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Push From Volume to Value Continues

As the end of 2015 nears, CMS has used its blog to reflect on its continued efforts to move the U.S. health care system from one that pays for the volume of care provided to one that pays for the value of that care.
The blog notes the replacement of the sustainable growth rate (SGR formula) with a new payment system that better supports patient-centered care; the creation of the Home Health Value-Based Purchasing model; and the introduction of Medicare reimbursement for advance care planning.
cmsThe blog also describes the many programs launched by the Affordable Care Act-created Center for Medicare and Medicaid Innovation, including the Pioneer ACO Model, the Medicare Shared Savings Program, the Comprehensive Care for Joint Replacement program, the Comprehensive Primary Care Initiative, the Independence at Home demonstration, the Bundled Payment for Care Improvement Initiative, and the State Innovation Models initiative.
Together, CMS hopes these and other programs will help achieve its stated goal of paying for 30 percent of Medicare services through alternative payment models and making 85 percent of payments based on quality or value by the end of 2016.
For a better sense of how CMS sees these efforts pushing toward its policy objectives, see the commentary “Continuing the shift from volume to results in American healthcare” here, on the CMS blog.

2015-11-30T06:00:46+00:00November 30th, 2015|Affordable Care Act, Health care reform, Medicare|Comments Off on Push From Volume to Value Continues

House May Address Doc Fix Bill This Week

Means-testing for Medicare beneficiaries.
Modest raises for doctors now and the promise of no cuts for a decade.
An extension of the Children’s Health Insurance Program (CHIP) for ten years.
These and other provisions are part of a new bill expected to move to the House this week that would eliminated the use of the Medicare sustainable growth rate formula (SGR) that threatens to cut Medicare payments to doctors 21 percent beginning on April 1.
Doctor listening to patientFor years Congress has implemented temporary measures to prevent similar cuts but now, it appears to be serious about addressing the problem permanently by eliminating the SGR formula and introducing in its place a new payment system for doctors that pays them based on the quality rather than the quantity of care they deliver.
What’s in this latest proposal?  Kaiser Health News has published an FAQ that describes the issue, the proposed solutions, and the challenges those solutions face in the coming days.  See that FAQ here.
 

2015-03-24T06:00:58+00:00March 24th, 2015|Medicare|Comments Off on House May Address Doc Fix Bill This Week

Congress Mulls Another Medicare Doc Fix

With a March 31 deadline looming before Medicare payments to physicians are scheduled to decline more than 20 percent, it appears Congress may be considering permanent repeal of the underlying root of the problem rather than yet another short-term patch.
At the heart of the problem is the sustainable growth rate formula, or SGR, that determines how Medicare pays physicians.  For years Congress has applied short-term solutions to the SGR problem and paid for those solutions with short-term spending cuts.  Now it appears congressional leaders are contemplating a permanent repeal of the troublesome formula.
Group of healthcare workersThe cost of doing so is about $175 billion for ten years, and Congress reportedly is considering cuts in both benefits and provider payments.
Because many Pennsylvania safety-net hospitals own physician practices, this issue is very important to them.
The Wall Street Journal has taken a closer look at this matter, examining the issue, the stakes, and both the policy and the political challenges congressional negotiators now face.  See its report here.

2015-03-17T06:00:59+00:00March 17th, 2015|Uncategorized|Comments Off on Congress Mulls Another Medicare Doc Fix

PA Congressional Delegation Seeks Medicare “Doc Fix”

Seventeen of the 18 members of Pennsylvania’s U.S. House delegation have sent a joint, bipartisan letter to House Speaker John Boehner and minority leader Nancy Pelosi asking them make a priority of repealing – before the current session of Congress ends – the sustainable growth rate formula (SGR) used to determine how doctors are paid to serve Medicare patients.
See their letter here.

2014-11-18T06:00:21+00:00November 18th, 2014|Uncategorized|Comments Off on PA Congressional Delegation Seeks Medicare “Doc Fix”

The Time May Have Arrived for a Permanent “Doc Fix”

Congress appears serious about addressing a long-running problem:  the need for an annual “Medicare doc fix” to address the problem stemming from the use of the sustainable growth rate formula, or SGR, to determine Medicare payments for physician services.
Doctor listening to patientFor years, application of the SGR called for reductions in Medicare payments to doctors, forcing Congress to apply temporary patches to the problem – and to find ways to pay for those patches.
Now, however, Congress appears intent on doing away with the SGR and fixing the problem once and for all.
But what exactly is the problem, what will it cost to fix, and how might Congress fix it?  And why address it now, after years of short-term solutions?  These questions and others are answered in a new Kaiser Health News FAQ, which you can find here.

2014-01-20T06:00:06+00:00January 20th, 2014|Uncategorized|Comments Off on The Time May Have Arrived for a Permanent “Doc Fix”
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