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Alternative payment model

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https://www.readbyqxmd.com/read/28345144/adapting-evaluations-of-alternative-payment-models-to-a-changing-environment
#1
Thomas W Grannemann, Randall S Brown
OBJECTIVE: To identify the most robust methods for evaluating alternative payment models (APMs) in the emerging health care delivery system environment. STUDY DESIGN (APPROACH): We assess the impact of widespread testing of alternative payment models on the ability to find credible comparison groups. We consider the applicability of factorial research designs for assessing the effects of these models. PRINCIPAL FINDINGS: The widespread adoption of alternative payment models could effectively eliminate the possibility of comparing APM results with a "pure" control or comparison group unaffected by other interventions...
March 27, 2017: Health Services Research
https://www.readbyqxmd.com/read/28338515/surgeon-participation-in-early-accountable-care-organizations
#2
Matthew J Resnick, Amy J Graves, Melinda B Buntin, Michael R Richards, David F Penson
OBJECTIVE: We aimed to characterize the landscape of surgeon participation in early accountable care organizations (ACOs) and to identify specialty-, organization-, and market-specific factors associated with ACO participation. BACKGROUND: Despite rapid deployment of alternative payment models (APMs), little is known about the prevalence of surgeon participation, and key drivers behind surgeon participation in APMs. METHODS: Using data from SK&A, a research firm, we evaluated the near universe of US practices to characterize ACO participation among 125,425 US surgeons in 2015...
March 23, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28333869/macra-a-new-age-for-physician-payments
#3
Kent Kwasind Huston
The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 introduced a new system of physician payments in the United States. This legislation and the complex rules written to enact the law intend to force a shift away from volume-based payments and into so called value-based payments. Physicians and other clinicians will be graded via quality and cost metrics and payments will be adjusted based on performance. Robust use of certified electronic health records is required under MACRA. Physicians will follow one of two payment reform tracks known as the Merit-Based Incentive Payment System (MIPS) and the Alternative Payment Model (APM) pathways...
April 2017: Journal of Clinical Rheumatology: Practical Reports on Rheumatic & Musculoskeletal Diseases
https://www.readbyqxmd.com/read/28332943/effects-of-different-models-of-dialysis-care-on-patient-important-outcomes-a-systematic-review-and-meta-analysis
#4
Priya Ramar, Ahmed T Ahmed, Zhen Wang, Sagar S Chawla, Maria Lourdes Gonzalez Suarez, LaTonya J Hickson, Ann Farrell, Amy W Williams, Nilay D Shah, M Hassan Murad, Bjorg Thorsteinsdottir
Ongoing payment reform in dialysis necessitates better patient outcomes and lower costs. Suggested improvements to processes of care for maintenance dialysis patients are abundant; however, their impact on patient-important outcomes is unclear. This systematic review included comparative randomized controlled trials or observational studies with no restriction on language, published from 2000 to 2014, involving at least 5 adult dialysis patients who received a minimum of 6 months of follow-up. The effect size was pooled and stratified by intervention strategy (multidisciplinary care [MDC], home dialysis, alternate dialysis settings, and electronic health record implementation)...
March 23, 2017: Population Health Management
https://www.readbyqxmd.com/read/28321766/partnering-with-insurers-in-caring-for-the-most-vulnerable-youth-with-diabetes-nich-as-an-integrator
#5
REVIEW
Samantha A Barry, Lena Teplitsky, David V Wagner, Amit Shah, Brian T Rogers, Michael A Harris
PURPOSE OF REVIEW: In this review, we outline barriers to appropriately caring for high-risk youth with diabetes and discuss efforts in partnering with insurers through Alternative Payment Models to achieve the Triple Aim (improved health, improved care, and reduced costs) for this population. RECENT FINDINGS: Current approaches in caring for youth with diabetes who evidence a high degree of social complexity are woefully ineffective. These youth are vulnerable to repeat diabetic ketoacidosis episodes, poor glycemic control, and excessive utilization of healthcare resources...
April 2017: Current Diabetes Reports
https://www.readbyqxmd.com/read/28318863/it-is-a-brave-new-world-alternative-payment-models-and-value-creation-in-total-joint-arthroplasty-creating-value-for-tjr-quality-and-cost-effectiveness-programs
#6
Kevin K Chen, Jonathan H Harty, Joseph A Bosco
BACKGROUND: The increasing cost of our country's healthcare is not sustainable. To address this crisis, the federal government is transiting healthcare reimbursement from the traditional volume-based system to a value-based system. As such, increasing healthcare value has become an essential point of discussion for all healthcare stakeholders. METHODS: The purpose of this study is to discuss the importance of healthcare value as a means to achieve this goal of value-based medicine and 3 methods to create value in total joint arthroplasty...
