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Vt. will move to voluntary all-payer ACO in Jan.

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The CMS has announced that in January, Vermont will become the first state  to move to a voluntary all-payer Accountable Care Organization model.

While Vermont’s program is somewhat modeled after a similar one in Maryland,  the Maryland program covers only hospitals while Vermont’s will cover close to all providers. The Vermont ACO will include Medicare, Medicaid and commercial payers, requiring those who participate to pay similar rates for all services.The CMS is giving Vermont $9.5 million in start-up funding to support the transition. The demonstration project is supposed to last  five years.

“This model is historic in terms of its scope, aiming to include almost all providers and people throughout the state in an all-payer ACO model to drive improved quality, better care coordination, healthier people, and smarter spending,”  Patrick Conway, M.D., the CMS’s chief medical officer, said.

“We will become the first state in America to fundamentally transform our entire health care system so it is geared towards keeping people healthy, not making money,” said Vermont Gov. Peter Shumlin, who negotiated a deal with HHS Secretary Sylvia Mathews Burwell.

The state seeks to have 70 percent of its insured residents covered by an ACO by 2022. The model will be considered an advanced Alternative Payment Model under the new Medicare reimbursement program, making participants eligible for a performance bonus.

Vermont will limit  per-capita  annual spending growth for major payers to 3.5 percent and Medicare growth to at least 0.1 to 0.2 percentage points below projected national Medicare growth.  In recognition of the role of behavioral health in other health, state officials also said they will seek to improve access to primary care and treatment for substance abuse, mental health and chronic disease as part of the ACO project.

The Vermont Legislative Joint Fiscal Office said that better care and an improved  state economy might well come out the initiative. However, it also  warned of such risks as uncertainty that the federal funding would cover transition costs and whether all providers will be adequately represented.

To read a Modern Healthcare article on this, please hit this link.

CMS widens options for APMs

CMS  offering additional opportunities for physicians and other clinicians to join advanced Alternative Payment Models beginning in 2017 and 2018.

The advanced Alternative Payment Model is the more lucrative of two options under the Medicare Access and CHIP Reauthorization Act, (MACRA) a payment system for Medicare physician fees that replaces the controversial Sustainable Growth Rate formula.

CMS will offer the Oncology Care Model with two-sided risk as a qualifying advanced APM beginning in 2017 and  will reopen applications for the Comprehensive Primary Care Plus model and the Next Generation ACO model for the 2018 performance year.

Patrick Conway, M.D., deputy CMS Administrator,  said:

“With these new opportunities, CMS expects that by the 2018 performance period, 25 percent of clinicians in the Quality Payment Program will earn incentive payments by being a part of these advanced models. Thanks to MACRA and the Innovation Center, we’re striving to see more Medicare patients benefit from better care when they visit their doctor for a knee replacement, receive cancer treatment or have a coordinated care team manage their complex conditions.”

Physicians who participate in Medicare must submit at least some performance data next year to avoid a penalty under MACRA. These data will determine payment adjustments beginning in 2019. Physicians who qualify as an advanced APM will avoid some reporting requirements and be eligible for a 5 percent lump-sum bonus.

To read a Becker’s Hospital Review article on this, please hit this link.


Feds okay broad Wash. State Medicaid reform

ranier

Mt. Rainier, in Washington State, considered a very dangerous volcano whose eruption could kill many thousands of people.

The CMS has granted Washington State preliminary approval to reform its Medicaid program  aimed at addressing cost and clinical-care challenges associated with the state’s swelling Medicaid population and moving to value-based care from fee for service. An aim is to move  90 percent of Medicaid payments to a value-based model by 2021.
The five-year waiver program will get $1.5 billion in federal funds.

The program calls for   delivery-system reforms and expanding  the range of  long-term services and supports.

Washington’s  Medicaid population has jumped nearly 60 percent since 2013, to 1.7 million,  as spending has risen to $10.4 billion a year from $7.8 billion.

Key to the changes  is creating so-called Accountable Communities of Health.  Each will be charged with crafting delivery-system reforms that consider social conditions that can affect health.

To read a Modern Healthcare article on this, please hit this link.

 


10 things to know about final MACRA rule

 

Becker’s Hospital Review, in another of its “things to know” articles, presents 10 things to know about the final MACRA rule.

