Medicare Accountable Care Organizations qualified for more than $422 million in shared savings in 2014 by meeting quality standards and their savings threshold, the Centers for Medicare & Medicaid Services announced yesterday. Eleven Pioneer ACOs earned $82 million in shared savings and three owed $9 million in shared losses. In addition, 92 Medicare Shared Savings Program ACOs earned more than $341 million in shared savings. Pioneer ACOs are early adopters of coordinated care and assume greater performance-based financial risk. There were 20 Pioneer and 333 MSSP ACOs in 2014. ACOs with three years of experience in the program were more likely to earn savings (37%) than those participating one (19%) or two years (27%). Pioneer ACOs improved on 28 of 33 quality measures in 2014, while MSSP ACOs improved on 27 of 33 measures. CMS expects to announce new and renewing ACOs later this year.
News Item - 08/25/2015
Statement from the Peterson Foundation on CBO's Updated Budget and Economic Outlook
by Michael A. Peterson
Today, the Congressional Budget Office released its Update to the Budget and Economic Outlook: 2015-2025, which projects that federal debt will rise to 77 percent of GDP in 2025, a historically high level of debt that threatens economic growth over the long term.
Beyond 2025, debt will rise sharply relative to GDP, and CBO warns that “such high and rising debt would have serious negative consequences both for the economy and for the federal budget."
Study: Narrow physician networks more common in certain 2014 Marketplaces
The prevalence of narrow physician networks in the Health Insurance Marketplaces varied widely by state in 2014, according to a new study by researchers at the University of Pennsylvania’s Leonard Davis Institute of Health Economics. The study considers networks narrow if 25% or fewer physicians in a rating area participate. Twelve states had no narrow networks, while the prevalence in other states ranged from 83% in Georgia to 13% in Idaho and North Carolina. States with a high prevalence of narrow networks (60% or more) were dominated by Health Maintenance Organizations, while states with the lowest prevalence (20% or less) were dominated by Preferred Provider Organizations, the study found.
News Item - 08/21/2015
The Centers for Medicare & Medicaid Service (CMS) announced that more than 2,100 acute care hospitals, skilled nursing facilities, physician group practices, long-term care hospitals, inpatient rehabilitation facilities, and home health agencies transitioned from a preparatory period to a risk-bearing implementation period in which they assumed financial risk for episodes of care.
The participants include 360 organizations that have entered into agreements with CMS to participate in the Bundled Payments for Care Improvement initiative and an additional 1,755 providers who have partnered with those organizations. CMS defines an episode of care as the set of services provided to treat a clinical condition or procedure, such as a heart bypass surgery or a hip replacement.
Bundling payment for services that patients receive across a single episode of care is one way to encourage doctors, hospitals and other health care providers to work together to better coordinate care for patients, both when they are in the hospital and after they are discharged. Through the Bundled Payments for Care Improvement initiative, CMS is testing how bundled payments for clinical episodes can result in better care, smarter spending, and healthier people. Today’s announcement means several hundred providers are advancing into a program that rewards them for increasing quality and reducing costs while also penalizing them if costs exceed a set amount.
The initiative includes four models of bundled payments tied to inpatient hospital admission. The models vary by the types of providers involved and the length of the bundle after the hospitalization.
CMS recently announced a new Medicare Part A and B payment model, the Comprehensive Care for Joint Replacement Model. Although the Comprehensive Care for Joint Replacement Model is distinct from the Bundled Payments for Care Improvement initiative, both initiatives are part of the innovative framework established by the Affordable Care Act to move our health care system toward one that rewards providers based on the quality, not quantity, of care they deliver to patients. The Administration earlier this year announced the goal of tying 30 percent of Medicare payments to quality and value through alternative payment models by 2016 and 50 percent of payments by 2018.
Program moving away from 'unsustainable financial path,' opinion piece says
Although Medicare was built on a failing model of fee-for-service, the nation's largest insurer has been making plans to transform itself into the future, say two health policy experts.
Medicare has been facing an "unsustainable financial path" because its fee-for-service payment method "contributed greatly to higher spending without improving health outcomes," Douglas Holtz-Eakin, president of the American Action Forum, and Kenneth Thorpe, professor and chairman of the Department of Health Policy and Management at Emory University, write in an opinion piece for The Hill.
HHS seeks to have 85 percent of Medicare fee-for-service payments in value-based purchasing categories 2 through 4 by 2016 and 90 percent by 2018
Improving the quality and affordability of care for all Americans has always been a pillar of the Affordable Care Act, alongside expanding access to such care. The law gives us the opportunity to shape the way health care is delivered to patients and to improve the quality of care system-wide while helping to reduce the growth of health care costs.
When it comes to improving the way providers are paid, we want to reward value and care coordination – rather than volume and care duplication. In partnership with the private sector, the Department of Health and Human Services (HHS) is testing and expanding new health care payment models that can improve health care quality and reduce its cost.