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Alternative payment model

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https://www.readbyqxmd.com/read/29232073/medicare-program-cancellation-of-advancing-care-coordination-through-episode-payment-and-cardiac-rehabilitation-incentive-payment-models-changes-to-comprehensive-care-for-joint-replacement-payment-model-extreme-and-uncontrollable-circumstances-policy-for-the
#1
(no author information available yet)
This final rule cancels the Episode Payment Models (EPMs) and Cardiac Rehabilitation (CR) Incentive Payment Model and rescinds the regulations governing these models. It also implements certain revisions to the Comprehensive Care for Joint Replacement (CJR) model, including: Giving certain hospitals selected for participation in the CJR model a one-time option to choose whether to continue their participation in the model; technical refinements and clarifications for certain payment, reconciliation and quality provisions; and a change to increase the pool of eligible clinicians that qualify as affiliated practitioners under the Advanced Alternative Payment Model (Advanced APM) track...
December 1, 2017: Federal Register
https://www.readbyqxmd.com/read/29232069/medicare-program-cy-2018-updates-to-the-quality-payment-program-and-quality-payment-program-extreme-and-uncontrollable-circumstance-policy-for-the-transition-year-final-rule-with-comment-period-and-interim-final-rule-with-comment-period
#2
(no author information available yet)
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established the Quality Payment Program for eligible clinicians. Under the Quality Payment Program, eligible clinicians can participate via one of two tracks: Advanced Alternative Payment Models (APMs); or the Merit-based Incentive Payment System (MIPS). We began implementing the Quality Payment Program through rulemaking for calendar year (CY) 2017. This final rule with comment period provides updates for the second and future years of the Quality Payment Program...
November 16, 2017: Federal Register
https://www.readbyqxmd.com/read/29223432/contemporary-risk-model-for-inhospital-major-bleeding-for-patients-with-acute-myocardial-infarction-the-acute-coronary-treatment-and-intervention-outcomes-network-action-registry%C3%A2-get-with-the-guidelines-gwtg-%C3%A2
#3
Nihar R Desai, Kevin F Kennedy, David J Cohen, Traci Connolly, Deborah B Diercks, Mauro Moscucci, Stephen Ramee, John Spertus, Tracy Y Wang, Robert L McNamara
BACKGROUND: Major bleeding is a frequent complication for patients with acute myocardial infarction (AMI) and is associated with significant morbidity and mortality. OBJECTIVE: To develop a contemporary model for inhospital major bleeding that can both support clinical decision-making and serve as a foundation for assessing hospital quality. METHODS: An inhospital major bleeding model was developed using the Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines (ACTION Registry-GWTG) database...
December 2017: American Heart Journal
https://www.readbyqxmd.com/read/29195052/accountability-for-community-based-programs-for-the-seriously-ill
#4
Joan M Teno, Russ Montgomery, Tom Valuck, Janet Corrigan, Diane E Meier, Amy Kelley, J Randall Curtis, Ruth Engelberg
Innovation is needed to improve care of the seriously ill, and there are important opportunities as we transition from a volume- to value-based payment system. Not all seriously ill are dying; some recover, while others are persistently functionally impaired. While we innovate in service delivery and payment models for the seriously ill, it is important that we concurrently develop accountability that ensures a focus on high-quality care rather than narrowly focusing on cost containment. The Gordon and Betty Moore Foundation convened a meeting of 45 experts to arrive at guiding principles for measurement, create a starter measurement set, specify a proposed definition of the denominator and its refinement, and identify research priorities for future implementation of the accountability system...
December 1, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29182351/the-influence-of-provider-characteristics-and-market-forces-on-response-to-financial-incentives
#5
Brock O'Neil, Mark Tyson, Amy J Graves, Daniel A Barocas, Sam S Chang, David F Penson, Matthew J Resnick
OBJECTIVES: Alternative payment models, such as accountable care organizations, use financial incentives as levers for change to facilitate the transition from volume to value. However, implementation raises concerns about adverse changes in market competition and the resultant physician response. We sought to identify physician characteristics and market-level factors associated with variation in response to financial incentives for cancer care that may ultimately be leveraged in risk-shared payment models...
