Kaiser Health News reports from the Associated Press, that big players in the health industry are seeing the cost benefits of nabbing problems before they start. That hot lunch delivered to your door? Your health insurer might pick up the tab. The cleaning crew that fixed up your apartment while you recovered from a stroke? The hospital staff helped set that up.
Some insurers are paying for rides to fitness centers and checking in with customers to help ward off loneliness. Hospital networks are hiring more workers to visit people at home and learn about their lives, not just their illnesses.
The health care system is becoming more focused on keeping patients healthy instead of waiting to treat them once they become sick or wind up in the hospital. This isn’t a new concept, but it’s growing. Insurers are expanding what they pay for to confront rising costs, realizing that a person’s health depends mostly on what happens outside a doctor’s visit. Read More
The Department of Health & Human Services (HHS) finalized a new payment system for Medicare clinicians that will continue to reform how the health care system pays for care. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program, which replaces the Sustainable Growth Rate (SGR), is designed to consolidate the SGR, Meaningful Use, and the Value Modifier into a single alternative payment system. According to the HHS press release, the Administration is building a system that delivers better care, one in which clinicians work together and have a full understanding of patients’ needs, Medicare pays for what works and spends taxpayer money more wisely, and patients are in the center of their care, resulting in a healthier country. Read More
Public and private payers can apply through June 1 to participate in a new medical home model that will build on the Comprehensive Primary Care model to help practices support patients with serious or chronic diseases, the Centers for Medicare & Medicaid Services announced today.
Under the CPC+ model, CMS will partner with insurers and Medicaid agencies in up to 20 regions and up to 5,000 practices to provide monthly care management fees based on beneficiary risk tiers. The model can accommodate up to 5,000 practices, 20,000 doctors and the 25 million people they serve. Read More
Medicare on Friday launches an experiment changing how it pays for hip and knee replacements in an effort to raise quality and lower costs. The idea is to follow patients more closely to smooth their recovery and head off unwanted complications that increase costs.
Hip and knee replacements are the most common inpatient surgery for beneficiaries, and Medicare will be using financial rewards and penalties to foster coordination among hospitals, doctors, and rehab centers. Traditional payment for such surgeries has been by tying payment to the volume of procedures. Medicare says that Comprehensive Care for Joint Replacement Model tests bundled payment and quality measurement for an episode of care associated with hip and knee replacements to encourage hospitals, physicians, and post-acute care providers to work together to improve the quality and coordination of care from the initial hospitalization through recovery. Read More
According to a story released by Kaiser Health News, the Government Accounting Office (GAO) has found that Medicare’s quality incentive program for hospitals, which provides bonuses and penalties based on performance, has not led to demonstrated improvements in its first three years.
GAO's analysis found no apparent shift in existing trends in hospitals' performance on the quality measures included in the HVBP program during the program's initial years. However, shifts in quality trends could emerge in the future as the HVBP program continues to evolve. For example, new quality measures will be added, and the weight placed on clinical process measures—on which hospitals had little room for improvement—will be substantially reduced. Read More
The Centers for Medicare & Medicaid Service (CMS) announced that over 2,100 acute care hospitals, skilled nursing facilities, physician group practices, long-term care hospitals, inpatient rehabilitation facilities, and home health agencies transitioned to a risk-bearing implementation period in which they assumed financial risk for episodes of care.
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. Read More
Some hospitals question whether the Centers for Medicare and Medicaid should be tying patient satisfaction surveys to financial incentives, according to an article in the Wall Street Journal. Read More
Walmart has announced that beginning in January 2013, employees will have access to certain spinal and heart surgeries at reputable hospitals around the country, travel and lodging included, at no cost to employees, according to Reuters. Read More
A precursor program similar to the ACO model generated some Medicare savings, especially among dual-eligible beneficiaries, according to a study in the Journal of the American Medical Association. Read More
The Center for Medicare and Medicaid Services Value-Based Purchasing program will not have much impact on hospital payments when it is launched in October, according to a study in Health Affairs. Read More
Over 2000 hospitals across the country stand to lose approximately $280 million in Medicare reimbursement dollars beginning in October 2012, as Medicare begins to penalize hospitals for readmissions within 30 days of hospital discharge, according to an analysis by Kaiser Health News. Read More
Massachusetts physician groups participating in a global budget reimbursement model were able to reduce the rate of increase in health care spending in year 2 by 3.3 percent, up from 1.9 percent in year 1, according to the Commonwealth Fund. Read More
The Centers for Medicare and Medicaid Services will be launching a third group of Advance Payment Model ACOs on January 1, 2013, according to The Commonwealth Fund. Read More
The Centers for Medicare and Medicaid Services sent out twenty thousand “Resource Reports” to physicians in the midwest, which show the amount their patients cost on average as well as the quality of the care they provided, according to an article by Kaiser Health News and the Washington Post. Read More
Pay-for-performance may not benefit low performing hospitals, according to a study in Health Affairs. Read More
The Centers for Medicare & Medicaid Services results for the 2010 Physician Quality Reporting System and the 2010 Electronic Prescribing (eRx) Incentive Program show significant increases in participation and incentives paid to eligible health care professionals since 2009, according to a press release. Read More
The Premier Hospital Quality Incentive Demonstration (Premier HQID), a 6-year demonstration of pay for performance for hospitals, did not reduce 30-day mortality more than hospital quality reporting alone, according to a study in the New England Journal of Medicine. Read More
Several Massachusetts hospitals are tying about 10 percent of doctors’ salaries to practice size and the complexity of their patients’ illnesses, according to the Boston Globe. Read More
Two former health and public policy advisers in the Obama administration predict that by 2020, insurance companies will be replaced by Accountable Care Organizations, in an opinion article in the New York Times. Read More