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ICYMI: Notes from the field for July 2020

DATE: July 31, 2020

A spike in COVID-19 cases following the loosening of restrictions in some parts of the country is keeping the spotlight on the pandemic, while many in the healthcare industry are alarmed by the dramatic reduction in demand for care for other acute and chronic conditions. Another likely effect of the pandemic is the acceleration of the move from fee-for-service to value-based care models. Here are the stories that caught our eye this month.

COVID-19 pandemic

What are the effects of COVID-19 on care volumes and alternative payment models? How can APMs be structured to prepare for future disease outbreaks? The changes in practice patterns may offer an opportunity to better assess the value of some care, according to this Health Affairs blog.

In response to COVID-19, CMS is offering new flexibilities for its bundled payment programs. Read our breakdown of the options in Managed Healthcare Executive.

The pandemic is also increasing costs to providers, prompting the American Medical Group Association to ask CMS to modify the Medicare Shared Savings Program and extend the program’s 2021 application deadline. No word from CMS yet on if they’ll consider it.

Value-based care

One of the top causes for the financial challenges that many providers are currently facing is the fee-for-service payment model, according to this InterSystems blog post. Providers participating in risk-based contracts or capitated payment models are still struggling, although they are faring better than their FFS peers.

The Medicare Access and CHIP Reauthorization Act of 2015 hasn’t achieved its potential, according to the authors of a Bloomberg Law Op/Ed. They suggest rethinking Medicare’s APM incentives and offer specific policy suggestions to restructure thresholds and improve the APM experience for participants.

The healthcare industry will need to see a significant increase in participation in APMs by specialists before the move away from fee-for-service gains more momentum. This blog post in Health Affairs offers a multi-stakeholder perspective on considerations for condition-based APMs.

The chief operating officer of Southwestern Health Resources in Texas discussed the organization’s emphasis on value-based care and the transformation of the care delivery system in this interview with Modern Healthcare.

The deadline for Bundled Payments for Care Improvement Advanced episode selection is approaching. Our video, BPCI Advanced Episode Selection, discusses four key steps toward picking the right episodes.

While hospitals and physicians can benefit from a bundled payment program, achieving optimal results depends on several factors — including patient optimization. Learn more on OrthopedicsToday.

Medicare bundles lead to some hospital savings, but mortality rates stay flat, according to a study that examined bundles for four common medical conditions. Researchers compared 226 hospitals that participate in the bundled payment programs with 700 that don’t.

CMS released a report on risk-based bundled payment. What does the analysis of data from the first six months of BPCI Advanced tell us? Effective episode design is critical.

A network of nonprofit hospices in California is preparing to enter into value-based payment programs. Learn more about the steps the hospices are taking.

Other news

Where do you stand in BPCI-A participation? Our new BPCI-A tools give provider organizations a clear comparison of their participation to national and regional trends. Learn more on NewKerala.com.

CMS has proposed a new rule updating rates and payment policies for dialysis. Here is what you need to know.