November 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29167886/payment-reform-to-enhance-collaboration-of-primary-care-and-cardiology-a-review
#6
Steven A Farmer, Paul N Casale, Linda D Gillam, John S Rumsfeld, Shari Erickson, Neil M Kirschner, Kevin de Regnier, Bruce R Williams, R Shawn Martin, Mark B McClellan
Importance: The US health care system faces an unsustainable trajectory of high costs and inconsistent outcomes. The fee-for-service payment model has contributed to inefficiency, and new payment methods are a promising approach to improving value. Health reforms are needed to increase patient access, reduce costs, and improve health care quality, and the landmark Medicare Access and CHIP Reauthorization Act presents a roadmap for reform. The product of a collaboration between primary care and cardiology clinicians, this review describes a conceptual approach to delivery and payment reforms that aim to better support primary care-cardiology comanagement of chronic cardiovascular disease (CVD)...
November 22, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/29137554/the-alternative-quality-contract-impact-on-service-use-and-spending-for-children-with-adhd
#7
Nina R Joyce, Haiden A Huskamp, Scott E Hadland, Julie M Donohue, Shelly F Greenfield, Elizabeth A Stuart, Colleen L Barry
In 2009, Blue Cross-Blue Shield of Massachusetts (BCBSMA) implemented the alternative quality contract (AQC), which pays provider organizations a global payment for all services used by enrollees. BCBSMA claims for 2006-2011 were used to compare youths enrolled in provider organizations participating in the AQC (7,407 person-years [PYs]) with those not participating (45,398 PYs). Difference-in-differences models estimated changes in mental health and substance abuse treatment service utilization and spending attributable to the AQC...
November 15, 2017: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/29137503/global-lessons-in-frugal-innovation-to-improve-health-care-delivery-in-the-united-states
#8
Yasser Bhatti, Andrea Taylor, Matthew Harris, Hester Wadge, Erin Escobar, Matt Prime, Hannah Patel, Alexander W Carter, Greg Parston, Ara W Darzi, Krishna Udayakumar
In a 2015 global study of low-cost or frugal innovations, we identified five leading innovations that scaled successfully in their original contexts and that may provide insights for scaling such innovations in the United States. We describe common themes among these diverse innovations, critical factors for their translation to the United States to improve the efficiency and quality of health care, and lessons for the implementation and scaling of other innovations. We highlight promising trends in the United States that support adapting these innovations, including growing interest in moving care out of health care facilities and into community and home settings; the growth of alternative payment models and incentives to experiment with new approaches to population health and care delivery; and the increasing use of diverse health professionals, such as community health workers and advanced practice providers...
November 2017: Health Affairs
https://www.readbyqxmd.com/read/29037365/a-look-ahead-into-advanced-alternative-payment-models-in-vascular-surgery
#9
Taylor A Smith, Jordan Knepper, Karen Woo, Jill Rathbun, Brad Johnson
No abstract text is available yet for this article.
November 2017: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/29033158/revision-total-knee-arthroplasty-for-periprosthetic-joint-infection-is-associated-with-increased-postoperative-morbidity-and-mortality-relative-to-noninfectious-revisions
#10
Venkat Boddapati, Michael C Fu, David J Mayman, Edwin P Su, Peter K Sculco, Alexander S McLawhorn
BACKGROUND: Periprosthetic joint infection (PJI) after primary total knee arthroplasty (TKA) is a devastating complication. The short-term morbidity profile of revision TKA performed for PJI relative to non-PJI revisions is poorly characterized. The purpose of this study is to determine 30-day postoperative outcomes after revision TKA for PJI, relative to primary TKA and aseptic revision TKA. METHODS: The American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2015 was queried for primary and revision TKA cases...
September 23, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29021109/design-and-impact-of-bundled-payment-for-detox-and-follow-up-care
#11
Amity E Quinn, Dominic Hodgkin, Jennifer N Perloff, Maureen T Stewart, Mary Brolin, Nancy Lane, Constance M Horgan
INTRODUCTION: Recent payment reforms promote movement from fee-for-service to alternative payment models that shift financial risk from payers to providers, incentivizing providers to manage patients' utilization. Bundled payment, an episode-based fixed payment that includes the prices of a group of services that would typically treat an episode of care, is expanding in the United States. Bundled payment has been recommended as a way to pay for comprehensive SUD treatment and has the potential to improve treatment engagement after detox, which could reduce detox readmissions, improve health outcomes, and reduce medical care costs...
