APM | ACO Exhibit Hall

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

May 29, 2020Garrett SchmittNo CommentsAdvanced Alternative Payment Models, Advanced APM, APM, APMs, payment reform

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…

Emergency CMS rule provides optimism for alternative payment models

May 15, 2020Garrett SchmittNo CommentsAdvanced Alternative Payment Models, APM, APMs

Hospitals and providers face unprecedented financial pressure amid the COVID-19 pandemic. Providers are losing $1.4 billion daily as they experience significant declines in patient volume, according to consulting firm Crowe. Healthcare executives are responding to the financial declines with workforce reductions, pay cuts and other cost-cutting measures. Debbie Zimmerman, MD, Corporate CMO at Lumeris, a value-based…

The Interim ACO Rule Explained: A Pause, Not A Reprieve

May 6, 2020Garrett SchmittNo CommentsAdvanced Alternative Payment Models, APM, APMs, MIPS

As the coronavirus pandemic continues to upend health care in the U.S., pressure has mounted on CMS to adjust its efforts to drive providers to adopt risk. In response, at the end of last week CMS announced a carve-out of COVID-19 patient expenses from certain reporting requirements. In this round, ACOs were on the receiving…

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

April 6, 2020Garrett SchmittNo CommentsAdvanced APM, APM, APMs

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…

Value-Based Care Defined: Know the Vocabulary of Health Care Reform

March 12, 2020Garrett SchmittNo CommentsAPM, Captitation, Corona, Coronavirus, Primary Care First

Today, as we confront a viral threat that is challenging our health system, its capacity, and how care is financed, it seems appropriate to review some fundamentals. Health care reform has been speeding down a particular track, changing how health care is covered, paid, delivered, and organized. These reforms may seem to be about health…

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

March 3, 2020Garrett SchmittNo CommentsAdvanced APM, APM, APMs

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…

The Year in Policy and Payment: A Look at One Critical Alternative Payment Issue

December 23, 2019Garrett SchmittNo CommentsAdvanced APM, APM, APMs

This week, I’m looking back at the year 2019, in two parts. In this blog, I’ll look at policy; in my second blog in this series, I’ll look at “everything else”—fully recognizing, of course, that policy and “everything else” are completely interconnected; but I needed to divide up this year in review conceptually, so that’s…

New CHIME Report Indicates Slow Movement to Alternative Payment Models

November 14, 2019Garrett SchmittNo CommentsAdvanced APM, APM, APMs, CHIME

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

September 24, 2019Garrett SchmittNo CommentsAdvanced APM, AMA, APM, APMs, PCMH

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

August 27, 2019Garrett SchmittNo CommentsAdvanced Alternative Payment Models, Advanced APM, APM, APMs

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…