CMS announces final round of application for Next Generation ACO model

The Centers for Medicare & Medicaid Services’ (CMS) Innovation Center is accepting the second and final round of applications for its Next Generation Accountable Care Organization (ACO) model, which will begin its second performance year on Jan. 1, 2017.

The Next Generation ACO Model is an initiative for ACOs that are experienced in coordinating care for populations of patients and allows doctors and hospitals to assume higher levels of financial risk and reward than are available under the current Pioneer Model and Shared Savings Program (MSSP). The goal of the Model is to test whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care management, can improve health outcomes and lower expenditures for Original Medicare fee-for-service (FFS) beneficiaries.

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Return of capitation? Massachusetts insurer expands global payment model

Further signifying a “fundamental” change in health care reimbursement, Blue Cross Blue Shield of Massachusetts (BCBSMA) last week announced a five-year agreement with Boston-based Caritas Christi Health Care that revolves around a global payment system rather than the standard fee-for-service model, the Wall Street Journal reports.

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MedPAC releases report on Medicare payment policy on changing incentives to reward value, not volume

Today the Medicare Payment Advisory Commission (MedPAC) releases its June 2009 Report to the Congress: Improving Incentives in the Medicare Program. MedPAC’s report focuses on how incentives in the Medicare payment systems could be changed to strengthen the Medicare program and promote quality care for Medicare beneficiaries.

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Article warns CMS policy on falls may lead to greater use of restraints

Writing in today's New England Journal of Medicine, Dr. Sharon K. Inouye of Harvard Medical School and her coauthors argue that because falls have proved to be such an intractable problem despite broad efforts to reduce them, they should not be included on a list of avoidable medical errors that result in hospitals not being paid.

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Medicare to launch pay-for-performance demo for nursing homes

The Centers for Medicare & Medicaid Services seeks nursing homes and skilled nursing facilities in Arizona, Mississippi, New York and Wisconsin to participate in a three-year pay-for-performance demonstration program. CMS will accept applications from Medicare-certified nursing homes and SNFs through May 1, and expects to announce the participants in June.

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Nearly all acute care hospitals receive full CMS payment update for outpatient quality reporting

The Centers for Medicare & Medicaid Services (CMS) has notified more than 3,000 of the nation’s hospitals that they will receive the full payment update for calendar year (CY) 2009 as part of the new Hospital Outpatient Quality Data Reporting Program. The successful hospitals represent 99.3 percent of all hospitals that participated in the program that began in 2008 as an effort to strengthen the tie between the quality of care furnished to people with Medicare in hospital outpatient departments and the payments hospitals receive for those services.

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CMS and Joint Commission to retire Beta-Blocker at Arrival (AMI-6) as of April 1, 2009 Discharges

The Centers for Medicare and Medicaid Services (CMS) announced today (http://www.cms.hhs.gov/HospitalQualityInits/Downloads/HospitalAMI-6FactSheet.pdf) that it plans to retire one of the quality measures it collects under the Agency’s hospital quality pay-for-reporting program. As of April 1, 2009, CMS plans to retire measure AMI-6, known as, “Acute myocardial infarction patients without beta-blocker contraindications who received a beta-blocker within 24 hours after hospital arrival.” Hospitals will see a change in their reporting requirements as of April 1, 2009, and consumers will also notice changes to the information available to them on the Hospital Compare website.

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CMS announces new hospital and physician bundling payment system demo

The Centers for Medicare & Medicaid Services (CMS) today announced site selections for the Acute Care Episode (ACE) demonstration. ACE is a new hospital-based demonstration that will test the use of a bundled payment for both hospital and physician services for a select set of inpatient episodes of care to improve the quality of care delivered through Medicare fee-for-service.
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CMS selects hospitals for bundled physician-hospital payment demo

The Centers for Medicare & Medicaid Services selected five hospitals to participate in a three-year bundled payment demonstration, which the agency plans to launch early this year. The hospitals are Baptist Health System in San Antonio; Oklahoma Heart Hospital in Oklahoma City; Exempla Saint Joseph Hospital in Denver; Hillcrest Medical Center in Tulsa, OK; and Lovelace Health System in Albuquerque, NM.

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Medicare proposes non-payment policy for surgical errors

CMS this week proposed national coverage determinations (NCDs) for three preventable errors—surgery on the wrong body part, surgery on the wrong patient, and wrong surgery performed on a patient. These NCDs would stop Medicare payment for such events. The errors are among the 28 Serious Reportable Events, or “never events,” identified by the National Quality Forum and can result in serious injury or death, said CMS Acting Administrator Kerry Weems, although they tend to be rare.

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