Toward Accountable Payment

Our latest update on health care payment reform and innovation

We've moved

Rob Lazerow April 23, 2014

We often talk about aligning care and payment transformation. Regardless if you lead with risk-based contracts or system redesign, you need both models to work together to succeed under value-based care.

That's why we've merged Toward Accountable Payment with the Care Transformation Center Blog.

To read my latest accountable care updates on topics like ACOs, bundled payment, and pay-for-performance, visit the blog today and make sure you're subscribed so you don't miss any future posts.

Thanks for your continued readership. As always, if there is anything I can do to be helpful, please feel free to call or email me directly.

Which early Medicare ACOs earned bonuses?

Rob Lazerow March 12, 2014

CMS continues to release performance results for the 114 organizations that joined the Medicare Shared Savings Program (MSSP) in 2012.

Back in January, CMS announced that 54 ACOs successfully reduced spending for attributed beneficiaries below their expenditure target and that 29 of these ACOs generated sufficient savings to qualify for bonuses. But the agency did not identify the names of the 29 ACOs—until now.

Check out the early MSSP winners below.

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Are you in the penalty zone for CMS's HAC program?

February 25, 2014

Eric Fontana

Just as hospitals are getting a handle on the quality metrics and revenue implications of the value-based purchasing and readmissions programs, CMS is introducing a third pay-for-performance program in FY 2015: the Hospital-Acquired Conditions (HAC) Reduction Program.

Make no mistake—this program is entirely separate from the Present on Admission (POA) program that was introduced in 2008. However, unlike POA, this program actually carries teeth, with the worst-performing quartile of hospitals set to see a 1% reduction to their inpatient Medicare revenue.

By 2017, this could mean a worst-case 6% cut to inpatient Medicare reimbursement when all three programs are in full swing.

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CMMI hints at new outpatient bundled payment pilot

Rob Lazerow February 19, 2014

Last week, CMS’s Center for Medicare and Medicaid Innovation (CMMI) issued a request for information (RFI) on a potential new bundled payment program, introducing two important evolutions in the use of bundled payments.

First, the RFI signals Medicare’s interest in expanding the application of bundling from inpatient to outpatient care. To date, Medicare’s bundled payment programs—including both the Acute Care Episode Demonstration and Bundled Payments for Care Improvement (BPCI) Initiative—have primarily focused on inpatient care.

Second, the RFI shifts the focus of bundling from institutions to individual physicians. BPCI, for example, is structured around use of hospitals and post-acute services. CMMI’s new RFI focuses specifically on specialty practitioners, noting that one objective of a future outpatient bundling pilot would be "to improve the effectiveness and efficiency of specialty care, in part by clarifying the specialist practitioner’s clinical role."

CMMI is currently requesting feedback on the potential development of two different types of outpatient specialty bundles: procedures and complex chronic care. CMMI appears open to bundled payment proposals for a wide range of specialty services except for medical oncology, as a separate model is under development for medical oncologists.

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A new look at how 25% of Pioneer ACOs reduced cost growth

February 10, 2014

Tom Liu

CMS recently released a new evaluation of the Pioneer ACOs' early performance, which put gross savings at $146.9M—nearly double the initial estimate of $87.6M last summer.

But why the discrepancy? And how did the Pioneers generate these savings?

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Where the Medicare ACOs are, 2014 edition

Rob Lazerow February 3, 2014

On Thursday, CMS released the first results from the Medicare Shared Savings Program (MSSP), announcing the performance of the 114 organizations that joined the program in 2012.

Nearly half of the 2012 ACOs—54 out of 114—successfully reduced spending for attributed beneficiaries below their expenditure target. However, only 29 of the ACOs generated enough savings to qualify for shared savings bonuses. These top-performing ACOs earned $126 million in shared savings payments. Overall, the 2012 ACOs generated $128 million in net savings for CMS.

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What's your provider identity?

January 7, 2014

Sarah Gabriel

Thanks to the 88 member organizations that participated in our accountable payment survey earlier this year, we're able to share trends on the pacing of risk-based contract adoption, which payers providers plan to contract with, and now, the projected revenue distribution among the different contract types.

Although close to 80% of revenue comes from fee-for-service today, the majority of an average provider’s revenue will likely come from a risk-based arrangement in ten years.

After digging deeper though, we noticed clear differences in providers’ ultimate destinations. Respondents’ plans for transiting to risk-based payment tended to fall into four distinct groups, ranging from maintaining volume incentives to living in two worlds.

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Mortality rates are only one of many VBP changes to come

December 4, 2013

Eric Fontana

You may have seen the recent analysis from Kaiser Health News that roughly 1,500 hospitals will receive penalties in the second year of Medicare's Value-Based Purchasing (VBP) Program.

A significant challenge for many organizations was the introduction of new mortality measures for heart attacks, heart failure, and pneumonia—which accounted for 25% of the Total Performance Score (TPS).

But the changes don't stop there. In FY 2015, 20% of your TPS will be based on spending per beneficiary, CMS's first and only care efficiency measure in the program to date.

Your organization's performance on measures under the outcomes and care efficiency domains matters more each year.

Here's a close look at the new metrics coming your way—and how to tackle them before the program hits its maximum penalty of 2% in FY 2017.

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