Value-based payment programs tie healthcare reimbursement rates to quality care by offering providers incentive payments to meet specified quality measures during and after healthcare delivery. As the industry moves away from fee-for-service models and toward value-based care models, CMS has implemented several programs to improve patient care, advance population health, and lower healthcare costs. These value-based…
Over the last ten years, policymakers of both parties have identified health care payment reform as a critical national priority. Payment incentives offered by Medicare and other large payers create the environment in which providers must choose between being rewarded for performing more services and procedures, as in fee-for-service medicine or, for efficiently managing the…
The Medicare Access and CHIP Reauthorization Act (MACRA) has neither fueled growth in alternative payment models (APMs) nor has it imposed any significant payment differential based on value in the Merit-based Incentive Payment System (MIPS). Currently, the maximum increase MIPS offers is 1.86%, and in 2018, nearly all (98%) eligible clinicians had a positive MIPS…
Earlier this month, Premier hosted a panel on value-based care (VBC), with providers from across the healthcare continuum discussing its merits and pitfalls. In attendance were members of Congress and their staffers to hear how precisely VBC has been effective and policy changes needed to continue its forward progress. One message came through above all…
In a recent post, the administrator of the Centers for Medicare and Medicaid Services (CMS) reported that the Medicare Shared Savings Program (MSSP) generated $2.6 billion in gross savings in 2019 and $1.2 billion in net savings after accounting for shared-savings payments to participating accountable care organizations (ACOs). Achieving this level of savings would constitute remarkable…
With the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), CMS did away with the Sustainable Growth Rate model. Now, they are able to reward high-value, high-quality Medicare clinicians with payment increases, while at the same time reducing payments to those clinicians who aren’t meeting performance standards. CMS intentionally wanted to make sure that…
A new survey confirms a growing concern among accountable care organizations (ACOs) – most ACOs are unlikely to meet rising participation thresholds for MACRA’s Advanced Alternative Payment Models (APMs) in 2021. The survey from the National Association of ACOs (NAACOS) recently found that more than 90 percent of ACOs participating in an Advanced APM, including the Medicare Shared…
The newly published 2021 CMS Physician Fee Schedule and Quality Payment Program (QPP) Proposed Rule reflects our harsh reality: Operate under the constraints of the COVID-19 pandemic, while moving toward uniformity and Risk. That tension is palpable in the Proposed Rule’s “push-pull” of CMS trying to continue to advance a Value agenda while stuck in the mud…
The Centers for Medicare & Medicaid Services (CMS) on Aug. 3 released a rule that proposes changes to the Quality Payment Program (QPP) and Medicare Shared Savings Program (MSSP) for 2021. According to federal officials, because providers must stay focused on the COVID-19 pandemic, the number of significant proposed changes to the programs are limited….
AMGA (American Medical Group Association) recently sent a letter to Congress outlining what it views as 2020’s top priorities for medical groups and health systems. Chief among the group’s recommendations was better claims data access for providers and patients in a value-based care world. Congress and the administration have made it clear that how healthcare is financed…