November 2017: Journal of Substance Abuse Treatment
https://www.readbyqxmd.com/read/28983431/evaluation-of-policy-options-for-increasing-the-availability-of-primary-care-services-in-rural-washington-state
#12
Mark W Friedberg, Grant R Martsolf, Chapin White, David I Auerbach, Ryan Kandrack, Rachel O Reid, Emily Butcher, Hao Yu, Simon Hollands, Xiaoyu Nie
The Washington State legislature has recently considered several policy options to address a perceived shortage of primary care physicians in rural Washington. These policy options include opening the new Elson S. Floyd College of Medicine at Washington State University in 2017; increasing the number of primary care residency positions in the state; expanding educational loan-repayment incentives to encourage primary care physicians to practice in rural Washington; increasing Medicaid payment rates for primary care physicians in rural Washington; and encouraging the adoption of alternative models of primary care, such as medical homes and nurse-managed health centers, that reallocate work from physicians to nurse practitioners (NPs) and physician assistants (PAs)...
January 2017: Rand Health Quarterly
https://www.readbyqxmd.com/read/28983220/similar-cost-savings-of-bundled-payment-initiatives-applied-to-lower-extremity-total-joint-arthroplasty-can-be-achieved-applying-both-models-2-and-3
#13
Allyson Alfonso, Lorraine Hutzler, Bill Robb, Chad Beste, André Blom, Joseph Bosco
BACKGROUND: In an effort to control cost and increase value, Medicare is transitioning from fee-for-service to value-based alternative payment models (APMs). The Bundled Payments for Care Improvement (BPCI) initiative represents one such voluntary APM. BPCI offers four different bundling options: model 1 covers all Diagnosis Related Groups (DRGs) and Models 2-4 cover 48 clinical episodes, including 186 separate DRGs. QUESTIONS/PURPOSES: The purpose of this investigation is to analyze and compare the cost savings achieved by two different BPCI program participants, provider A and provider B, enrolled in different models of BPCI (Models 2 and 3) for lower extremity joint replacements (LEJRs)...
October 2017: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
https://www.readbyqxmd.com/read/28981388/where-are-the-opportunities-for-reducing-health-care-spending-within-alternative-payment-models
#14
Gabrielle B Rocque, Courtney P Williams, Kelly M Kenzik, Bradford E Jackson, Karina I Halilova, Margaret M Sullivan, Rod P Rocconi, Andres Azuero, Elizabeth A Kvale, Warner K Huh, Edward E Partridge, Maria Pisu
PURPOSE: The Oncology Care Model (OCM) is a highly controversial specialty care model developed by the Centers for Medicare & Medicaid aimed to provide higher-quality care at lower cost. Because oncologists will be increasingly held accountable for spending as well as quality within new value-based health care models like the OCM, they need to understand the drivers of total spending for their patients. METHODS: This retrospective cohort study included patients ≥ 65 years of age with primary fee-for-service Medicare insurance who received antineoplastic therapy at 12 cancer centers in the Southeast from 2012 to 2014...
October 5, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28976250/recommendations-from-the-first-national-academic-consortium-of-telehealth
#15
Judd E Hollander, Theresa M Davis, Charles Doarn, Jason C Goldwater, Stephen Klasko, Curtis Lowery, Dimitrios Papanagnou, Peter Rasmussen, Frank D Sites, Danica Stone, Brendan G Carr
In January 2015, the US Secretary of Health and Human Services announced targets for the transformation of Medicare reimbursement from a fee-for-service model to payments based on alternative payment models. People now use technology for virtually everything - from paying bills to purchasing almost anything; it is therefore natural to think that they will use technology to take ownership of their own health care. The remote provision of health care, where providers and patients are not in the same location, will allow patients to receive the right care, at the right time, at the right place, and in the manner they consider right for them...
