On January 26, 2015, the United States Department of Health & Human Services (HHS) announced its timeline for shifting Medicare reimbursements from volume-based criteria to value-based criteria. HHS has adopted a framework that categorizes health care payments according to how providers receive payment to provide care:<\/p>\n
\u2022\u00a0 Category 1\u2014fee-for-service with no link of payment to quality
\n\u2022\u00a0 Category 2\u2014fee-for-service with a link of payment to quality
\n\u2022 \u00a0Category 3\u2014alternative payment models built on fee-for-service architecture
\n\u2022\u00a0 Category 4\u2014population-based payment<\/p>\n
In Monday\u2019s announcement, HHS disclosed its initiative to drive more of the Medicare payments to categories 3 and 4. This is the first time in history that HHS has set explicit goals for alternative payment models and value-based payments.\u00a0 HHS declared: \u201cImproving the quality and affordability of care for all Americans has always been a pillar of the Affordable Care Act, alongside expanding access to such care. The law gives us the opportunity to shape the way health care is delivered to patients and to improve the quality of care system-wide while helping to reduce the growth of health care costs.\u201d<\/p>\n
By the end of 2016, HHS has set a goal of tying 30 percent of traditional, fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements. By the end of 2018, the goal is 50 percent of these payments.<\/p>\n
An ACO is an organization of health care providers that agree to be accountable for the quality, cost, and overall care of a group of Medicare beneficiaries. Reimbursement is tied to quality metrics to reduce the total cost of care for the assigned population of patients. Hospitals and physicians have been forming ACOs, and HHS\u2019s most recent initiative should drive even more dollars in this direction.<\/p>\n
However, in our experience, long-term care facilities (LTC Facilities) have been slow to adopt the ACO model. Refusal to join an ACO could result in fewer referrals from hospitals and other providers, since ACO members will refer to the facility (or facilities) within the ACO. LTC Facilities with high ratings for their Quality Measures (on Nursing Home Compare) and low re-hospitalization rates will be more attractive to ACOs.\u00a0 Now is the time to join an ACO, before it is too late.<\/p>\n","protected":false},"excerpt":{"rendered":"
On January 26, 2015, the United States Department of Health & Human Services (HHS) announced its timeline for shifting Medicare reimbursements from volume-based criteria to value-based criteria. HHS has adopted a framework that categorizes health care payments according to how providers receive payment to provide care: \u2022\u00a0 Category 1\u2014fee-for-service with no link of payment to … <\/p>\n