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September 28, 2017

ACO roundup: CMS postpones October overall star ratings update

Daily Briefing
    • ACA exchange plans include few in-network mental health care providers, study finds. The average provider network for plans offered through the Affordable Care Act's insurance exchanges includes just 11 percent of all mental health care providers in a given market, according to a study in Health Affairs. For the study, researchers assessed 2016 data from the Robert Wood Johnson Foundation on 531 provider networks offered via 281 insurers in each state's exchange and in Washington D.C. The researchers found that the average exchange plan network included less than 25 percent of a given market's psychiatrists and only 10 percent of a given market's non-physician mental health care providers, such as psychologists or counselors.

    • Medicare improperly paid $51.6M to acute-care hospitals, HHS' OIG says. Medicare made $51.6 million improper payments to acute-care hospitals for outpatient services provided to beneficiaries who were inpatients at other facilities between January 2013 and August 2016, according to an audit from HHS' Office of Inspector General (OIG). The audit also found that the payment mix-up cost Medicare beneficiaries nearly $14.4 million in improper out-of-pocket costs. OIG recommended Medicare contractors recover the $51.6 million in improper payments, instruct acute-care hospitals to refund beneficiaries the $14.4 million in improper out-of-pocket payments, and identify improper payments to acute-care hospitals from after the audit period and instruct them to refund beneficiaries any improper out-of-pocket costs they may been charged improperly.

    • CMS delays overall hospital star ratings. CMS on Wednesday announced that it will not update its overall hospital star ratings system as scheduled in October as it reviews the methodology behind the rating system. CMS said the review comes amid "public feedback" on the system. According to Politico Pro, hospital groups have expressed concerns that the system is flawed and produces misleading rankings.

    From Advisory Board:

    • How to reduce avoidable ED utilization. Heightened demand for emergency services and increased consumerism in health care has left EDs overburdened with rising costs and volumes. Since the majority of these visits are considered unnecessary, provider organizations can capitalize on the opportunity to cut avoidable emergency department visits. Join us on Wednesday, Oct. 18, to learn tactics to increase patient access to primary care, inflect patient behavioral change by boosting awareness of alternate care points and self-management strategies, and implement targeted measures for high-risk patients.

    Register Here

    • 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.

    Get the Report

    • Address patients' non-clinical risk factors in ongoing management. Join us on Thursday, Dec. 7, to learn how to partner with community-based organizations already providing quality non-clinical support for a range of needs, from healthy food access to stable housing, to scale patient management beyond traditional care settings.

    Register Here

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