February 14, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28306149/medicare-access-and-chip-reauthorization-act-what-do-geriatrics-healthcare-professionals-need-to-know-about-the-quality-payment-program
#7
Kathleen T Unroe, Peter A Hollmann, Alanna C Goldstein, Michael L Malone
Commencing in 2017, the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 will change how Medicare pays health professionals. By enacting MACRA, Congress brought an end to the (un)sustainable growth rate formula while also setting forth a vision for how to transform the U.S. healthcare system so that clinicians deliver higher-quality care with smarter spending by the Centers for Medicare and Medicaid Services (CMS). In October 2016, CMS released the first of what stakeholders anticipate will be a number of (annual) rules related to implementation of MACRA...
March 17, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28291598/identifying-radiology-s-place-in-the-expanding-landscape-of-episode-payment%C3%A2-models
#8
Andrew B Rosenkrantz, Joshua A Hirsch, Bibb Allen, H Benjamin Harvey, Gregory N Nicola
The current fee-for-service system for health care reimbursement in the United Stated is argued to encourage fragmented care delivery and a lack of accountability that predisposes to insufficient focus on quality as well as unnecessary or duplicative resource utilization. Episode payment models (EPMs) seek to improve coordination by linking payments for all services related to a patient's condition or procedure, thereby improving quality and efficiency of care. The CMS Innovation Center has implemented a broadening array of EPMs...
March 10, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28272277/value-based-payment-reform-and-the-medicare-access-and-chip-reauthorization-act-macra-of-2015-a-primer-for-plastic-surgeons
#9
Lee Squitieri, Kevin C Chung
In 2015, the U.S. Congress passed the Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act (MACRA), which effectively repealed the Centers for Medicare and Medicaid Services (CMS) sustainable growth rate (SGR) formula and established the CMS Quality Payment Program (QPP). MACRA represents an unparalleled acceleration toward value-based payment models and a departure from traditional volume-driven fee-for-service reimbursement. The QPP includes two paths for provider participation: the merit-based incentive payment system (MIPS) and advanced alternative payment models (APMs)...
March 6, 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28262453/symposium-introduction-it-s-a-brave-new-world-alternative-payment-models-and-value-creation-in-total-joint-arthroplasty
#10
EDITORIAL
Richard Iorio, Kelvin Kim
No abstract text is available yet for this article.
February 14, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28242063/foundational-changes-critical-to-payments-for-radiology-services
#11
Joshua A Hirsch, Andrew B Rosenkrantz, Bibb Allen, Laxmaiah Manchikanti, Gregory N Nicola
In early 2015, Sylvia Burwell, Secretary of the Department of Health and Human Services, described the federal administration's goals for delivery of health care in the United States. Prominently featured was a conversion from volume to value through the incorporation of Alternative Payment Models. The Department of Health and Human Services laid the framework, but recognized significant knowledge gaps in how providers and institutions would develop Alternative Payment Models. To that end, the Health Care Payment Learning and Action Network was conceived...
February 24, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28240631/physician-payment-methods-and-the-patient-centered-medical-home-comment-on-a-troubled-asset-relief-program-for-the-patient-centered-medical-home
#12
Kevin Quinn
This commentary analyzes the patient-centered medical home (PCMH) model within a framework of the 8 basic payment methods in health care. PCMHs are firmly within the fee-for-service tradition. Changes to the process and structure of the Resource Based Relative Value Scale, which underlies almost all physician fee schedules, could make PCMHs more financially viable. Of the alternative payment methods being considered, shared savings models are unlikely to transform medical practice whereas capitation models place unrealistic expectations on providers to accept epidemiological risk...
April 2017: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/28187994/defining-the-value-of-magnetic-resonance-imaging-in-prostate-brachytherapy-using-time-driven-activity-based-costing
#13
Nikhil G Thaker, Peter F Orio, Louis Potters
Magnetic resonance imaging (MRI) simulation and planning for prostate brachytherapy (PBT) may deliver potential clinical benefits but at an unknown cost to the provider and healthcare system. Time-driven activity-based costing (TDABC) is an innovative bottom-up costing tool in healthcare that can be used to measure the actual consumption of resources required over the full cycle of care. TDABC analysis was conducted to compare patient-level costs for an MRI-based versus traditional PBT workflow. TDABC cost was only 1% higher for the MRI-based workflow, and utilization of MRI allowed for cost shifting from other imaging modalities, such as CT and ultrasound, to MRI during the PBT process...
February 7, 2017: Brachytherapy
https://www.readbyqxmd.com/read/28182472/integrating-health-care-for-high-need-medicaid-beneficiaries-with-serious-mental-illness-and-chronic-physical-health-conditions-at-managed-care-provider-and-consumer-levels
#14
Jung Y Kim, Tricia Collins Higgins, Dominick Esposito, Allison Hamblin
OBJECTIVE: Policies supporting value-based care and alternative payment models, notably in the Affordable Care Act and the Medicare Access & CHIP Reauthorization Act of 2015, offer hope to advance care integration for individuals with behavioral and chronic physical health conditions. The potential for integration to improve quality while managing costs for individuals with high needs, coupled with the remaining financial, operational, and policy challenges, underscores a need for continued discussion of integration programs' preliminary outcomes and lessons...
