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Alternate payment model

P Maxwell Courtney, David C Markel
With renewed focus on achieving value for patients in total hip and knee arthroplasty, payors, hospitals, and physicians strive to provide quality care while minimizing cost. Large registry datasets have gained popularity in the United States to track implant survivorship and outcomes after joint replacement. Partnerships among surgeons, insurers, and health systems have improved on earlier administrative datasets from Medicare to measure quality and outcomes. Participation in state and national registries can help surgeons and hospitals gain a financial advantage in several insurers' quality programs and alternative payment models...
October 24, 2016: Journal of Knee Surgery
Daniel T Engelman
No abstract text is available yet for this article.
September 24, 2016: Journal of Thoracic and Cardiovascular Surgery
Khaled J Saleh, William O Shaffer
In 2015, the US Congress passed legislation entitled the Medicare Access and CHIP [Children's Health Insurance Program] Reauthorization Act (MACRA), which led to the formation of two reimbursement paradigms: the merit-based incentive payment system (MIPS) and alternative payment models (APMs). The MACRA effectively repealed the Centers for Medicare and Medicaid Services (CMS) sustainable growth rate (SGR) formula while combining several CMS quality-reporting programs. As such, MACRA represents an unparalleled acceleration toward reimbursement models that recognize value rather than volume...
November 2016: Journal of the American Academy of Orthopaedic Surgeons
William J Kassler, Mollie Howerton, Alice Thompson, Elizabeth Cope, Dawn E Alley, Darshak Sanghavi
As Medicare and Medicaid increasingly shift to alternative payment models focused on population-based payments, there is an urgent need to develop measures of population health that can drive health improvement. In response, an assessment and design project established a framework for developing population health measures from a payer perspective, conducted environmental scans of existing measures and available data infrastructure, and conducted a gap analysis informing measure development and infrastructure needs...
October 5, 2016: Population Health Management
Rochelle Steven, James C R Smart, Clare Morrison, J Guy Castley
Conservation of biodiversity, including birds, continues to challenge natural area managers. Stated preference methods (e.g. choice experiments - CE) are increasingly used to provide data for natural ecosystem valuations. Here we use a CE to calculate birders' willingness to pay for different levels of bio-ecological attributes (threatened species, endemic species and diversity) of birding sites, with hypothetical entry fees. The CE was delivered at popular birding and avitourism sites in Australia and the United Kingdom...
October 3, 2016: Conservation Biology: the Journal of the Society for Conservation Biology
Mariétou H Ouayogodé, Carrie H Colla, Valerie A Lewis
BACKGROUND: Medicare's Accountable Care Organization (ACO) programs introduced shared savings to traditional Medicare, which allow providers who reduce health care costs for their patients to retain a percentage of the savings they generate. OBJECTIVE: To examine ACO and market factors associated with superior financial performance in Medicare ACO programs. METHODS: We obtained financial performance data from the Centers for Medicare and Medicaid Services (CMS); we derived market-level characteristics from Medicare claims; and we collected ACO characteristics from the National Survey of ACOs for 215 ACOs...
September 27, 2016: Healthcare
Benjamin P Falit, Hubert Y Pan, Benjamin D Smith, Brian M Alexander, Anthony L Zietman
Examinations of the US radiation oncology workforce offer inconsistent conclusions, but recent data raise significant concerns about an oversupply of physicians. Despite these concerns, residency slots continue to expand at an unprecedented pace. Employed radiation oncologists and professional corporations with weak contracts or loose ties to hospital administrators would be expected to suffer the greatest harm from an oversupply. The reduced cost of labor, however, would be expected to increase profitability for equipment owners, technology vendors, and entrenched professional groups...
November 1, 2016: International Journal of Radiation Oncology, Biology, Physics
Laxmaiah Manchikanti, Standiford Helm Ii, Ramsin M Benyamin, Joshua A Hirsch
UNLABELLED: The Merit-based Incentive Payment System (MIPS) was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to improve the health of all Americans by providing incentives and policies to improve patient health outcomes. MIPS combines 3 existing programs, Meaningful Use (MU), now called Advancing Care Information (ACI), contributing 25% of the composite score; Physician Quality Reporting System (PQRS), changed to Quality, contributing 50% of the composite score; and Value-based Payment (VBP) system to Resource Use or cost, contributing 10% of the composite score...
September 2016: Pain Physician
Thomas C Tsai, Felix Greaves, Jie Zheng, E John Orav, Michael J Zinner, Ashish K Jha
US policy makers are making efforts to simultaneously improve the quality of and reduce spending on health care through alternative payment models such as bundled payment. Bundled payment models are predicated on the theory that aligning financial incentives for all providers across an episode of care will lower health care spending while improving quality. Whether this is true remains unknown. Using national Medicare fee-for-service claims for the period 2011-12 and data on hospital quality, we evaluated how thirty- and ninety-day episode-based spending were related to two validated measures of surgical quality-patient satisfaction and surgical mortality...
September 1, 2016: Health Affairs
Camille Haycock, Michelle L Edwards, Christopher S Stanley
The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule that details a consolidated pay-for-performance provider payment system within the Medicare Access and CHIP Reauthorization Act. This proposed rule establishes policy for the new provider Merit-Based Incentive System and Alternative Payment Models. While the rule is extremely complex, and not yet finalized, there are significant implications for nursing and advanced practice providers. This proposed rule intends to drastically change the current provider payment system and reward providers who demonstrate better quality outcomes at a lower cost...
