Medicare
Unveils Alternative Payment Models
Find the source article here: Christopher Cheney, for
HealthLeaders Media , January 27, 2015 - http://www.healthleadersmedia.com/print/HEP-312576/Medicare-Unveils-Alternative-Payment-Models
Here is the summary:
HHS officials highlight a three-year
payment reform timeline, which calls for boosting fee-for-service Medicare
reimbursements and increasing reimbursements linked to quality and value.
Federal
officials have announced an accelerated effort to use payment reform as a
mechanism to shift Medicare and the broader healthcare industry away from the
fee-for-service model.
3-Year
Timeline
A three-year payment reform timeline is expected to 1) boost the percentage of fee-for-service Medicare reimbursements based on
alternative payment models (APM) and 2) to increase the percentage of all
reimbursements linked to quality and value.
In the
early phase of the payment reform initiative's implementation, APMs will be
limited to three pathways: Medicare's existing accountable care organization
efforts, the Pioneer ACO program and the Medicare Shared Savings Program;
bundled payments; and payment models tied to patient-centered medical homes.
More
ambitious value-based payment models are in the works, including episode-of-care payment for
chronic illnesses and oncology care that will require providers to shoulder a
significant level of cost risk.
The
reform initiative calls for Medicare fee-for-service payments through APMs to
rise from the current 20% level to 30% by the end of 2016. The percentage is
slated to rise to 50% by the end of 2018.
It
additionally calls for the percentage of Medicare payments that are linked to
quality and value to reach 85% by 2016 and 90% by 2018. Existing Medicare
quality and value linked payment programs include the Hospital Value-Based
Purchasing (VBP) program and the Hospital Readmission Reduction Program (HRRP).
Marrying
Value-Based Care Delivery With Value-Based Payment
HHS officials started foreshadowing the Medicare payment reform initiative in
the fall.
In
November, the Centers for Medicare & Medicaid Services released
details about
developing and optimizing APMs, linking fee-for-service payments to quality and
value, Medicare ACO and bundled payment projects, and PCMH models.
A primary goal of the Medicare
payment reform initiative is to develop and enhance the alignment between
value-based healthcare delivery and value-based healthcare payment models.
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