February 9, 2017: Psychiatric Rehabilitation Journal
https://www.readbyqxmd.com/read/28169976/the-impact-of-alternative-payment-in-chronically-ill-and-older-patients-in-the-patient-centered-medical-home
#15
Claudia A Salzberg, Asaf Bitton, Stuart R Lipsitz, Cal Franz, Shimon Shaykevich, Lisa P Newmark, Japneet Kwatra, David W Bates
BACKGROUND: Patient-centered medical home (PCMH) has gained prominence as a promising model to encourage improved primary care delivery. There is a paucity of studies that evaluate the impact of payment models in the PCMH. OBJECTIVES: We sought to examine whether coupling coordinated, team-based care transformation plan with a novel reimbursement model affects outcomes related to expenditures and utilization. RESEARCH DESIGN: Interrupted time-series model with a difference-in-differences approach to assess differences between intervention and control groups, across time periods attributable to PCMH transformation and/or payment change...
February 6, 2017: Medical Care
https://www.readbyqxmd.com/read/28152947/measuring-value-in-bundled-payments-for-head-and-neck-cancer
#16
Tracy E Spinks, Alexis B Guzman, Randal S Weber, Ehab Y Hanna, Amy Clark Hessel, Beth Michelle Beadle, Kate A Hutcheson, James Incalcaterra, Nancy M Wood, Delrose Jones, Thomas W Feeley
11 Background: Value, defined as outcomes relative to costs, cannot be improved without rigorous long-term measurement. To assess value within a bundled payment pilot for head and neck cancer, we aim to generate timely, patient-centered outcomes and robust, near-real time financial tracking (Porter and Teisberg, Redefining health care. Creating value-based competition on results; Harvard Business School Press, 2006). METHODS: Clinical and quality experts created an outcome measure set for head and neck cancer, using a three-tiered outcomes hierarchy from Michael Porter of Harvard Business School as a framework...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152747/connecting-specialty-practices-with-primary-care
#17
Suzanne Morton, Tyler Oberlander, Sarah Hudson Scholle, Michael Barr
47 Background: Public and private payers are beginning to adopt alternative payment structures that call for greater attention to patient-centered care and quality improvement activities (CMMI 2015; MACRA 2015). The National Committee for Quality Assurance (NCQA) developed standards for Patient-Centered Specialty Practice based on American College of Physicians principles. The report describes achievement on the standards among an initial cohort of recognized physicians. METHODS: We analyzed practice characteristics and determined how practices performed on each of the 21 elements in the PCSP program by showing the percent of practices scoring less than 50% of points, or 100% of points (i...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152738/designing-and-implementing-a-payment-system-to-support-cancer-care-coordination-a-literature-review
#18
Chloe Gerves-Pinquie, Etienne Minvielle
40 Background: Demands for new payment systems to better coordinate services along the care continuum are emerging in oncology. Among them, bundling payments for defined episodes of care are considered as a promising payment option. The study objective was to understand how to develop an optimal payment system in order to foster coordination between hospitals and post-acute providers, and to identify potential pitfalls associated with its implementation. METHODS: We conducted a literature review, exploring articles published between 2010 and 2015 in Medline...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28132819/macra-alternative-payment-models-and%C3%A2-the-physician-focused-payment-model-implications-for-radiology
#19
Andrew B Rosenkrantz, Gregory N Nicola, Bibb Allen, Danny R Hughes, Joshua A Hirsch
The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 describes alternative payment models (APMs) as new approaches to health care payment that incentivize higher quality and value. MACRA incentivizes increasing APM participation by all physician specialties over the coming years. Some APMs will be deemed Advanced APMs; clinicians who are a Qualifying Participant in an Advanced APM will receive substantial benefits under MACRA including an automatic 5% payment bonus, regardless of their performance and savings within the APM, and a larger payment rate increase beginning in 2026...
January 26, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28103923/risk-adjustment-methods-for-all-payer-comparative-performance-reporting-in-vermont
#20
Karl Finison, MaryKate Mohlman, Craig Jones, Melanie Pinette, David Jorgenson, Amy Kinner, Tim Tremblay, Daniel Gottlieb
BACKGROUND: As the emphasis in health reform shifts to value-based payments, especially through multi-payer initiatives supported by the U.S. Center for Medicare & Medicaid Innovation, and with the increasing availability of statewide all-payer claims databases, the need for an all-payer, "whole-population" approach to facilitate the reporting of utilization, cost, and quality measures has grown. However, given the disparities between the different populations served by Medicare, Medicaid, and commercial payers, risk-adjustment methods for addressing these differences in a single measure have been a challenge...
January 19, 2017: BMC Health Services Research
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