In order for the Medicare Shared Savings Program to reach its full potential, some key changes must be made, according to the authors in a recent Health Affairs blog post. Medicare ACOs have made progress on care quality and patient experience, however, only 1 in 4 MSSP ACOs have cut spending enough to share in overall savings.
According to authors in Health Affairs, the Medicare Shared Savings Program needs to make the following changes to truly thrive:
- Increased certainty: A major issue with MSSPs is uncertainty. In order to correct this, CMS should transition to a benchmark calculation formula that combines ACOs’ historical spending and regional spending to eventually transition to a benchmark based completely on regional spending.
- Clear definition of the transition away from fee-for-service: CMS should drive the transition with incentives greater than those for fee-for-service for organizations that demonstrate reduced costs and improved quality.
- Alignment of MSSP with other Medicare reimbursement programs: In order to get MSSP and other Medicare alternative payment models on the same page, the authors recommend risk adjustment calculations, reporting mechanisms and requirements, and consistent quality measures.
- Patient engagement: ACOs need more support to communicate and engage with their patients. The authors suggest expanding CMS’ pilot program for Pioneer ACOs’ “attestation models.”
- Use of pointers from commercial ACOs: Many ACOs in the private sector have seen more success than those under Medicare by shifting away from fee-for-service with limited financial risk. CMS “should seek to reinforce those successful steps.”
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The Medicare Payment Advisory Commission (MedPAC) has recently been examining hospitals’ increased use of “observation status” and its effects on beneficiaries and other stakeholders. MedPAC has referenced possible policy changes that could help offset increased costs resulting from hospital short-stay policy recommendations. One of the options under consideration that was discussed was the expansion of the post-acute hospital transfer policy to include “early” discharges to hospice care. The extension of the post-acute transfer policy to include hospice was examined by HHS and the OIG in a May report. Click here to see it.
In its March meeting, MedPAC indicated that rather than considering a recommendation on including hospice in the post-acute transfer policy at this time, it instead intends to explore the issue in more depth as part of future meetings before issuing a recommendation.
NAHC has expressed concern about extension of the post-acute transfer policy to hospice in its discussions with MedPAC. NAHC believes that election of hospice care represents a decision to forego curative care, and that post-acute care discharge to hospice represents a “shift in focus of treatment” that would create a financial incentive for hospitals to retain patients on care. Click here to read NAHC’s full letter to MedPAC.
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CMS is extending the deadline for its long-term and post-acute care (LTPAC) health IT survey. The survey applies to home health and hospice providers, and offers an opportunity to share the challenges and opportunities associated with health IT implementation. They survey period for the voluntary LTPAC EHR survey has been extended to April 3, 2015.
Click here to participate in the survey.
Click here to read more from NAHC.