There is a new kid on the block in the CMS alphabet soup of value-based payment models. The Transforming Episode Accountability Model (TEAM) pushes hospitals and health systems to better manage five surgical episodes of care for the initial admission and the thirty-days following. TEAM is a mandatory model for selected markets launching January 2026. […]
What is the Primary Care First Program (PCF)? PCF is a voluntary 5-year CMS Advanced Alternative Payment Model (APM) with two care models—one for “Advanced” primary care and one for high-need, seriously ill Medicare beneficiaries (Seriously Ill Population, or SIP). The latter is aimed primarily at providers who typically provide hospice or palliative services. Practices […]
CMS published its final rule, the “Pathways to Success” for the Medicare Shared Savings Program, in December 2018. CMS’ overall goal is clear and unchanged from the proposed rule: to put the “accountability” back in accountable care by moving ACOs more quickly to downside risk. While the final rule tracks the proposed rule issued in […]
On August 9, 2018, CMS issued new proposed regulations for MSSP ACOs that, if finalized, will result in far-reaching changes in the program. The motivation for the proposed changes, which CMS calls “Pathways to Success,” is simple: CMS wants to move ACOs to risk more quickly. The great majority of 2018 participating ACOs are not […]
Accountable Care Organizations (“ACOs”) receive a substantial portion of their revenue through shared savings programs in which payers pay the ACO a portion of total cost savings generated by member providers through effective care management. The ACOs then distribute part of the shared savings to participating healthcare providers, based on a distribution formula; the remainder […]
Despite many uncertainties, the shift toward value based payment continues. More Medicare Shared Savings Program (MSSP) ACOs have entered risk-based tracks (Tracks 2, 3, and now Track 1+), to take advantage of MACRA’s[1] 5% bonus to physicians in risk-based payment models. The latest numbers about exactly how many have selected risk for next year will […]
To date, just under one-third of accountable care organizations (ACOs) have been eligible to share in savings. This situation is changing somewhat as ACOs gain experience in managing populations of patients for high quality and low cost healthcare. As of 2016, nearly 50 percent of Medicare lives were covered in non-traditional arrangements, including Medicare Advantage […]
CMS wants more physicians to participate in ACOs and other alternative payment models (APMs). It’s best if they are risk-taking ACOs, but any ACO seems to be better than none. At least, that is what the incentives in MACRA seem to indicate. Prior to the passage of MACRA (the Medicare Access and CHIP Reauthorization Act […]
John M. Harris and Craig E. Holm describe howimplementation of MACRA bring significant strategic implications for hospitals and health systems as well and physicians.