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August 3, 2017

ACO roundup: Providers treating high-risk patients more likely to be penalized under VBP program, study finds

Daily Briefing
    • MedStar, Mount Sinai, others launch home-based care initiative. The Home Centered Care Institute, MedStar Health, and seven other academic medical institutions on Tuesday unveiled an initiative to train recently graduated physicians, NPs, and physician assistants in how to provide home care. The organizations said the effort aims to increase the total number of home care providers from an estimated 1,000 currently to 5,000 within five years. Classes, slated to begin in 2018, will be offered by all participating organizations, including MedStar, Cleveland Clinic, the Icahn School of Medicine at Mount Sinai, Northwestern University Feinberg School of Medicine, the Perelman School of Medicine at the University of Pennsylvania, University of Arizona Center on Aging, University of Arkansas for Medical Sciences, and the University of California at San Francisco.

    • Providers with high-risk patients more likely to get penalized under VBP program. Physician practices that provided care for a disproportionate share of high-risk patients in the first year of the Medicare Physician Value-Based Payment Modifier Program were more likely than other physician practices to be penalized under the program, according to a new study in the Journal of the American Medical Association. For the study, researchers assessed program payments issued in 2015 to nearly 900 large practices that provided care for more than 5.1 million Medicare beneficiaries. According to the study, practices that served socially high-risk patients had lower quality scores and lower costs, while those serving more medically high-risk patients reported lower quality scores and higher costs—patterns that the researchers linked to fewer bonuses and more penalties under the program.

    • CMS proposes $43B in cuts to Disproportionate Share Hospital payments. CMS last week published a proposed rule for implementing $43 billion in Medicaid Disproportionate Share Hospital (DSH) payment cuts over eight years. Under the proposed rule, Medicaid DSH payments would be cut by $2 billion in FY 2018, with the cuts growing by $1 billion annually until they reached $8 billion in FY 2024. The DSH payment cut would remain at $8 billion in FY 2025, bringing the total to $43 billion in payment cuts over eight years. CMS is accepting public comments on the proposed rule until Aug. 28.

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    • Is your Medicare risk strategy MACRA-ready? While the GOP's health reform effort continues to evolve, Medicare payment reform has quietly marched on with bipartisan support. And with MACRA well underway, the new administration has shown no signs of reversing course. As a result, hospital and health system leaders need to develop an intentional Medicare risk strategy. Check out our new research report to learn how to navigate the Medicare ACO programs, expand into the Medicare Advantage market, and ensure the longevity of your Medicare risk strategy by actively cultivating contracts over time.

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