Researchers Give Medical Homes Mixed Reviews

Patient-centered medical homes are one of the delivery system innovations encouraged by the Affordable Care Act (ACA). But recent studies present a mixed picture of the effectiveness of medical homes in improving quality and reducing costs through care coordination.

 

The National Committee for Quality Assurance (NCQA) has been “designating” medical homes since it started its recognition program in 2008. NCQA recognition, however, doesn’t necessarily deliver the anticipated results. “There is criticism that physicians and other providers are more concerned with checking NCQA’s boxes to document processes than with providing coordinated care and achieving better outcomes.” (“Reform Update: Medical-home adoption growing; evidence of effectiveness still elusive,” Modern Healthcare Daily Dose, August 18, 2014)

 

The medical home should add accountability, ease quality measurement and allow for better tracking of patient tests results and specialist visits. But three recent primary-care studies are not conclusive about the success of medical homes.

 

  • Health Services Research: Compared cost and quality measures for 308 NCQA-recognized medical homes with 1,906 non-recognized practices. Results showed that after receiving NCAQ recognition, total Medicare Payments, acute care payments and ED visits declined compared with non-recognized practices.

 

  • Health Affairs: Researchers concluded that “neither the patient-centered medical home score, nor pay-for-performance incentives, nor the acceptance of risk for the cost of hospital care for the [small] practice’s patients was significantly associated with the ambulatory care-sensitive admission rate.” (This study looked at small physician practices and found one- to two-doctor practices had 33 percent fewer ambulatory care-sensitive hospital admissions than practices with 10 to 19 doctors. Also reported was that physician-owned practices had fewer preventable admissions than hospital-owned practices.)

 

  • Millbank Reports: Concluded that payer alignment and corresponding payment reforms must be in place for medical homes to succeed. The report’s authors noted that typically no single payer can invest enough to make transforming the entire practice cost-effective.

 

(Report synopses from “Reform Update: Medical-home adoption growing; evidence of effectiveness still elusive,” Modern Healthcare Daily Dose, August 18, 2014)

 

 

iProtean subscribers, your next course, Physicians and the New Healthcare Business Model, provides a concise look at patient-centered medical homes and how this care model melds both population health management and value-based care.

 

A course about physicians by physicians—Todd Sagin, M.D., J.D. and Larry McEvoy, M.D.—it examines how physicians are making the changes necessary for the new business model, and offers unorthodox suggestions to boards and executives about how to work with physicians as the entire organization goes through radical change.

 

 

 

For a complete list of iProtean courses, click here.

 

For more information about iProtean, click here.

 

Some Hospitals Will See Increases in Medicare Payments in 2015

Hospitals that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful electronic health record (EHR) users will see an increase of 1.4 percent operating payment rates for inpatient stays in 2015, according to a final rule released last week by CMS.

 

However, overall payments under the Inpatient Prospective Payment System (IPPS) will decrease by more than $750 million (0.6 percent). CMS explained that the rate increase will be offset by reductions under the Hospital Readmissions Reduction program, changes to Medicare disproportionate share hospital payments, the expiration of some statutory provisions that gave special temporary increases in payments to hospitals, and other changes to IPPS policies.

 

Some of the specific quality-related changes noted in the final rule include:

 

  • Hospital Value-Based Purchasing Program: An increase in FY 2015 of the applicable percent reduction to 1.5 percent of base operating DRG payment amounts to participating hospitals

 

  • Hospital Readmissions Reduction Program: Increase in the maximum reduction in payments from 2 percent to 3 percent, as required by law

 

  • Hospital Acquired Condition Reduction Program: Reduction of inpatient payments of 1 percent by those hospitals with the poorest performance

 

  • Inpatient Quality Reporting: Finalization of 63 measures (47 required, 16 voluntary) set for the FY 2017 payment determination and subsequent years—11 measures were added and 19 were removed

 

“The rule’s changes to Medicare quality incentive programs will continue to encourage high quality care while decreasing the time and effort it takes for providers to report the information,” CMS said in the fact sheet. (“Fact sheets: CMS to Improve Quality of Care during Hospital Inpatient Stays, CMS.gov, August 4, 2014)

 

To read the CMS press release, click here.

 

 

To read the CMS fact sheet on quality, click here.

 

 

 

To read the CMS fact sheet on policy and payment changes, click here.

 

 

(Additional source: “Medicare Inpatient Hospital Payment to Decline Under CMS Final Rule,” Health Lawyers Weekly, August 8, 2014)

 

 

 

iProtean subscribers, your next course, Physicians and the New Healthcare Business Model, will be published at the end of August. A course about physicians by physicians—Todd Sagin, M.D., J.D. and Larry McEvoy, M.D.—it examines how physicians are making the changes necessary for the new business model, and offers unorthodox suggestions to boards and executives about how to work with physicians as the entire organization goes through radical change.

 

 

 

For a complete list of iProtean courses, click here.

 

For more information about iProtean, click here.

 

Provider Interest in Bundled Payments Increases

The bundled payment initiative initially attracted about 2,400 providers over the 18 months since it was launched in January 2013. CMS recently announced an additional 4,100 provider candidates in the initiative, bringing the total to approximately 6,500.

 

These candidates will analyze Medicare spending data to decide whether to enter into bundled-payment contracts. Under these contracts, payments are “bundled” for multiple services connected to certain episodes of care. Participating providers profit when their spending on these episodes of care falls below Medicare’s savings target. Providers must reduce Medicare costs by 2% to 3.5% before they are rewarded, with some exceptions.

 

Hospitals and doctors can test any of four bundles that include some or all medical expenses for care provided throughout a hospital stay; one to three months after patients leave; or both.

 

Bundled payments and accountable care, both financing experiments under the Patient Protection and Affordable Care Act (ACA), have gained significant traction “even though providers have limited experience with them and previous demonstrations have shown mixed results.” (“Interest surges in Medicare bundled-payment initiative,” Modern Healthcare, July 31, 2014)

 

The initiatives hold potential but also pose risks, health policy experts say. “Bundles and accountable care may reduce waste and fragmentation under existing financing, which pays providers for each procedure, visit or service, creating an incentive to do more regardless of need. But the incentive to control spending may also entice providers to reduce necessary care or avoid costly patients.” (“Interest surges in Medicare bundled-payment initiative,” Modern Healthcare, July 31, 2014)

 

The success of the bundled payment initiative will depend on how many  providers move from exploration to the contract stage. Providers at the exploration stage examine their performance to determine whether they can withstand the risk. Of the original group of candidate providers, 236 proceeded to contract; 86 did not.

 

The surge in interest in bundled payments suggests growing comfort among providers with reimbursement that comes with heightened financial risk, an executive from the Health Care Incentives Improvement Institute noted. The Medicare initiative’s four models give providers the opportunity to test bundled payments on a limited scale, unlike contracts that require a more global budget, he said. “There is a pent-up demand; this is a manifestation of that pent-up demand,” he said. (“Bundled payment attracts providers—but will they sign?,” Modern Healthcare AM, August 1, 2014)

 

Challenges hospitals face with bundled payments include achieving clinical depth to prevent hospital readmissions, and building a strong case management team.

 

 

 

iProtean subscribers, your next course, Physicians and the New Healthcare Business Model, will be published at the end of August. A course about physicians by physicians—Todd Sagin, M.D., J.D. and Larry McEvoy, M.D.—it examines how physicians are making the changes necessary for the new business model, and offers unorthodox suggestions to boards and executives about how to work with physicians as the entire organization goes through radical change.

 

 

 

For a complete list of iProtean courses, click here                                     

 

For more information about iProtean, click here.