Understanding the ACO Opportunity For Hospices

Hospice News | April 15, 2024

Though the Medicare Advantage hospice carve-in is going away at the end of this year, those operators still have a role to play in value-based care. The carve-in, formally known as the hospice component of the value-based insurance design model (VBID), will expire on Dec. 31. The program was designed to test hospice coverage through Medicare Advantage (MA). Though this does not mean that MA will never be involved in hospice, for now, organizations like Accountable Care Organizations (ACOs) may be providers’ best entry point into value-based systems. Hospices can leverage their existing skill sets in end-of-life, palliative care and serious illness management to succeed in a value-based environment, Robin Stawasz, program development executive for Acclivity Health Solutions, said during a session at the National Hospice and Palliative Care Organization’s (NHPCO) virtual Interdisciplinary Conference.

ACOs led by independent physicians save Medicare ‘substantially’ more money, CBO says

Healthcare Dive | April 17, 2024

Accountable care organizations led by independent physicians save Medicare more money than other types of ACOs, according to a new Congressional Budget Office review of existing research. Independent physician-led ACOs have clear financial incentives to reduce hospital care to lower spending, while hospital-led ACOs — which earn more revenue when patients are admitted — do not, the CBO found. Hospitals also have less direct control over what services patients receive. ACOs with a larger proportion of primary care providers also saved Medicare more money, along with ACOs whose initial spending was higher than their peers in the same region, according to the report.

Value-based care adoption is a journey, not a destination. And the map you follow can make all the difference

Medical Economics | April 17, 2024

What is the transformation and what is the value-based care journey, how is the financial system in health care changing, and how does that change impact health care practice? The health care system has been steadfastly forging ahead toward a value-based care (VBC) reimbursement model over the past several years. As we enter the seventh year of Medicare’s Quality Payment Program (QPP) and continue to see new alternative payment models (APMs) implemented and tested by both CMS and the private payers, it’s clear we are still in the early phases of this complex journey. These reimbursement model changes are redefining the role of the physician practice.

Best practices, legislative priorities and SNFs: 4 key takeaways from the NAACOS spring conference

Fierce Healthcare | April 16, 2024

The National Association of ACOs (NAACOS) hosted a spring conference last week, with sessions on post-acute care, fraud, implementation best practices, health equity and legislative priorities. CMS officials, industry executives and independent experts gave their thoughts on where the industry is headed and where improvements are needed in the accountable care world. Here are four takeaways from the event: 1. CMS is monitoring ACOs’ concerns over DME fraud. Urinary catheter fraud uncovered by NAACOS earlier this year could severely impact organizations’ finances, effecting benchmark payments and long-term stability. CMS officials said they are grateful NAACOS brought issues of fraud to light, and a new approach for “anomalous billing” will be presented in the upcoming weeks for the Medicare Shared Savings Program (MSSP) and ACO REACH.