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From Health Law Daily, January 26, 2015

Goals and timeline set for achieving value-based Medicare reimbursement

By Harold M. Bishop, J.D.

HHS Secretary Burwell has announced two goals, each with a clear timeline, for moving from volume to quality and value in determining Medicare fee-for-service payments to providers. Burwell hopes that the implementation of these goals will result in a Medicare payment system that will deliver better care to patients, while spending the nation’s health care dollars more wisely.

Goal No. 1: Alternative payment model. The first goal is for all Medicare provider payments to use alternative payment models tied to the quality of the care they provide to their patients, rather than how much care they provide. Burwell wants 30 percent of providers to use these alternative payment models by 2016, and for 50 percent to use them by 2018.

The Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) created a number of new alternative payment models that reward quality. In her announcement, Burwell noted three current examples of these ACA-payment models that put quality of care first:

  • Through Accountable Care Organizations, providers partner together on a patient’s care and are rewarded for delivering better care while spending less.

  • In the Patient-Centered Medical Home model, instead of doctors working separately in their own siloes, care coordinators oversee all the care a patient is getting. This means patients are more likely to get the right tests and medications rather than getting duplicative tests, procedures, etc.

  • In the “bundled payment” model, providers are reimbursed together for the entire cost of what’s called an “episode of care” – such as a hip replacement. As such, lab tests, pre-visits, hip replacements, etc. are all paid for in the same lump sum, regardless of whether the same test is conducted once, twice or five times. 

Goal No. 2: Quality and value. Burwell’s second goal is for practically all Medicare fee-for-service payments to be tied to quality and value. Burwell wants at least 85 percent of all traditional Medicare payments tied to quality or value by 2016, and 90 percent by 2018, through programs such as the Hospital Value-Based Purchasing and the Hospital Readmissions Reduction Programs.

Learning and Action Network. To achieve these goals, Burwell also has announced the creation of a Health Care Payment Learning & Action Network to facilitate a public-private sector partnership.  The first meeting of the network will be held in March 2015. The Learning and Action Network will work with private payers, employers, consumers, providers, states, state Medicaid programs, and other partners to expand alternative payment models into their programs. 

Benefits. Burwell believes that by reaching these goals a variety of shareholders will benefit, including doctors, employers, workers, and the country as a whole. First, doctors will benefit by realigning the practice of medicine with the best ideals of the profession and by simplifying the business side of their practices.

Second, businesses and their workers will benefit through slowing the historic growth in health care costs. This will allow employers to reinvest their savings in higher quality care for their employees.

These goals are intended to make the country more competitive in the global economy.

MainStory: TopStory ReimbursementNews HealthCareReformNews ACONews IPPSNews CMSNews BillingNews CoPNews MedicaidPaymentNews OPPSNews PaymentNews PhysicianNews QualityNews

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