ACO roundup: CMS eases ACO access to SNF waivers

  • AHA: Medicare, Medicaid underpaid hospitals by $76.8B in 2017. Medicare and Medicaid underpaid U.S. hospitals by $76.8 billion in 2017, with Medicare accounting for $53.9 billion in underpayments and Medicaid accounting for $22.9 billion, according to data from the American Hospital Association (AHA). Specifically, AHA said hospitals received only 87 cents for every dollar they spent on Medicare or Medicaid patients in 2017. Overall, according to AHA, hospitals in 2017 spent $38.4 billion on uncompensated health care.
  • CMS eases ACO access to SNF waivers. CMS on Monday released guidance that eases requirements for ACOs' seeking a three-day rule waiver for inpatients being transferred to a skilled-nursing facility (SNF). Under the guidance, which applies only to ACOS participating in or applying to performance-based risk tracks in the Medicare Shared Savings Program, ACOs must provide a list of SNFs they plan to partner with—all of which must have a CMS quality rating of at least three stars—and an affiliate agreement for each SNF. The guidance also permits, for the first time, critical-access hospitals and other small hospitals in rural areas that operate under swing-bed agreements to be eligible as potential affiliates. According to CMS, the waiver can be used only for patients who are prospectively attributed to the ACO.
  • Do mandatory bundled payments cut spending? Yes—but only slightly, study suggests. Medicare spending on hip and knee replacement surgeries decreased slightly over two years under the Comprehensive Care for Joint Replacement (CJR) program, according to study published Wednesday in the New England Journal of Medicine. The researchers found hospitals in geographic regions chosen for mandatory participation spent 3.1%, or $812, less on each joint replacement episode than hospitals in a control group encompassing 121 geographic regions—a difference the researchers said occurred largely because hospitals in the mandatory regions were less likely to discharge patients to post-acute care facilities. According to Advisory Board's Eric Fontana and Kenna Hawes, the results could lead HHS to take "a second look" at other similar types of bundles.

From Advisory Board:

MACRA 101. Join us for 30 minutes on Thursday, January 31, at 3:00 p.m. ET where we'll break down MACRA's origins and provide an introduction to the two Quality Payment Program (QPP) tracks: the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM).

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The care transformation state of the union. Join us on Thursday, January 31, at 3:00 p.m. ET to explore these disruptors and how population health leaders must evolve their strategy.

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Examine Medicare's Hospital Inpatient Pay-for-Performance update, FY 2019. Join us on Wednesday, February 27, at 3:00 p.m. ET to learn about important updates to CMS' three inpatient pay-for-performance programs, which place up to 6% of a given hospital's inpatient payments at risk in FY 2019.

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