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Trump changes linked to worrisome decline in ACO partcipation

From FierceHealthcare:

“Some Accountable Care Organization (ACO) groups are worried that a dip in participation this year could be the start of a worrisome trend due to major changes made to the program by the Trump administration.

“The Centers for Medicare & Medicaid Services (CMS) announced Wednesday that 518 ACOs are part of the program as of July 1, a decline from 561 ACOs that participated in 2018. The new data have the National Association of ACOs (NAACOS) worried about whether the decline is an anomaly or the start of a trend thanks to major changes to the Medicare Shared Savings Program (MSSP).

“CMS Administrator Seema Verma wrote in a blog post on Health Affairs Wednesday that CMS approved 206 ACOs to start July 1 and that 41 of them are new to the program. The number of new entrants is below the normal rate of more than 100 ACOs that have signed up each year since the program started seven years ago.”

To read the whole article, please hit this link.

CMS sets plan to cut regulations

FierceHealthcare reported Sept. 17:

“CMS took the latest step in its Patients over Paperwork initiative on Monday, issuing a proposed rule that would eliminate or update a slew of regulations deemed ‘unnecessary, obsolete or excessively burdensome’ on providers.

“Should  the rule be finalized, the Centers for Medicare & Medicaid Services estimates that it would save providers $1.12 billion each year and eliminate millions of hours in administrative time. Through 2021, CMS projects $5.2 billion in total savings and 53 million hours of administrative burden eliminated.”

“Much of the rule focuses on streamlining CMS’s conditions of participation and conditions for coverage, which the agency says will allow providers to operate more fluidly and efficiently without impacting patient safety and care quality. Some of the key changes the rule proposes include:

  • “Allowing health systems to use an integrated quality assessment and improvement platform across all their member hospitals.
  • “Creating a simpler process for providers to order portable X-ray machines and updating the requirements for portable X-ray technologists.
  • “Easing requirements for hospitals and ambulatory surgery centers for conducting physicals and collecting patient histories ahead of procedures.”


To read the full article, please hit this link.

Feds to ask ACOs to take on more risk

From FierceHealthcare:

“A long-awaited proposal from the Trump administration will ask Accountable Care Organizations (ACO) to take on more risk going forward, a move that is likely to drive providers out of the program.

The proposed rule (PDF) issued by the Center for Medicare & Medicaid Services (CMS) on Aug. 9, shrinks the amount of time ACOs can be in an upside only model to two years. Currently, 82 percent of ACOs participating in the Medicare Shared Savings Program (MSSP) are in an upside only model.

Additionally, those in a Track 1 upside only model would only be able eligible to take in 25 percent of any savings. Under the current program, Track 1 ACOs take a 50 percent cut. In an upside model, ACOs get a portion of any savings generated in treating patients but are still paid by CMS if they incur losses.”

To read the full Fierce article, please hit this link.

Trump administration seems to support value-based care after all

Med City News looks at whether the Trump administration is pushing back against value-based care. The article notes:

“{T}he administration has shifted to a focus on voluntary bundles. CMS announced BPCI Advanced, the next-gen version of the original BPCI, in January. The first cohort will start participating in the model, which is voluntary, in October.” BPCI means Bundled Payments for Care Improvement.

“Via email, a CMS spokesman said the alterations to the mandatory programs ‘were made after a robust comment solicitation and were intended to encourage health system change while minimizing provider burden and maintaining access to care.’ The agency is examining the models started by the Obama administration ‘on a case by case basis’ to pinpoint opportunities to improve them.

“With all these cancellations and changes, is the Trump administration undermining value-based care? One industry expert said no, implying the genie can’t be put back in the bottle.”

“I think it’s clear that the principles of value-based care are still endorsed and appreciated industry-wide,” Dr. Charles Saunders,  M.D.,  of Integra Connect CEO, said in a recent phone interview. “I don’t think that there’s any backing off.” Integra provides solutions to optimize value-based patient care at individual, practice and population levels.

“Saunders noted that going forward, the models are likely to change and evolve, particularly as the culture of healthcare continues to adjust to value-based care,” Med City reported.

“I believe that we’ll continue on the course as an industry towards payment for value because the cost of healthcare is on an unsustainable growth path.”

“And perhaps he’s right. With Alex Azar taking the seat as HHS secretary earlier this year, the administration appears to be stressing the significance of fee-for-value. At his Senate confirmation hearing in January, Azar surprisingly expressed support of mandatory bundles.”

To read the whole article, please hit this link.

