In the rush forward into alternative payment models, including accountable care organization (ACO)-based models, could primary care physicians be in the process of being progressively disadvantaged? A new analysis by a medical researcher suggests that such might be the case, at least when it comes to payment for evaluation and management (E&M) services. Writing in…
Transitioning the U.S. healthcare system from one driven by volume to one driven by value could take another 15 to 20 years, experts say. For the independent physician, there is ample opportunity to consider a leadership role in the evolution by joining an accountable care organization (ACO). Federally regulated, fee-for-service Medicare ACOs are setting the…
Executive Summary Alternative payment models (APMs) are central to the efforts to reduce the growth in healthcare costs and improve outcomes for patients. Yet some stakeholders remain skeptical of their potential. This is understandable, because APMs have shown mixed results. We have identified seven characteristics of well-designed models that yield meaningful savings for payers, improve…
CMS Administrator Seema Verma on Tuesday said the agency is exploring ways to apply its value-based payment models beyond Medicare and encourage more providers to buy in to the programs. Currently, only 14% of Medicare providers participate in value-based arrangements, Verma said at the CMS Quality Conference in Baltimore. But the agency hopes its new…
Performance measurement is central to the promise of better care, better health and lower cost that alternative payment models (APMs) seek to deliver. The Healthcare Payment Learning and Action network’s (LAN) annual progress report showed increased uptake of APMs, with 34 percent of 2017 payments in category 3 and 4 APMs and with payers anticipating continued APM expansion. As…
Home health agencies are still unsure what a recent overhaul of Medicare’s accountable care organization (ACO) program means for them. They will be affected, experts say, but how and to what extent remains unclear. Called “Pathways to Success,” the new policies for ACOs were announced by the Centers for Medicare & Medicaid Services (CMS) about a month…
Accountable care organizations (ACOs) expressed concern over new Trump administration regulations that reduced the amount of time they can remain in upside-only models. Last month, the Centers for Medicare & Medicaid Services (CMS) finalized a new rule that forces ACOs onto a two-sided risk track after a maximum of 2 or 3 years instead of 6 years….
The move to value-based care is not happening a year from now, or in a month, or even tomorrow. It’s happening as we speak. Why do I say that? An analysis from the Health Care Payment Learning & Action Network (HCP-LAN) in October 2018 revealed that 34% of healthcare dollars of 2017 flowed in from Alternative Payment…
Hospital-affiliated accountable care organizations participating in the Medicare Shared Savings Program achieved $174 million in net savings to Medicare in 2017, according to an AHA infographic released today. Among other achievements, the 297 hospital-affiliated ACOs in the program spent about $690 million less than their 2017 benchmarks and achieved a quality score of 92.3 percent. Depending on…
The Centers for Medicare & Medicaid Services has released a guide showing which Medicare Shared Savings Program tracks for 2019 qualify as an alternative payment model or advanced APM under the Quality Payment Program. The guide also explains whether eligible clinicians participating in an MSSP accountable care organization are eligible for the Merit-based Incentive Payment System APM…
