As hospice seeks greater participation in alternative payment models, the Medicare Payment Advisory Board (MedPAC) is calling on Congress to reduce and restructure these programs.
Hospice providers are targeting APMs to appear at the Medicare & Medicaid Innovation Center (CMMI). These models are the gateway to value-based reimbursement and the means to support additional business lines such as palliative care, PACE and other services.
MedPAC initially called on Congress and CMMI to streamline these models in its June 2021 report. This year, the Commission outlined a concrete strategy for implementing that recommendation.
“APM typically provides healthcare provider organizations with a more efficient combination of services and financial incentives to improve the care they provide,” the new report shows. “The presence of multiple APMs operating at the same time can create unnecessary complexity, if Medicare beneficiaries are due to multiple models at the same time, and / or if the provider participates in multiple APMs at the same time. , May weaken incentives. “
Extensive payment and care delivery systems may fall under the APM designation. One of the general principles is the concept of population-based redemption.
In this approach, healthcare providers typically agree to accept responsibility for a group of patients in exchange for a given amount, along with incentives for cost savings and quality improvements.
Examples of APM or related demonstrations include Value-based Insurance Design Demonstrations (VBID), ACO Realization Equity, Access, and Community Health (REACH) Models, Medicare Shared Savings Programs, and Medicare Care Choice Models.
MedPAC recommends reducing the number of ACO model tracks currently in existence. The remaining trucks can turn around providers of different sizes and carry different levels of financial risk.
“It is important to make sure that providers have a strong incentive to participate in APM. Not all providers can take financial risks under a population-based payment model, the Commission Does not consider a rapid transition to compulsory participation in ACOs practical, “MedPAC wrote in the report. “However, we encourage CMSs to look for ways to increase their incentives to participate in a population-based payment model, especially for large provider organizations.”
The Commission’s recommendations contained many provisions regarding the ACO’s arrangements. This includes migrating from regular rebases of spending benchmarks as notified by the actual spending of these organizations. Instead, the Commission proposed using specific growth factors to rebase payments.
This will prevent ACOs that have succeeded in reducing spending from being penalized for the next few years by “ratcheting down” the benchmark. MedPAC also recommended an episode-based payment model operated by Medicare nationwide, which is mandatory for specific providers.
The US Medicare & Medicaid Service Center (CMS) has not yet commented on this report, but CMMI has previously expressed interest in streamlining the model.
In October last year, CMMI announced a “strategic renewal” that would guide the development of future payment models.
In a document outlining the new strategy, the Center showed that the complexity of payment policies and the overlap between payment models can provide conflicting or opposite incentives for healthcare providers.
Some of the goals are to promote the expansion of accountable care and increase the number of beneficiaries in relation to such entities.
These may include, among other things, the practice of a group of physicians, the Medicare Advantage Plan, an Accountable Care Organization (ACO), or a PACE program. According to CMMI, in 2020, 67% of Medicare recipients enrolled in Part A and Part B were included in the MA plan or were due to ACO.
“Accountable care provides all participating providers with incentives and tools to provide high quality, coordinated team-based care that promotes health, thereby fragmenting people and the healthcare system. And to reduce costs, “CMMI said in a document.
