The healthcare industry in the U.S. has spent a whole generation talking about moving from a fee-for-service to a value-based model, focusing more on improved patient outcomes and early interventions rather than disease treatment. This shift has occurred gradually, sometimes purposefully, and sometimes in fits and starts, but overall, it has been slower than expected….
During the past year, the pandemic strained the entire health care system. Many health care providers experienced significant disruptions with reductions in use and lower revenue. Some providers were able to weather the crisis by relying on the organizational competencies they had built for value-based payment models. Providers in more advanced payment models had more…
Medicare needs to streamline its portfolio of alternative payment models (APMs), the Medicare Payment Advisory Commission (MedPAC) said Tuesday in its annual report to Congress. “CMS [the Centers for Medicare & Medicaid Services] is to be commended for the vigor with which it has approached its mandate of implementing a wide variety of APMs over…
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,…
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…
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…
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 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…
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 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…