ICYMI: Notes from the field for July 2019

DATE: 08/07/2019

Here’s what caught our attention in July. What did we miss?

Downside risk and bundled payments

CMS is pushing more payment models with risk but the proportion of accountable care organizations with downside risk has remained largely stagnant.
On the rise: Reimbursement to doctors will increasingly be via bundled payments, ACOs, medical home models and pay-for-performance contracts.
On average, Medicare payments to hospitals participating in the Comprehensive Care for Joint Replacement program appear to be decreasing, compared to hospitals not taking part in the program. The model has achieved nearly $17.4 million in savings.
New policies adopted by the American Medical Association support the creation of alternative payment models that specifically address high-risk and vulnerable populations.

Price transparency and data

Ninety-one percent of hospitals are concerned about the implementation of a CMS rule requiring providers to publish prices. How will the more recent presidential executive order on healthcare price transparency impact healthcare costs? Time will tell.
The push toward interoperability is complicated. The Office of the National Coordinator for Health Information Technology is again asking for public comments for its Interoperability Standards Advisory.

News from CMS

Breaking news: CMS is proposing major policy changes. In the new proposed Merit-based Incentive Payment System framework, beginning in the 2021 performance period, participating clinicians would report on a smaller set of measures that are more specialty-specific.
CMS has named 58 healthcare organizations as Network of Quality Improvement and Innovation Contractors. Can these NQIICs serve as representative change agents for heatlhcare?
CMS announced new numbers for participation in the Pathways to Success program within the Medicare Shared Savings Program for ACOs. While roughly 40 new ACOs have entered the program, this is less than the 100+ new ACOs MSSP averaged in its first seven years.
On July 3, CMS released the Quality Measure Sets for Bundled Payments for Care Improvement-Advanced Model Year 3, which qualifies as an Advanced Alternative Payment Model under the Quality Payment Program.