CMS to expand MA value-based model to 15 more states


The Centers for Medicare & Medicaid Services has announced that starting in 2019, the federal government will expand the Medicare Advantage value-based insurance design model to an additional 15 states and broaden the options available for participants. The expansion will mean that the  model will be used  in a total of 25 states in 2019.

The program began back in 2015, with the idea of letting MA plans  offer custom-designed supplementary benefits for beneficiaries with such conditions as hypertension, diabetes and congestive heart failure.

The CMS  will let  insurers propose their own systems or methods for identifying eligible enrollees, including Medicare beneficiaries who have different chronic conditions than those previously set  by the CMS.

To read more, please hit this link.

CMS chief wants to toughen Medicaid rules


In a Governing magazine news article,  CMS Administrator Seema Verma discusses how she would like to make Medicaid recipients take more personal responsibility, including by CMS imposing work requirements across America.

She’s already implementing changes that could  remake how America cares for its poorest citizens for decades to come. And she may well become the next secretary of health and human services.

“The goal of the program should be to help people rise out of poverty,” Ms. Verma told Governing.  For able-bodied adults, the program should be “a stepping stone, not a long-term plan. We should be aiming higher.”

But, reports Governing, “{M}any critics simply don’t agree that work requirements and other mandates have any place in a health-care plan.”

”Medicaid’s purpose is not to encourage employment or train people. That’s the Department of Labor’s job,”  Jessica Schubel, Medicaid policy expert with the left-leaning Center on Budget and Policy Priorities, told the magazine.

To read the full article, please hit this link.




A new day may be coming for CMS star ratings

— Photo by ESA/Hubble

With the exit in expense-account scandal of Tom Price, M.D., as secretary of health and human services, CMS may finally be allowed to update its star  ratings of hospital quality, writes healthcare-sector consultant Rita Numerof, Ph.D., in Hospital Impact.

She notes that the ratings “evaluate provider performance across a variety of metrics, condensing the results into a single score. They offer the potential for patients and their loved ones to compare nearby facilities side-by-side, giving them the knowledge to ask important questions about their treatment, the process it is likely to follow, the costs they can anticipate, and the outcomes they can expect.”

“While the ratings were initially intended for quarterly updates and revisions, officials have stymied attempts to roll out a fresh review since July 2016. Just prior to Tom Price’s resignation from his post as Health and Human Services secretary, his department announced yet another push to delay the release of new ratings.”

“Though Price, a practicing physician, took a hard line against the ratings rollout, his potential successors may be more willing to revisit discussions on the system’s efficacy. Chief among them is CMS Administrator Seema Verma, whose work with Medicaid looked to combine institutional accountability with patient-centered care. It now seems that there may be a fresh opportunity to reopen the conversation on new ratings.”

To read all of Ms. Numerof’s observations, please hit this link.




ACA exchanges’ navigators are hitting roadblocks


— Photo by HurwiczRocks


For Kaiser Health News

While healthcare uncertainty roils Washington, the rest of the country is coasting toward  signup season on the Affordable Care Act insurance exchanges.

Open enrollment is just about a month away. But the current landscape is marked by funding cuts and other White House efforts to pull back on ACA outreach, which has led some people to brace for what they foresee as the toughest season yet.

And the latest wrinkle? In states that use the federal marketplace,, many navigators — nonprofit groups and workers who receive federal funding to help consumers enroll — are hitting snags completing a mandatory certification course. Those credentials are required before they can formally advise consumers or organize educational events about getting coverage.

To be sure, the training — which involves buggy, not-so-user-friendly software — has never been a smooth process.

But this year, many say they’re experiencing more technical glitches and — in a critical shift — getting less help from the Centers for Medicare & Medicaid Services, the federal agency tasked with supporting them.

“It used to be … you got the impression they were trying to help you,” said Randal Serr, director of Take Care Utah, a navigator organization based in Salt Lake City. “Now it seems, passively, this is not their priority.” He reports that he has experienced firsthand the slow responses to these technical difficulties.

CMS did not provide comment for this story.CMS

Chief among the complaints are repeated error messages and lost or unsaved work after sections of the training are completed.

Based on interviews with navigators as well as advocates and experts who work with their organizations, when these problems arise, they compound an already uphill climb to sign people up for ACA health coverage.

“I don’t know how much icing we need on this cake, but it’s more icing on the cake,” said Shelli Quenga, director of programs for the Palmetto Project, in South Carolina, whose federal grant was cut by more than 50 percent.