October 4, 2017: Population Health Management
https://www.readbyqxmd.com/read/28963077/payment-and-care-for-hematopoietic-cell-transplantation-patients-toward-a-specialized-medical-home-for-complex-care-patients
#16
James L Gajewski, Mark B McClellan, Navneet S Majhail, Parameswaran N Hari, Christopher N Bredeson, Richard T Maziarz, Charles F LeMaistre, Michael C Lill, Stephanie H Farnia, Krishna V Komanduri, Michael J Boo
Patient-centered medical home models are fundamental to the advanced alternative payment models defined in the Medicare Access and Children's Health Insurance Plan Reauthorization Act (MACRA). The patient-centered medical home is a model of healthcare delivery supported by alternative payment mechanisms and designed to promote coordinated medical care that is simultaneously patient-centric and population-oriented. This transformative care model requires shifting reimbursement to include a per-patient payment intended to cover services not previously reimbursed such as disease management over time...
September 28, 2017: Biology of Blood and Marrow Transplantation
https://www.readbyqxmd.com/read/28961643/hospital-value-based-purchasing-the-association-between-patient-experience-and-clinical-outcome
#17
D Rob Haley, Hanadi Hamadi, Mei Zhao, Jing Xu, Yi Wang
The Affordable Care Act of 2010 introduced a Hospital Value-Based Purchasing Total Performance Score for payment purposes and to evaluate hospital quality of care. In fiscal year 2016, Total Performance Score was composed of (1) Clinical Processes of Care, (2) Patient Experience of Care, (3) Outcome, and (4) Efficiency domains. The objective of this study was to examine the association between the Patient Experience of Care and Outcome domains. The Donabedian model of structure, process, and outcome was used as a conceptual framework for this study...
October 2017: Health Care Manager
https://www.readbyqxmd.com/read/28956027/the-impact-of-changes-in-medicare-s-physician-payment-system-on-critical-care
#18
Charles E Hobson, Azra Bihorac, Mehrnaz Hadian, Daniel L Herr, Thomas G Rainey, Frank B Cerra, Lena M Napolitano, John W Hoyt
In 2015 President Obama signed the Medicare Access and CHIP Reauthorization Act (MACRA) which repealed the Sustainable Growth Rate (SGR) mechanism for Medicare physician reimbursement and mandated that CMS develop alternative payment methodologies to "reward health care providers for giving better care not more just more care." MACRA makes 3 major changes to Medicare reimbursements: (1) it ends the SGR formula; (2) it establishes a new framework to reward physicians based on performance and health outcomes rather than volume; and (3) it aims to combine existing quality reporting programs into one streamlined system...
February 2017: Critical Connections: the Complete News Source for Critical Care Professionals
https://www.readbyqxmd.com/read/28954711/risk-adjusted-regional-outcomes-in-elective-medicare-colorectal-surgery
#19
Donald E Fry, Susan M Nedza, Michael Pine, Agnes M Reband, Chun-Jung Huang, Gregory Pine
BACKGROUND: Regional differences in utilization of services in healthcare are commonly understood, but risk-adjusted evaluation of outcomes has not been done. METHODS: Risk-adjusted adverse outcomes (AOs) for elective Medicare colorectal resections were studied for 2012-2014. Risk-adjusted metrics were inpatient deaths, prolonged postoperative length-of-stay, 90-day post-discharge deaths, and 90-day relevant post-discharge readmissions. The nine Census Bureau regions of the U...
September 20, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28952981/reporting-from-the-front-lines-implementing-oregon-s-alternative-payment-methodology-in-federally-qualified-health-centers
#20
Erika K Cottrell, Jennifer D Hall, Glenn Kautz, Heather Angier, Sonja Likumahuwa-Ackman, Laura Sisulak, Sara Keller, David C Cameron, Jennifer E DeVoe, Deborah J Cohen
Alternative payment models have been proposed as a way to facilitate patient-centered medical home model implementation, yet little is known about how payment reform translates into changes in care delivery. We conducted site visits, observed operations, and conducted interviews within 3 Federally Qualified Health Center organizations that were part of Oregon's Alternative Payment Methodology demonstration project. Data were analyzed using an immersion-crystallization approach. We identified several care delivery changes during the early stages of implementation, as well as challenges associated with this new model of payment...
September 25, 2017: Journal of Ambulatory Care Management
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