Nearly a third of physicians could be exempt from Medicare’s new merit-based incentive payment system under a final rule the CMS issued Friday. The CMS also signaled it would broaden the opportunities for physicians to participate in alternative models.

The news service seeks to answer:

1. Who qualifies for the Quality Payment Program?

2. When does the Quality Payment Program start?

3. What options are there for participation?

4. What is MIPS and how has it changed from the proposed rule?

5. What qualifies as an advanced APM? 

6. How will small practices be able to participate?

7. How is the final rule more streamlined?

9. How are people responding?

10. What’s next?

Meanwhile, an analysis of the rule suggests that almost a third of physicians could be exempt from Medicare’s new merit-based incentive payment system.  And the CMS also indicated it would make it easier for physicians to participate in alternative models.

To read the whole Becker’s article, please hit this link.

 


Many physicians still worried about MACRA

 

Despite soothing words from CMS, and some adjustments based on criticisms from providers, many physicians remain worried that the  final rule to implement the Medicare Access and CHIP Reauthorization Act (MACRA) is still too narrow and complex to reach its  goal of creating a mostly value-based payment system.

Many fear that the final rule will hurt small and rural medical practices and set primary-care doctors against specialists.

Under MACRA, better-performing doctors will get bonuses and under-performers will face financial punishments based on a variety of metrics of cost and quality of care.

To read a MedPage Today article on this, please hit this link.

 


HealthInsight gets CMS contract to improve Indian Health Service

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The CMS has awarded a contract to  HealthInsight to improve care quality at the Indian Health Service’s hospitals, first by fixing alarming deficiencies there that have attracted federal scrutiny. HealthInsight,  a nonprofit, community-based organization, is charged with “supporting, building and redesigning if needed” the infrastructure of IHS hospitals.

“IHS hospitals—and our staff members across the country—are focused on continuous improvement. (HealthInsight) will provide training for our staff and access to experts to strengthen IHS capacity to deliver quality health care for American Indian and Alaska Native patients,” said Mary L. Smith, IHS’s principal deputy director.

HealthInsight operates in Nevada, New Mexico, Oregon and Utah, which have large populations of Native Americans. It serves as the CMS’s quality-innovation network-quality improvement organization for those states under a five-year contract that began July 2014 .

“HealthInsight works with providers and the community on multiple, data-driven quality initiatives to improve patient safety, reduce harm, engage patients and families, and improve clinical care locally and across our region,” the organization’s Web site explains. That involves “transforming physician practices, employing lean methodology, assisting with value-based purchasing programs and developing innovative approaches to quality improvement.”

Although the contract particularly targets  Medicare beneficiaries,  the CMS said that the work involved would “result in systemic change that improves all of the care provided at these facilities.”

To read more, please hit this link.


Providers plead for new-payment-model slowdown

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Stressed healthcare providers are pleading with the CMS to slow its flood of new payment models  that the agency is pushing in order to move  healthcare  from fee-for-service to value-based care.

Modern Healthcare reports that “Since the start of the year, the agency has introduced or expanded nine pay models and announced selected markets for another three. In comments on a July proposed rule that would make 98 markets financially accountable for the cost and quality of all care associated with bypass surgery and heart attacks, industry stakeholders ask the agency to step on the brakes.”

The Federation of American Hospitals said its members “have become increasingly concerned about the pace of change proposed by the CMS and the unreasonable expectations and burden that such rapid and multiple changes in the delivery system and related payment structure place on hospitals and their work forces….Simply put, this is too fast and too soon.”

The publication reported that “The trade group said it believes that the CMS first needs to evaluate and learn from hospitals’ Comprehensive Care for Joint Replacement Model, or CJR experience, which is less than 6 months old, and from the results of the Bundled Payments for Care Improvement initiative.”

The American Hospital Association said:  “In failing to take the time to learn from CJR, the agency has missed a critical opportunity to move bundled-payment models forward in a meaningful way. This proposed rule {in July} raises serious concerns about the agency’s pace of change, as well as its ability to accurately track and process the outcomes of its myriad, increasingly complex alternative payment models.”

Hospitals have been  pushing back against the CMS’s proposal to expand the CJR program to include surgical hip and femur fracture treatment episodes, or to make certain CJR hospitals implement the cardiac bundled-payment model. Providers complain that  neither the CMS nor participating hospitals  have had the time or the data to to properly analyze lessons learned from the model as it is.

