Where’s the Value in MACRA?
By DAVID INTROCASO
The intent of Title I of the 2015 Medicare Access and CHIP Reauthorization Act (MACRA) is to improve care quality and reward value. 1 Tying an increasing percent of Medicare fee for service payments to quality or value through alternative payment models such as Accountable Care Organizations (ACOs) is also Department of Health and Human Services Secretary Sylvia Burwell’s goal. 2 However, in the proposed MACRA rule published in May, CMS will measure and score quality and resource use or spending independently. 3 CMS will not measure outcomes in relation to spending. CMS will not measure for...
Source: The Health Care Blog - June 23, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
Understanding the True Costs of ACOs and Medical Homes
By KIP SULLIVAN
One of the privileges of being a managed care advocate is that you never have to discuss the unpleasant question of how much your proposed intervention will cost. Whether your proposed intervention is HMOs, report cards, pay-for-performance, ACOs, “medical homes,” or electronic medical records, you never have to estimate what your bright idea will cost. With this privilege comes another: You are free to criticize doctors and hospitals for being “cost unconscious.”
Over the last decade, CMS has become a proponent of this double standard – cost consciousness for doctors and hospitals and cost uncons...
Source: The Health Care Blog - June 22, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
All Risk is Local
By JEFF GOLDSMITH and BRUCE HENDERSON
We all knew how this was going to go, or thought we did. Fee-for-service payment for health services was going to disappear, and be replaced by population health risk-based payment (or as some term it, “capitation”- fixed payment for each enrolled life). Hospitals and care systems invested substantial time and dollars building capacity to manage the health of populations, yet many are discovering a shortage of actual revenues for this complex new activity. Was population health a mirage, or an actual opportunity for hospitals, physicians and health systems?
The historic...
Source: The Health Care Blog - June 16, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized ACO Affordable Care Act Jeff Goldsmith risk Source Type: blogs
CMMI’s New Comprehensive Primary Care Plus: Its Promise And Missed Opportunities
The Center for Medicare and Medicaid Innovation (CMMI, or “the Innovation Center”) recently announced an initiative called Comprehensive Primary Care Plus (CPC+). It evolved from the Comprehensive Primary Care (CPC) initiative, which began in 2012 and runs through the end of this year. Both initiatives are designed to promote and support primary care physicians in organizing their practices to deliver comprehensive primary care services. Comprehensive Primary Care Plus has some very promising components, but also misses some compelling opportunities to further advance payment for primary care services.
The earlier init...
Source: Health Affairs Blog - May 31, 2016 Category: Health Management Authors: Paul B. Ginsburg, Margaret Darling and Kavita Patel Tags: Costs and Spending Insurance and Coverage Payment Policy Quality ACOs Alternative Payment Models CMMI Comprehensive Primary Care Plus PCMHs Source Type: blogs
Big Bureaucracies Beget Bad Behavior
One of the problems with big government is that it stimulates the worst sort of behavior from people and attracts legions of cheaters on the inside and outside.
On the outside, the more than 2,300 federal subsidy programs are under constant assault by dishonest individuals, businesses, and criminal gangs. The improper payment rates for the earned income tax credit and school breakfast programs, for example, are more than 20 percent. Medicare and Medicaid are ripped off by tens of billions of dollars a year. It’s a sad reality that when the government dangles free money, millions of people will falsify application forms t...
Source: Cato-at-liberty - May 27, 2016 Category: American Health Authors: Chris Edwards Source Type: blogs
Understanding How Payment And Benefit Designs Work Together In Health Care
There is a lot of commotion around payment reform, with a proliferation of ways to pay health care providers and many different definitions of similar terms. This has led to efforts by experts and stakeholders in health care to define or classify payment methods — e.g. Harold Miller’s Payment Reform Glossary and the Learning and Action Network’s Framework. However, none of these has both defined and critically analyzed the various payment methods, or examined how they may interact with each other as well as the insurance benefit designs to which providers’ patients are subject.
Speaking of benefit designs, they...
Source: Health Affairs Blog - May 25, 2016 Category: Health Management Authors: Suzanne Delbanco, Robert Berenson, Divvy Upadhyay and Roslyn Murray Tags: Costs and Spending Featured Medicaid and CHIP Medicare Payment Policy ACOs Alternative Payment Models Catalyst for Payment Reform Payment Reform Landscape Source Type: blogs
The High Cost of Obama's Overtime Edict
The Obama administration this week announced final regulations doubling the salary threshold (from $23,660 to $47,476) at which most employers must pay time-and-a-half overtime to white-collar workers, and indexing future thresholds to advances in the wage level. Employees 25-34 and those with a bachelor’s degree are expected to be the most heavily affected groups; among sectors expected to be hard hit are not only retail chains, restaurants, and small businesses that hire on-site managers, but also colleges and even food co-ops.
As colleague Jeffrey Miron observed in this space on Wednesday, the notional pay...
Source: Cato-at-liberty - May 20, 2016 Category: American Health Authors: Walter Olson Source Type: blogs
The American College of Cardiology Scientific Session on MACRA
The American College of Cardiology recently held the 65th Annual Scientific Session and Expo, where several sessions focused on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). During the session it was clear that CMS's intention was to only accept ACO's that accept risk in the APM model payments.