Software problems are occurring more frequently than in the past at her organization, Quenga said. Meanwhile, she added, it can take weeks before CMS resolves the issue — a delay she didn’t recall experiencing in previous years. On top of the funding cuts and administration’s messages that undermine enrollment, it’s “a new circle of Dante’s hell,” she said.

But even as navigators from a number of states report problems, others say their experiences haven’t differed from other years.

Adam VanSpankeren, a Wisconsin-based navigator, said he faced a few bugs in completing his training, but nothing unusual. When he sought technical support, he added, he received quick and thorough help. Amalia Benvenutti, a Georgia-based insurer, reported a similar encounter.

“There has always been the occasional odd bug with a particular module not saving or the site crashing — the interface is a bit clunky — but nothing that I would describe as more restrictive or onerous than previous years,” VanSpankeren said.

Daniel Bouton, who organizes the marketplace program at a Dallas-based navigator group and has already experienced some of these problems, sees a larger pattern. He worries that will almost certainly affect how many consumers can both access information about their insurance options and how many actually get covered.

Together, these challenges underscore the impact of the Trump administration’s broader disinterest in maintaining much of Obamacare’s vast apparatus.

“Local organizations are feeling the cut on funding. Then you move to, ‘OK, I’m not going to have enough funds for a strong marketing campaign. I’ll utilize my navigators, and go back to grass roots, and do door-to-door marketing.’ But then you go back to, ‘I can’t send my navigators out because they’re not certified,’” Bouton said. “I have this feeling of having our hands tied.”

And there are other potential delays. Many navigator groups saw their federal funding cut this year — a change that required them to submit new working budget proposals to CMS by last Wednesday. It’s unclear if or when they will receive federal approval, which some said could further cut into planning and outreach efforts.

Meanwhile, these challenges come as open enrollment — which starts Nov. 1 — for the first time lasts only six weeks compared with three months in previous seasons. CMS also indicated it will for the first time be shutting down the website on most Sundays of open enrollment, which officials say is for maintenance. Sundays, though, have typically been a prime time for consumers to sign up.

And at the same time, the learning curve is steeper. Many consumers aren’t aware that the enrollment period is shorter, Quenga said. Because of congressional back-and-forth, she added, some aren’t even sure if Obamacare is still in effect.

“People need that in-person assistance to understand the subtleties and nuances of a very complicated system,” she said. “You’re cutting these people off at the knees.”

Moody’s see stable finances for for-profit hospitals

Moody’s Investors Service sees the financial outlook for U.S. for-profit hospitals as stable.

Key to this forecast is the expectation that outpatient services will drive revenue and earnings growth. The ratings company sees outpatient service growth fueling a 2.5-3 percent earnings growth for for-profit hospitals over the next 18 months as much of American healthcare, under pressure from consumers and public and private insurers, seeks lower-cost settings. At the same time, Moody’s predicted,  higher patient costs and an increase in the number of uninsured Americans may lead to more bad debt for hospitals.

Moody’s noted that patients with high-deductible health plans will seek less costly settings than hospitals to save money. Also, the company said, the CMS’s proposal to let more orthopedic procedures be done on an outpatient basis could do more financial damage to hospitals.

Moody’s warned:

“Higher patient responsibility and fewer insured patients will lead to lower volumes, but also higher costs of uncompensated care. Even with strong cost controls, given the high fixed costs of operating hospitals, it will be difficult to expand margins in an environment of weak patient volumes and rising bad debt expense. At the same time, nursing shortages and rising fees associated with medical specialists (including outsourced emergency departments) will also pressure margins.’’

Still, profit margins of some for-profit systems may well widen in the coming months, Moody’s said. citing Quorum Health and Community Health Systems (CHS) benefiting from selling off less profitable facilities and LifePoint Health and HCA Healthcare improving efficiencies at recently acquired facilities.

Moody’s expects for-profit hospitals in Texas and Florida will recover quickly from losses associated with recent hurricane damage.

To read more, please hit this link.


Value-based care is a ‘bipartisan movement’


Shannon Muchmore writes in Healthcare Dive that CMS’s scaling back of bundled-payment programs won’t stop the shift to alternative models. The agency’s changes to such programs could have “immediate and long-term effects,” she writes, “but value-based care remains a bipartisan movement that won’t be easily stopped.”

She concludes:

“The changes from CMS may hinder the broader movement and set back bundled models because of less reliable results from the government programs, but they aren’t going to put an end to reform efforts.”

To read her article, please hit this link.



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