Medicare alternative payment models

Azar: More Value-Based Care Coming

Medicare may add more value-based care initiatives and alternative payment models to those it already operates, Health and Human Services Secretary Alex Azar suggested at a recent event in Washington, D.C. During his remarks, Azar spoke about population health benefits, global budgeting for Medicare patients, more primary care programs, and new models that address kidney care and opioid use and hinted at future efforts that address social determinants of health. Learn more about Azar’s remarks about Medicare value-based purchasing and alternative payment models and other current federal health policy matters in the Healthcare Dive article “HHS chief keeps focus on [...]

iqtsupport2019-10-31T13:00:29-04:00October 31, 2019|Alternative payment models, Centers for Medicare & Medicaid Services, Medicare, Medicare reimbursement policy|

Mandatory Payment Models Coming to Medicare?

Even as CMS rolls out new, voluntary Medicare alternative payment models, it is contemplating making participation in future models mandatory rather than voluntary, as is currently the case. Or so Centers for Medicare & Medicaid Services administrator Seema Verma told a gathering in Baltimore last week. At the heart of the idea, Verma told her audience, is that while CMS is pleased with participation in voluntary accountable care organization models, organizations are choosing to participate in ACO models they think would benefit them most while posing little or no downside financial risk. The agency may need to move away from [...]

iqtsupport2019-05-02T06:00:59-04:00May 2, 2019|Accountable Care Organization, ACO, Alternative payment models, Centers for Medicare & Medicaid Services, Medicare, Medicare reimbursement policy|

Hospitals Flee Downside Risk in Medicare Bundled Programs

More than half of the hospitals that voluntary participate in Medicare bundled payment model programs leave those programs when faced with the possibility of financial penalties based on their performance. So concludes a new report by the U.S. Government Accountability Office. Some of these models feature both “upside” and “downside” risk. Upside risk offers financial incentives to participants that keep their costs below targeted amounts; they share those savings with Medicare. Downside risk occurs when hospitals are penalized when their costs exceed agreed-upon targets. Some of the model programs begin with only upside risk and later move into both upside [...]

iqtsupport2019-01-29T06:00:06-05:00January 29, 2019|Alternative payment models, hospitals, Medicare|

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues. The issues on MedPAC’s November agenda were: MedPAC’s mandated report on long-term care hospitals patient functional assessment data used in Medicare payment and quality measurement modifying advanced alternative payment model (A-APM) payments modifying the Medicare-dependent hospital program promoting greater Medicare-Medicaid integration in dual-eligible special-needs plans the Medicare Advantage quality bonus program Medicare Advantage encounter data MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program. While its recommendations are not binding on either Congress or the [...]

iqtsupport2018-11-06T06:00:50-05:00November 6, 2018|Medicare, Medicare post-acute care, Medicare reimbursement policy, MedPAC|

APM Use Rising

Alternative payment models now account for more than one-third of health care payments, according to a new analysis. Leading the way is Medicare Advantage plans, which expend nearly half of their Medicare payments through APMs. Learn more about this trend in health care delivery and payments in the report “APM Measurement: Progress of Alternative Payment Models,” which was prepared by the Health Care Payment Learning & Action Network and can be found here.

iqtsupport2018-10-26T06:00:53-04:00October 26, 2018|Alternative payment models|

Administration Slows Movement Toward Medicare Quality Payments

The Trump administration is slowing Medicare’s movement toward making greater use of quality in its payment system. The Obama administration’s goal of having 50 percent of Medicare payments made through a quality or alternative payment model by the end of 2018 now appears to be out of sight. Instead, the Centers for Medicare & Medicaid Services has partially canceled two bundled payment programs – one for joint replacement and another for cardiac rehabilitation programs – and announced that before introducing new programs it wants to take a closer look at the successes and failures of the alternative payment model programs [...]

iqtsupport2018-02-20T10:26:50-05:00February 20, 2018|Centers for Medicare & Medicaid Services, Medicare|

MedPAC Delivers Annual Report to Congress

The Medicare Payment Advisory Commission has issued its annual report and recommendations to Congress. The major issues addressed in the report include: implementing a unified payment system for post-acute care reforming Medicare payment for drugs under Part B redesigning the merit-based incentive payment system (MIPS) and strengthening advanced alternative payment models using premium support for Medicare the relationship between clinician services and other Medicare services payments from drug and device manufacturers to physicians and teaching hospitals in 2015 the medical device industry stand-alone emergency departments hospital and skilled nursing facility use by Medicare beneficiaries who reside in nursing facilities the [...]

iqtsupport2017-06-21T06:00:29-04:00June 21, 2017|Medicare, Medicare post-acute care, MedPAC|

Participation in Alternative Payment Models Rises

In 2017 nearly 360,000 clinicians will participate in Medicare and Medicaid Alternative Payment Model programs sponsored by the Centers for Medicare & Medicaid Services. CMS also reports that this year 570 accountable care organizations, including 131 that bear risk, will serve more than 12.3 million Medicare and Medicaid beneficiaries. In addition, nearly 3000 primary care practices will participate in advanced primary care medical home models Find more about the growth of participation in CMS’s alternative payment models, including descriptions of the different models and breakdowns in the numbers of participants, in this CMS news release.

iqtsupport2017-01-27T06:00:22-05:00January 27, 2017|Accountable Care Organization, ACO, Centers for Medicare & Medicaid Services, Medicaid, Medicare|