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November 2, 2017

ACO roundup: US health care payments increasingly tied to APMs, study finds

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    • CMS' nursing facility initiative saves nearly $50M, cuts avoidable hospitalizations. CMS' "Reduce Avoidable Hospitalizations among Nursing Facility Residents" initiative in its first three years has incurred nearly $50 million in savings and generates a 17% relative decline in potentially avoidable hospitalizations among participating organizations. According to Modern Healthcare's Virgil Dickson, under the program, enhanced care and coordination providers (ECCPs) hired nurses to train and support nursing home staff and help prevent unnecessary hospitalization. Overall, 143 nursing homes across seven states—as well as multiple health systems, colleges, and consultancies—participated in the first part of the initiative, which ended in 2016. Participants are now shifting to the second phase of the model, which compensates nursing homes at Medicare rates to care for patients with one of six conditions.

    • US health care payments increasingly tied to APMs, study finds. Twenty-nine percent of total health care payments in the United States in 2016 were linked to alternative payment models (APMs), up six percentage points from 2015, according to a new report from the Health Care Payment Learning & Action Network (LAN). Overall, those payments totaled $354.5 billion. According to LAN, the results align with the network's goal to have 30% of health care payments be tied to APMs by 2016 and 50% by 2018.

    • Everything you need to know about the 2016 MSSP results. Accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) in 2016 generated a total of $652 million in gross savings, according to CMS data released Friday. The data show that an estimated 134—or about 31 percent—of the 432 ACOs that participated in MSSP for the program's fifth performance year generated shared savings, while 294 generated neither savings nor losses, and four generated losses. Overall, CMS data show about 77 percent—or 330—of the 428 MSSP ACOs subject to pay-for-performance measures for the 2016 reporting period achieved an average quality score of 94%. The remaining 98 MSSP ACOs, which were in pay-for-reporting status, earned quality scores of 100.

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    • Innovations in cross-continuum palliative care. Today, the organizations with the strongest palliative care programs are those that successfully extend these services beyond the hospital. But this is no easy feat. Join us on Wednesday, Nov. 8, to learn how provider organizations are providing patients with palliative services across continuum.

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    • Medicare payment update final rule for hospital outpatient payments for CY 2018. Join us on Friday, Nov. 10, to discuss CMS' changes to hospital outpatient and ambulatory surgical center payments in CY 2018. We'll pay special attention to CMS' changes to outpatient total knee replacement, reducing drug reimbursement under the 340B program, reducing payments to certain nonexcepted outpatient providers, and much more.

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