ICYMI: Notes from the field for September 2020

DATE: September 30, 2020

Six months after the initial lockdowns, COVID-19 continues to exert its grip on the country and the world. Amid this unprecedented crisis, the economy and human behavior are changing rapidly — and that holds true for the healthcare industry as well. Here are some updates from the past month that reflect an industry in the midst of change.

COVID-19 pandemic

COVID-19’s impact on primary care visits — and revenue — was the focus of a webinar summarized by the American Journal of Managed Care. Does CMS need to take a page out of its own playbook and amend policies for primary care physician payments, as it did for Bundled Payments for Care Improvement Advanced?

The pandemic has led to $15 billion in revenue losses for primary care physicians, while direct PCPs report stable revenue and better patient and clinician satisfaction. What does this mean for practices with a substantial population of Medicare or Medicaid patients? Learn more about the downsides to this payment model.

Value-based care

CMS announced major changes to BPCIA to try and mitigate a potential loss of $2 billion. DataGen’s manager of business intelligence analytics discusses the impact in a recent article from the Healthcare Financial Management Association.

To fill in the end-of-life care gap, CMS is adding a hospice component to the Medicare Advantage Value-Based Insurance Design model and rolling out Primary Care First. Will these value-based insurance design additions benefit providers and transform care as intended?

To help organizations understand these new programs, we’ve developed Navigating Alternative Payment Models: A User’s Guide to help you decide which, if any, programs are right for you.

The American College of Cardiology is getting involved in quality measure reporting, partnering with CMS to include National Cardiovascular Data Registry measures in Alternate Quality Measures. Learn how this will reduce the burden on National Cardiovascular Data Registry sites.

PCPs and nephrologists: Are you ready for the new CMS payment models? We’ve put together the key resources and analysis you need to prepare for Primary Care First and Kidney Care First.

CMS completed its third year of net savings from the Medicare Shared Savings Program, as more Accountable Care Organizations took on downside risks. RevCycle Intelligence explains why ACOs are incentivized to participate, why the National Association of ACOs is worried about participation, and how proposed legislation might affect the program.

Pathways to Success, the revised Shared Savings Program, had 205 new participants in 2019, bringing the total to 541 ACOs.  This Modern Healthcare article includes average net savings and other details.

You can get the CMS perspective from this HealthAffairs blog post by Seema Verma, in which she summarizes recent innovations in payment and discusses the 2019 performance results.

Findings by University of Michigan researchers suggest that CMS will end up paying substantial bonuses to hospitals, but it will not be due to meaningful reductions in costs.

Other news

The Medicare Payment Advisory Commission, which advises Congress on Medicare issues, submitted telehealth options to maximize care and minimize risk. Learn more about the possible future of telehealth delivery and payment in this Healthcare IT News article.

After provider organizations and patient advocacy groups raised concerns about unintended consequences, CMS is withdrawing the proposed Medicaid Fiscal Accountability Rule, reports Healthcare Dive.