October 2016: Nursing Administration Quarterly
Danny R Hughes, Miao Jiang, Geraldine McGinty, Sanjay K Shetty, Richard Duszak
PURPOSE: In an effort to curb health care costs and improve the quality of care, bundled payment models are becoming increasingly adopted, but to date, they have focused primarily on treatment episodes and primary care providers. To achieve current Medicare goals of transitioning fee-for-service payments to alternative payment models, however, a broader range of patient episodes and specialty physicians will need opportunities to participate. The authors explore breast cancer screening episodes as one such opportunity...
August 17, 2016: Journal of the American College of Radiology: JACR
Jesse M Pines, Frank McStay, Meaghan George, Jennifer L Wiler, Mark McClellan
Current alternative payment models (APMs) that move away from traditional fee-for-service payment often have explicit goals to reduce utilization in episodic settings, such as emergency departments (ED). We apply the new HHS payment reform taxonomy to illustrate a pathway to success for EDs in APMs. Despite the unique challenges faced by EDs, a variety of category 2 and 3 APMs may be applicable to EDs in the short- and long term to improve efficiency and value. Full and partially capitated models create incentives for longitudinal and episodic ED providers and payers to unite to create interventions to reduce costs...
August 2016: American Journal of Managed Care
Elizabeth A Stuart, Colleen L Barry, Julie M Donohue, Shelly F Greenfield, Kenneth Duckworth, Zirui Song, Elena M Kouri, Cyrus Ebnesajjad, Robert Mechanic, Michael E Chernew, Haiden A Huskamp
BACKGROUND AND AIMS: Global payment and accountable care reform efforts in the US may connect more individuals with substance use disorders (SUD) to treatment. We tested whether such changes instituted under an 'Alternative Quality Contract' (AQC) model within the Blue Cross Blue Shield of Massachusetts' (BCBSMA) insurer increased care for individuals with SUD. DESIGN: Difference-in-differences design comparing enrollees in AQC organizations with a comparison group of enrollees in organizations not participating in the AQC...
August 12, 2016: Addiction
P Maxwell Courtney, James I Huddleston, Richard Iorio, David C Markel
BACKGROUND: Alternative payment models, such as bundled payments, aim to control rising costs for total knee arthroplasty (TKA) and total hip arthroplasty (THA). Without risk adjustment for patients who may utilize more resources, concerns exist about patient selection and access to care. The purpose of this study was to determine whether lower socioeconomic status (SES) was associated with increased resource utilization following TKA and THA. METHODS: Using the Michigan Arthroplasty Registry Collaborative Quality Initiative database, we reviewed a consecutive series of 4168 primary TKA and THA patients over a 3-year period...
July 16, 2016: Journal of Arthroplasty
Jack Homer, Bobby Milstein, Gary B Hirsch, Elliott S Fisher
Leaders across the United States face a difficult challenge choosing among possible approaches to transform health system performance in their regions. The ReThink Health Dynamics Model simulates how alternative scenarios could unfold through 2040. This article compares the likely consequences if four interventions were enacted in layered combinations in a prototypical midsize US city. We estimated the effects of efforts to deliver higher-value care; reinvest savings and expand global payment; enable healthier behaviors; and expand socioeconomic opportunities...
August 1, 2016: Health Affairs
(no author information available yet)
No abstract text is available yet for this article.
May 15, 2015: American Family Physician
Jesse M Pines, Joshua B Stierwalt
The 2014 Maryland Medicare Waiver alters the reimbursement model by transitioning from fee-for-service to global payments for hospitals. This increases the need for hospital-based emergency departments to become more cost-conscious, particularly regarding high-cost imaging and admission decisions. Evidence based medicine offers a potential solution to achieve these aims. Development and use of validated clinical decision rules and care pathways can reduce unnecessary testing and reduce hospital admissions where a patient could be treated as an outpatient...
2015: Maryland Medicine: MM: a Publication of MEDCHI, the Maryland State Medical Society
Steven A Farmer, Joel Shalowitz, Meaghan George, Frank McStay, Kavita Patel, James Perrin, Ali Moghtaderi, Mark McClellan
BACKGROUND AND OBJECTIVES: Payers are implementing alternative payment models that attempt to align payment with high-value care. This study calculates the breakeven capitated payment rate for a midsize pediatric practice and explores how several different staffing scenarios affect the rate. METHODS: We supplemented a literature review and data from >200 practices with interviews of practice administrators, physicians, and payers to construct an income statement for a hypothetical, independent, midsize pediatric practice in fee-for-service...
August 2016: Pediatrics
Ezequiel Silva, Geraldine B McGinty, Danny R Hughes, Richard Duszak
The Medicare Access and CHIP Reauthorization Act (MACRA) replaces the sustainable growth rate with a payment system based on the Merit-Based Incentive Payment System and incentives for alternative payment model participation. It is important that radiologists understand the statutory requirements of MACRA. This includes the nature of the Merit-Based Incentive Payment System composite performance score and its impact on payments. The timeline for MACRA implementation is fairly aggressive and includes a robust effort to define episode groups, which include radiologic services...
July 14, 2016: Journal of the American College of Radiology: JACR
Ezequiel Silva, Geraldine B McGinty, Danny R Hughes, Richard Duszak
The passage of the Medicare Access and CHIP Reauthorization Act (MACRA) replaces the sustainable growth rate with a payment system based on quality and alternative payment model participation. The general structure of payment under MACRA is included in the statute, but the rules and regulations defining its implementation are yet to be formalized. It is imperative that the radiology profession inform policymakers on their role in health care under MACRA. This will require a detailed understanding of prior legislative and nonlegislative actions that helped shape MACRA...
July 13, 2016: Journal of the American College of Radiology: JACR
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