ICYMI: Notes from the field for August 2019

DATE: 09/10/2019

While many folks took some time off for vacation, the healthcare industry kept churning. It was a hot summer for news from CMS and we saw a number of responses from those impacted by proposed changes, new pilots and updated models. Here’s an end-of-summer recap.

New from CMS: Technology pilot and proposed bundled payment models

  • New bundled payment model: CMS proposed a mandatory radiation oncology bundled payment model that aims to improve the quality of care for cancer patients undergoing radiotherapy treatment and reduce provider burden. But, how will providers get paid?
  • Have you begun to address your data gaps? CMS launched a pilot program that aims to fill in provider information gaps by enabling access to patients’ claims data in their workflow. “Technology, coupled with open data sharing, is how we will improve value, control costs, and keep patients healthy while ensuring a solvent Medicare program for generations to come,” said Seema Verma, CMS administrator.
  • A bundle for treating opioid addiction: In an effort to fight back against the opioid epidemic, CMS recently recommended creating new bundled episodes of care for treatment of opioid use disorders. This effort will hopefully continue the trend of expanding access to care for the skyrocketing number of people struggling with addiction.

The move toward value-based care continues, but there’s still debate over the future of healthcare delivery

  • The future of the Affordable Care Act: Nearly 10 years after being passed, debate over the ACA continues. An upcoming ruling by the federal appeals court could have a major impact on the future of the program. Read more about what you should know about it.
  • The “one foot in each boat” issue: Embracing value-based initiatives continues to be critical for hospitals, medical groups and health system leaders. Even though the majority of revenue now comes from fee-for-service reimbursement, investing in value-based programs can drive real dividends.
  • CMS and physicians at odds: Major medical associations are concerned about the proposed 2020 changes to the physician fee schedule under the Medicare program announced on July 29 — and they’re pushing back. Could CMS be doing more to meet providers halfway?

Impact studies that may influence the future of healthcare

  • Good news for ACOs: A new study found that the CMS-developed Accountable Care Organization Investment Model (AIM) saved the agency more than $48 million in its first year while promoting improved healthcare in rural and underserved areas. Beyond that, AIM was associated with a $131 million reduction in aggregate Medicare spending.
  • A working model for reducing costs and improving quality: One of the country’s largest, longest-running private payment reform initiatives is also one of the most successful. Under the Alternative Quality Contract payment model, physicians receive a “global” budget rather than payment for each test and office visit. Results show the AQC model slowed the rate of healthcare spending while improving patient care.
  • Interoperability and data sharing: 2019 is proving to be a banner year for improvements in interoperability and information blocking, as the Office of the National Coordinator’s ambitious Trusted Exchange Framework and Common Agreement seeks to set some ambitious rules of the road for data sharing. Critics say it may be overregulating the issue.