing Career

December 9, 2022acoACOs, CMS, nursing homes, SNFs

Skilled nursing providers are facing an extremely challenging operating environment, but they must keep adapting and innovating as the shift toward value-based care continues across the U.S. health care system. And in fact, providers have tremendous opportunities to seize. “Value-based care through the population health management model is the most exciting thing I’ve had the…

Will Medicare Physician Fee Schedule Changes Drive Value-Based Care?

August 16, 2022aco2022 PFS, ACOs, CMS, Medicare, MSSP, PFS, Physician Fee Schedule, vbc

The proposed changes in the Medicare Physician Fee Schedule (PFS) for calendar year (CY) 2023 may offer incentives for provider groups to consider alternative payment models. Still, the policies will likely require more apparent benefits to significantly impact the shift to value-based care. The CY 2023 PFS proposed rule included changes to the Medicare Shared…

CMS moves toward guidance on health equity, climate change

August 8, 2022acoCMS, health equity

The CMS outlined potential guidance last week on issues like healthcare equity and climate change in its final inpatient payment rule as the federal government heightens its healthcare oversight on social issues. In the report, the CMS released comments that it received after soliciting public input during its proposed rule in April. The feedback on…

CMS Makes Significant Updates to ACOs But Still Leaves Nursing Homes Largely Out of Conversation

July 20, 2022acoACOs, CMS, nursing homes, SNFs

While the Centers for Medicare & Medicaid Services (CMS) proposes to make some of the most significant changes to its accountable care organization (ACO) model since it was finalized in 2011, it doesn’t appear that such updates will have a lasting impact on the broader skilled nursing industry. If anything, only operators with their own…

AMA says Medicare payment schedule rule threatens patient access

July 13, 2022acoAMA, CMS, patient access

The American Medical Association has criticized the new Medicare payment schedule proposed rule released last week by the Centers for Medicare and Medicaid Services, saying it fails to account for inflation in practice costs and “COVID-19-related challenges to practice sustainability.” The proposed 2023 Physician Fee Schedule (PFS) conversion factor is $33.08, a decrease of $1.53…

CMS 2023 Proposed Rule Accelerates ACOs, MVPs

July 12, 2022acoACOs, CMS, MVPs, Physician Fee Schedule

CMS just set off summer fireworks, amping up incentives to adopt Value-Based Care in its just-released, 2,066-page 2023 Proposed Physician Fee Schedule Rule. By encouraging formation of new ACOs, the Proposed Rule establishes a pathway to expand beneficiaries’ access to accountable care. Last year, CMS committed that every Medicare beneficiary will be in an accountable…

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