To read the whole article, please hit this link.

 

 


Study: MSSP at ACOs takes a while to succeed

stopwatch

A new report from Aledade, a company that helps physicians form and run Accountable Care Organizations (ACOs), says its ACOs have increased primary-care use (which should help boost prevention and reduce the need for expensive specialty care) and revenue, cut lab and imaging costs, and reduced emergency department and hospital use and readmissions in Medicare’s Shared Savings Program (MSSP) for ACOs.

Importantly, the CMS and Aledade both emphasized that more time in the program tends to result in more savings – e.g., CMS noted that 42 percent of ACOs that entered the program in 2012 generated savings above their minimum savings rate, compared to just 21 percent of those who entered in 2015.

The company cited problems involving benchmarking, hospital coding, risk adjustment and information flows/information blocking from EHR vendors and hospitals. Aledade also noted the importance of importance of scale, and said that that MSSP policies can be improved to shorten ACOs’ timeline to financial success.

To read the Aledade report, please hit this link.

 

 


Dartmouth discusses its ACO woes

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Dartmouth-Hitchcock Medical Center.

Healthcare leaders at the Geisel School of Medicine at Dartmouth College and the affiliated Dartmouth-Hitchcock Medical Center have been busily explaining to the national news media their decision to scrap their Accountable Care Organization — a  model mostly invented at Dartmouth.

A New York Times story said that Dartmouth’s ACO cut Medicare costs on hospital stays, tests, imaging and other procedures. But although it met its goal for quality of care, the Feds still penalized Dartmouth’s ACO  for not reaching cost-savings benchmarks, which prompted it to exit the program last fall.

Robert A. Greene, M.D., an executive vice president in the Dartmouth-Hitchcock Health System, told  The New York Times that  that the cost-cutting, in combination with federal penalties, was not sustainable for the system. Elliot S. Fisher, M.D., director of Dartmouth Institute for Health Policy and Clinical Practice and one of the designers of the ACO model, noted the disappointment of himself and his colleagues.

“It’s hard to achieve savings if, like Dartmouth, you are a low-cost provider to begin with,” Dr. Fisher told The Times.

A Health Affairs blog post said that  the Centers for Medicare & Medicaid Services  data suggest that while more ACOs are finding success,  financial performance and health outcomes can vary widely across America. In late August, CMS reported that that fewer than a third of ACOs qualified for Medicare bonuses.

To read a FierceHealthcare report on ACO issues, please hit this link.

To read a Health Affairs post on ACO performance, please hit this link.

To read The New York Times’s story on this, please hit this link.


CMS to let providers set pace to move to value-based payments

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The tortoise and the hare.

The Centers for Medicare & Medicaid Services has  announced that it   will let providers choose the level and speed at which they comply with the new payment-reform model  that emphasizes the medical value/outcomes of patient care over the volume of procedures. In the current, predominately “fee for service” system, the more procedures that providers order, the more they get paid. That is one reason that America’s physicians are by far the highest paid in the world.

Healthcare industry stakeholders have put the CMS under intense pressure  to ease implementation of the Medicare Access and CHIP Reauthorization Act, which is set to start Jan. 1, 2017. Two months ago, CMS Acting Administrator Andy Slavitt said the agency was considering delaying the start date.

And so eligible physicians and other clinicians next year will be given four options to comply with  such new payment schemes such as the Merit-based Incentive Payment System (MIPS) or an alternative payment model (APM), such as Accountable Care Organizations.

Modern Healthcare reported that under MIPS, physician payments “will be based on a compilation of quality measures and the use of electronic health records. About 90 percent of physicians are expected to pursue MIPS because a qualifying APM requires a hefty amount of risk.

“In the first option offered Sept. 8, any data reported will allow providers to avoid a negative payment adjustment. The goal is to ease providers into broader participation in the following two years, ” the publication reported.

The second option lets providers  submit data for a reduced number of days. “This means their first performance period could begin later than Jan. 1 and that practice could still qualify for a small payment if it submits data on how the practice is using technology and how it’s improving,” Modern Healthcare reported.

The third option is for practices that are ready to go in 2017.

To read the Modern Healthcare story, please hit this link.

 

 


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