Piecing Together the MACRA Puzzle
One session, entitled Piecing Together the MACRA Puzzle, was hosted by Robert Furno, Nancy Foster, and Harold Miller. This session started out with a broad overview of the MACRA program, followed by a presentation on how hospitals are preparing for MACRA, and then a presentat...
Source: Policy and Medicine - May 12, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
“Medical homes” aren’t cutting Medicare costs
Conclusion
I have described three reasons why MedPAC’s pessimistic assessment of the PCMH as an APM prototype is correct: Medicare’s PCMH demos are showing that PCMHs cannot cut Medicare costs and are having little impact on quality; PCMHs are expensive, and are probably costing doctors more than they are getting back in the form of “care management fees” and “shared savings”; and PCMHs can add to the emotional stress that is already at epidemic levels among physicians.
For all these reasons, we may conclude that the PCMH cannot play the role of an APM under MACRA. But that doesn’t mean CMS won’t force the ...
Source: The Health Care Blog - May 5, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
Who Benefits? - Hospital Profits and Quality May Fall, But Hospital Executives' Compensation Keeps Rising
Conclusion - Change Will be ResistedSo even when non-profit hospitals and hospital systems perform poorly, their executives continue to receive ever greater remuneration. The executives, their public relations flacks, and their often compliant boards of trustees continue to cite the same stale talking points to justify their pay. Yet these talking points are based on market fundamentalist theory and business school dogma whose credibility is increasingly challenged. In the absence of anyone willing to confront them with these criticisms, the apologists for soaring health care executive pay continue to pra...
Source: Health Care Renewal - May 2, 2016 Category: Health Management Tags: boards of trustees executive compensation hospital systems hospitals Lahey health market fundamentalism MetroHealth Medical Center pay for performance Source Type: blogs
Who Benefits? - Hospital Profits and Quality May Fall, But Hospital Executives' Compensation Keeps Rising
Conclusion - Change Will be Resisted < /b > < br / > < br / > So even when non-profit hospitals and hospital systems perform poorly, their executives continue to receive ever greater remuneration. & nbsp; The executives, their public relations flacks, and their often compliant boards of trustees continue to cite the same stale talking points to justify their pay. & nbsp; Yet these talking points are based on market fundamentalist theory and business school dogma whose credibility is increasingly challenged. & nbsp; In the absence of anyone willing to confront them with these criticisms, the apologists for soaring health ca...
Source: Health Care Renewal - May 2, 2016 Category: Health Management Tags: boards of trustees executive compensation hospital systems hospitals Lahey health market fundamentalism MetroHealth Medical Center pay for performance Source Type: blogs
The ACO Delusion
By ANISH KOKA, MD
Accountable care organizations (ACO’s) promise to save us. Dreamed up by Dartmouth’s Eliot Fisher in 2006, and signed into law as a part of the Patient Protection and Affordable Care Act (PPACA) in 2010, we have been sold on the idea that this particular incarnation of the HMO/Managed Care will save the government, save physicians and save patients all at the same time. I dare say that Brahma, Vishnu and Shiva together would struggle to accomplish those lofty goals. Regardless of the daunting task in front of them, the brave policy gods who see patients about as often as they see pink...
Source: The Health Care Blog - April 25, 2016 Category: Consumer Health News Authors: John Irvine Tags: THCB Uncategorized ACO Anish Koka Source Type: blogs
How School Districts Resist Reform: Newark Edition
Today, the Library of Law and Liberty is carrying my review of Dale Russakoff’s book, The Prize: Who’s in Charge of America’s Schools?, which explored the impact of Mark Zuckerberg’s $100 million gift to Newark’s district school system. Years later, it had little to show for it. At times The Prize reads like a comedy of errors, but given what was at stake, it was really a tragedy. But it didn’t have to be.
Zuckerberg’s gift was matched by other philanthropists and foundations, but even $200 million wasn’t enough to bring the “transformational” changes that reformers desired. The bureaucracy was ju...
Source: Cato-at-liberty - April 12, 2016 Category: American Health Authors: Jason Bedrick Source Type: blogs
Physician Payment Sunshine: Canadian Style
According to a report, 10 Canadian-based firms have agreed to divulge the amount of money they give to physicians and health organizations every year. They say the voluntary program should make the financial ties between pharma and medicine more visible – and help "neutralize" charges of conflict of interest. The firms plan to start publishing statistics on their overall payments to health professionals next year, though will stop short of releasing figures for individual physicians, as now required in the United States.
The program was started by GlaxoSmithKline Canada (GSK) and has been endorsed by Innovative Medicin...
Source: Policy and Medicine - April 11, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
Make sure you know who signs your doctor’s paycheck
You have a persistent cough and poor appetite, but for six months your doctor has prescribed an assortment of antibiotics after an initial chest x-ray showed a small pneumonia. Finally, short of breath, you go to the emergency room where a CT scan reveals untreatable lung cancer. Later you find your doctor has received a bonus from your HMO insurer for not ordering a CT scan earlier.
Physicians count on experience to pursue patient symptoms, but does dangling a bonus suppress their learned instinct from medical school and residency training? Ethically, is it also a violation of the Hippocratic Oath to do no harm if the bon...
Source: Kevin, M.D. - Medical Weblog - March 28, 2016 Category: Journals (General) Authors: Gene Uzawa Dorio, MD Tags: Physician Primary care Source Type: blogs
