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Alternative payment model

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https://www.readbyqxmd.com/read/28414044/the-impact-of-the-medicare-access-and-chip-reauthorization-act-macra-on-the-field-of-ophthalmology
#1
Brenton Kinker, Kaitlyn Dobesh, Nariman Nassiri, Mark S Juzych, M Roy Wilson
PURPOSE: To analyze the impact of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) on the field of ophthalmology. DESIGN: A perspective on the effects of MACRA's Quality Payment Program after analysis of the proposed rule, final rule, and commentary submitted by relevant stakeholders. RESULTS: Physicians will need to use one of two payment structures: Merit Based Incentive Payment Systems (MIPS), or Alternative Payment Models (APMs)...
April 13, 2017: American Journal of Ophthalmology
https://www.readbyqxmd.com/read/28396098/how-alternative-payment-models-in-emergency-medicine-can-benefit-physicians-payers-and-patients
#2
Nir J Harish, Harold D Miller, Jesse M Pines, Richard D Zane, Jennifer L Wiler
While there has been considerable effort devoted to developing alternative payment models (APMs) for primary care physicians and for episodes of care beginning with inpatient admissions, there has been relatively little attention by payers to developing APMs for specialty ambulatory care, and no efforts to develop APMs that explicitly focus on emergency care. In order to ensure that emergency care is appropriately integrated and valued in future payment models, emergency physicians (EPs) must engage with the stakeholders within the broader health care system...
March 14, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28389136/bpci-everyone-wins-including-the-patient
#3
Paul K Edwards, Simon C Mears, C Lowry Barnes
BACKGROUND: Alternative payment models are becoming increasingly more common with the rising cost of the US health care. Bundled payment programs for elective hip and knee arthroplasty have shown promising results by improved outcomes and significant cost reduction. METHODS: All consecutive total joint arthroplasty with diagnosis-related group (DRG) 469/470 were included in this study. And 1427 episodes from 2009 to 2012 were defined as the baseline group; 461 episodes from October 2013 to September 2014 were defined as the Bundled Payments for Care Improvement (BPCI) group...
February 28, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28376520/will-the-fixes-fall-flat-prospects-for-quality-measures-and-payment-incentives-to-control-healthcare-spending
#4
Erik Hauswald, David Sklar
Payment systems in the US healthcare system have rewarded physicians for services and attempted to control healthcare spending, with rewards and penalties based upon projected goals for future spending. The incorporation of quality goals and alternatives to fee-for-service was introduced to replace the previous system of rewards and penalties. We describe the history of the US healthcare payment system, focusing on Medicare and the efforts to control spending through the Sustainable Growth Rate. We describe the latest evolution of the payment system, which emphasizes quality measurement and alternative payment models...
April 2017: Southern Medical Journal
https://www.readbyqxmd.com/read/28375589/health-care-s-other-big-deal-direct-primary-care-regulation-in-contemporary-american-health-law
#5
Glenn E Chappell
Direct primary care is a promising, market-based alternative to the fee-for-service payment structure that shapes doctor–patient relationships in America. Instead of billing patients and insurers service by service, direct primary care doctors charge their patients a periodic, prenegotiated fee in exchange for providing a wide range of healthcare services and increased availability compared to traditional practices. This “subscription” model is intended to eliminate the administrative burdens associated with insurer interaction, which, in theory, allows doctors to spend more time with their patients and less time doing paperwork...
March 2017: Duke Law Journal
https://www.readbyqxmd.com/read/28373336/the-medicare-access-and-chip-reauthorization-act-effects-on-medicare-payment-policy-and-spending
#6
Peter S Hussey, Jodi L Liu, Chapin White
In 2015, Congress repealed the Sustainable Growth Rate formula for Medicare physician payment, eliminating mandatory payment cuts when spending exceeded what was budgeted. In its place, Congress enacted the Medicare Access and CHIP Reauthorization Act (MACRA), which established a two-track performance-based payment system that encourages physicians to participate in alternative payment models. MACRA could have huge effects on health care delivery, but the nature of those effects is highly uncertain. Using the RAND Corporation's Health Care Payment and Delivery Simulation Model, we estimated the effects of MACRA on Medicare spending and utilization and examined how effects would differ under various scenarios...
April 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28373329/substantial-physician-turnover-and-beneficiary-churn-in-a-large-medicare-pioneer-aco
#7
John Hsu, Christine Vogeli, Mary Price, Richard Brand, Michael E Chernew, Namita Mohta, Sreekanth K Chaguturu, Eric Weil, Timothy G Ferris
Alternative payment models, such as accountable care organizations (ACOs), attempt to stimulate improvements in care delivery by better alignment of payer and provider incentives. However, limited attention has been paid to the physicians who actually deliver the care. In a large Medicare Pioneer ACO, we found that the number of beneficiaries per physician was low (median of seventy beneficiaries per physician, or less than 5 percent of a typical panel). We also found substantial physician turnover: More than half of physicians either joined (41 percent) or left (18 percent) the ACO during the 2012-14 contract period studied...
April 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28365040/future-considerations-for-clinical-dermatology-in-the-setting-of-21st-century-american-policy-reform-the-medicare-access-and-children-s-health-insurance-program-reauthorization-act-and-alternative-payment-models-in-dermatology
#8
John S Barbieri, Jeffrey J Miller, Harrison P Nguyen, Howard P Forman, Jean L Bolognia, Marta J VanBeek
With the introduction of the Medicare Access and Children's Health Insurance Program Reauthorization Act, clinicians who are not eligible for an exemption must choose to participate in 1 of 2 new reimbursement models: the Merit-based Incentive Payment System or Alternative Payment Models (APMs). Although most dermatologists are expected to default into the Merit-based Incentive Payment System, some may have an interest in exploring APMs, which have associated financial incentives. However, for dermatologists interested in the APM pathway, there are currently no options other than joining a qualifying Accountable Care Organization, which make up only a small subset of Accountable Care Organizations overall...
March 30, 2017: Journal of the American Academy of Dermatology
https://www.readbyqxmd.com/read/28345144/adapting-evaluations-of-alternative-payment-models-to-a-changing-environment
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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