Leveraging Payment Reforms For COVID-19 And Beyond: Recommendations For Medicare ACOs And CMS’s Interim Final Rule

Garrett SchmittNo Comments, , , ,

The COVID-19 pandemic has significantly challenged clinician practices, hospitals, and all health care delivery organizations. Many such organizations have scrambled to build new capabilities and shift workflows to test, trace, and manage COVID-19 as well as remotely manage chronic conditions for their non-COVID patients. At the same time, health care delivery organizations are facing considerable…

CMS sends $51B in advance payments to hospitals

Garrett SchmittNo Comments

CMS announced April 9 that it has delivered more than $51 billion in payments to hospitals and other healthcare providers in the past week through the Accelerated and Advance Payment Program. CMS expanded the payment program to a broader group of healthcare providers in late March to help offset the financial impact of COVID-19. On April 7, the…

Alternative Payment Models During A Pandemic: Suspending Down-Side Risk During This Time Of National Crisis

Garrett SchmittNo Comments, ,

There have been a number of unprecedented regulatory flexibilities issued by the Centers for Medicare and Medicaid Services (CMS) in recent weeks given the COVID-19 pandemic, done with the intention of easing the burdens on the health care system to be more responsive to our patients’ needs. But one issue that has been left in…

Alternative Payment Models Save, But Drop-Out Rate Still a Concern

Garrett SchmittNo Comments, ,

Alternative payment models (APM) primarily run by Medicare have generally produced modest savings and quality improvements. However, popular APMs including accountable care organization (ACO) and bundled payment models have high drop-out rates, which may indicate a problem with downside risk, according to a new review article in Health Affairs. The article reviewed 40 APMs operated by the CMS…

New CHIME Report Indicates Slow Movement to Alternative Payment Models

Garrett SchmittNo Comments, , ,

Although legislative pressure to transition to value-based care began several years ago, movement to alternative payment models (APMs) and changes to healthcare reimbursement have been slow, according to CHIME HealthCare’s Most Wired report. The report, recently made public, was based on responses to CHIME’s 2019 Most Wired survey. CHIME (the College of Healthcare Information Management Executives) conducts…

54% of Physicians Participate in an Accountable Care Organization

Garrett SchmittNo Comments, , , ,

The majority of physicians now participate in an accountable care organization (ACO), the American Medical Association (AMA) recently reported. Overall, 53.8 percent of physicians polled in September 2018 for the AMA’s Physician Practice Benchmark Survey reported participating in at least one ACO type that year. The percentage is up from 44.0 percent in 2016, the recently…

Applying Sutton’s Law To Alternative Payment Models For The Seriously Ill

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When asked why he robbed banks, Willie Sutton, the infamous US bank robber, responded “because that’s where the money is.” This quote is the inspiration for “Sutton’s Law,” which recommends prioritizing those diagnostic tests that are most likely to yield a definitive diagnosis and quickly lead to a treatment recommendation. While Sutton’s Law has been…

A Roadmap For Driving High Performance In Alternative Payment Models

Garrett SchmittNo Comments, ,

Health care spending is projected to grow to 19.4 percent of gross domestic product (GDP) by 2027, and big gaps in quality and access to care persist. This has motivated payers and providers to implement alternative payment models (APMs) to enable higher-value care. There is bipartisan agreement, reflected in the Medicare Access and CHIP Reauthorization Act (MACRA)…

The seven characteristics of successful alternative payment models

Garrett SchmittNo Comments, ,

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…

 
The seven characteristics of successful alternative payment models