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November 15, 2018

ACO roundup: CMS seeks contractor to help explain value-based payment models

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    • CMS seeks contractor to demystify value-based payment models. CMS in a notice announced it is seeking a new contractor to help providers understand value-based care delivery models and their performance in those models. According to CMS, the contractor would establish policies to make MACRA's Quality Payment Program easier to comply with and develop a new IT interface aimed at providing physicians with more transparent feedback on their performance. In particular, CMS said it wants the contractor to help providers understand the Merit-Based Incentive Payment System's cost measures, stating, "The cost performance category feedback presents the greatest challenge for providing feedback since the measures are highly complex, the data is extracted from claim submissions and is not consciously submitted by clinicians."
    • Medicaid model for new births curbed costs, improved outcomes. Medicaid's Strong Start for Mothers and Newborn initiative, which ran from 2013 through 2017, successfully met its goal to curb pre-term births and improve outcomes for infants and pregnant women, according to a new assessment. The assessment found that the delivery costs for women enrolled in the initiative averaged $6,527—or about $1,759 less than spent on women in the comparison group. In addition, spending on women from delivery through the infant's first birthday was $10,562 for those in the program, compared with $12,572 for women who were not enrolled.
    • 93% of participants earned a MIPS bonus payment this year. (But it could be harder next year). Ninety-three percent of clinicians eligible to participate in MIPS received a bonus payment for the 2017 performance year—a result which Advisory Board's Naomi Levinthal and Ye Hoffman say reflects that "CMS eased the transition so much that for many providers it took little effort to participate at all." Yet, they say, that "looking forward, it won't be so easy."

    From Advisory Board:

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    • The 2019 Imaging Market Outlook. Join us on Wednesday, December 5, at 3:00 p.m. ET to learn about the rising tide of cost control, payer steerage, regulatory changes, and patient consumerism affecting imaging providers in 2019 and beyond.

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    • Cancer care reimbursement in 2019, explained. Join us on Tuesday, December 11, at 3:00 p.m. ET to learn about changes in the 2019 HOPPS and MPFS Medicare rules impacting payment for cancer services in the hospital-based and freestanding settings.

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