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MedPAC: CMMI Should Consider a ‘Smaller, More Harmonized’ Portfolio of Alternative Payment Models

June 15, 2021Garrett SchmittNo Commentsalternative payment models, APMs, CMMI, CMS, Home Health, Medicare, MedPAC

To reduce redundancies and confusion in the Medicare system, health care policymakers should consider implementing “a smaller, more harmonized” portfolio of alternative payment models (APMs). That’s according to the Medicare Payment Advisory Commission (MedPAC), which released its regular June report to Congress on Tuesday. “In many cases, providers participate in multiple [alternative payment models] simultaneously,…

A Decade of Value-Based Payment: Lessons Learned And Implications For The Center For Medicare And Medicaid Innovation, Part 1

June 9, 2021Garrett SchmittNo CommentsACOs, APMs, CMS, Cost Reduction, COVID-19, Fee for service, health spending, organization of care, payment, payment models, value-based payment, value-based purchasing, vbc

Over the past decade, adoption of value-based payment (VBP) models has increased substantially. The Center for Medicare and Medicaid Innovation’s has launched multiple new models since its authorization, commercial payers have structured almost one-third of their payments as alternative payment models (APMs), and state Medicaid programs have increasingly included payment reforms in their waivers and…

Bill aims to fix glitch that penalizes rural ACOs even if they generate savings

June 9, 2021Garrett SchmittNo CommentsAccountable Care in Rural America Act, CMS, MSSP, Rural, rural ACOs, rural providers

New bipartisan legislation aims to fix a glitch that can penalize rural accountable care organizations that reduce costs. The legislation, introduced Tuesday, would fix a flaw that requires all ACOs to measure their performance against themselves, which lawmakers say can disproportionately impact rural providers. The bill comes as ACO advocates have been worried about a…

As CMS Delays CHART, Rural Providers Need to Take Value-Based Care into Their Own Hands

June 2, 2021Garrett SchmittNo CommentsCHART, CMS, MSSP, rural providers, value-based care, vbc

The answer to solving a healthcare crisis that exacerbates barriers to care among some of the most vulnerable patient populations in the country is staring us in the face. For rural hospitals straining under the weight of erratic patient volumes, sicker populations and lack of funding, the path forward is in value-based care. But providers…

The CMS New Rule On Ambulatory Surgical Centers Earns Only Partial Credit

June 2, 2021Garrett SchmittNo Commentsambulatory surgical centers, ASCs, CMS, HOPDs, Medicare, Reimbursement

The Centers of Medicare and Medicaid Services (CMS) recently announced a directive to relax the requirement that surgeries for Medicare beneficiaries be performed only on an inpatient basis to qualify for reimbursement. Starting January 1, 2022, more than 250 musculoskeletal surgeries will be eliminated from the “inpatient-only list,” with an additional 1,500 surgeries eliminated in…

New ACO Playbook: To Show Standout Performance, ACOs Must Rethink Quality

May 24, 2021Garrett SchmittNo CommentsAAPMs, ACOs, APM Performance Pathway, APP, CMS, Data, MIPS, physician participation, quality care, quality measurement, Quality Reporting

The health care media are full of articles asserting that ACOs have proven their mettle in delivering health care of highest quality. Citing ACO quality reporting results, CMS and advocates point to the majority of ACOs passing CMS quality standards, and that ACOs are improving their results on quality measures over time. The vast majority…

CMS won’t extend the Next Generation ACO Model through 2022

May 21, 2021Garrett SchmittNo CommentsCMS, Global and Professional Direct Contracting Model, GPDC, Next Generation, Next Generation ACOs

CMS won’t extend the Next Generation ACO Model through 2022 but will allow participants to apply for the standard track of its Global and Professional Direct Contracting Model, the agency said in a letter to Next Gens on Friday. The American Hospital Association, National Association of Accountable Care Organizations and other provider groups had lobbied…

The Move to Value-Based Care Takes a Pandemic Pause

May 17, 2021Garrett SchmittNo CommentsCMMI, CMS, COVID-19, vbc

The move to value-based care—where payment for volume of services is being supplanted by payment for outcomes of care—has proceeded with remarkable speed since the Affordable Care Act (ACA) went into law a mere ten years ago. Payment for outcomes increasingly focuses on holding providers of healthcare responsible for total costs of care. Accountable Care…

New Rules for Some Medicare ACOs Are No Good, Say Healthcare Groups

May 12, 2021Garrett SchmittNo CommentsAlternative Payment Model Performance Pathway, alternative payment models, APP measures, CMS, Medicare ACOs, MSSPs

Groups representing doctors, hospitals, and accountable care organizations (ACOs) are pushing back on changes to quality reporting rules for Medicare Shared Savings Program (MSSP) ACOs that were finalized under the Trump administration. “We have significant concerns about the MSSP quality policies finalized at the very end of 2020,” a group of 11 healthcare organizations, including…

Rising costs, low-value care linked to hospital-employed physicians, studies show

May 5, 2021Garrett SchmittNo CommentsAHA, CMS, group practice, healthcare costs, HHS, low-value care, Medicare claims, Medicare Payment Advisory Commission, physician acquisition, physician employment, physician-hospital integration, physicians, private practice, vertical integration

Healthcare costs and low-value care tend to increase when hospitals acquire physicians, new studies published in Health Affairs show. The number of diagnostic and lab tests performed in hospitals versus unaffiliated facilities increased after doctors were acquired by hospitals, which inflated healthcare costs, according to an analysis of 30 million imaging procedures and 341 million…