Late last week the Centers for Medicare & Medicaid Services (CMS) announced its $840 million investment in a program aimed at supporting the adoption, development and sharing of quality improvement strategies to improve patient health and reduce healthcare costs. The “Transforming Clinical Practice” initiative is a new, innovative model and one of the largest […]
A new national scorecard on payment reform shows commercial health plans have dramatically shifted how they pay physicians and hospitals, with 40 percent of their payments “value-oriented” in 2014, according to the Catalyst for Payment Reform (CPR). This means that two-fifths of commercial health insurance payments were no longer traditional fee-for-service. Some financial experts […]
Last week we reported the CMS announcement on ACO success—savings of $372 million and $445 million paid in bonuses. But a new report from Avalere Health notes that quality results are not keeping pace with cost reductions. It’s a prime example of ACO payment complexity. Medicare Shared Savings Program (MSSP) ACOs were not required […]
Pioneer accountable care organizations (ACOs) and Medicare Shared Savings Program (MSSP) ACOs have saved $372 million to date and provided participants $445 million in bonuses, the Centers for Medicare and Medicaid (CMS) reported this week. The results came from preliminary quality and financial results from the second year of 23 pioneer ACOs, and from […]
Two recent studies on emergency departments (ED) show two sides to patients’ use of the ED. Researchers from the Colorado Hospital Association (CHA) reported that Medicaid enrollees added under healthcare reform are both sicker and increasing their use of hospital EDs. The national analysis is based on data from 450 hospitals in 25 states, […]
Patient-centered medical homes are one of the delivery system innovations encouraged by the Affordable Care Act (ACA). But recent studies present a mixed picture of the effectiveness of medical homes in improving quality and reducing costs through care coordination. The National Committee for Quality Assurance (NCQA) has been “designating” medical homes since it started […]
Hospitals that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful electronic health record (EHR) users will see an increase of 1.4 percent operating payment rates for inpatient stays in 2015, according to a final rule released last week by CMS. However, overall payments under the Inpatient Prospective Payment System […]
30-day readmission penalties may unfairly impact safety net hospitals because those facilities tend to care for more patients with socio-economic challenges, according to researchers and health policy analysts. Earlier this year, the National Quality Forum (NQF) issued a draft report where it noted: “failing to adjust performance measures for socio-demographic factors could produce incorrect […]
Traditionally, Medicare has required that its beneficiaries have at least three days in the hospital to qualify for follow-up nursing home care. The Centers for Medicare and Medicaid Services (CMS) is testing the effectiveness of that requirement by exempting patients at some hospitals participating in certain Affordable Care Act (ACA) pilot projects. These projects have […]
With all the news about declining payments to hospitals, gratifying news surfaced last week: the Centers for Medicare and Medicaid Services (CMS) wants to raise Medicare outpatient payments to hospitals by 2.1 percent in 2015. Ambulatory surgery center payments would increase by 1.2 percent. The proposed increases are higher than those finalized by CMS for […]