Feds outline ambitious quality vision for Medicare

Reimbursement
By Healthcare Finance Staff | January 27, 2015 | 12:42 PM

The U.S. Department of Health and Human Services wants have 50 percent of Medicare reimbursements tied to quality and value by 2018, even if that includes fee-for-service.

In an new proposal by the Obama Administration, HHS outlined a plan to have 30 percent of reimbursement for traditional Medicare benefits tied to alternative payment models such as ACOs or bundled payment by the end of 2016 -- and half of all payments by 2018.

"We believe these goals can drive transformative change, help us manage and track progress, and create accountability for measurable improvement," said HHS Secretary Sylvia M. Burwell.

By the end of 2016, the administration also wants 85 percent of Medicare's hospital payments to be tied to value-based payment models programs such as the Hospital Value-Based Purchasing Program or the Hospital Readmissions Reduction Program.

Industry groups praised the plan, including the American Hospital Association and America's Health Insurance Plans, but also said they would like to see more specifics.

"Advancing a patient-centered health system requires a fundamental transformation in how we pay for and deliver care," said AHIP President and CEO Karen Ignagni. The announcement "is a major step forward in achieving that goal. Health plans have been on the forefront of implementing payment reforms in Medicare Advantage, Medicaid Managed Care, and in the commercial marketplace. We are excited to bring these experiences and innovations to this new collaboration."
 
Burwell elaborated on the ideas in the proposal in a New England Journal of Medicine essay, writing that "much of the hard work of improving our health care system lies ahead of us."
 
Hospitals were "much safer in 2013 than it was in 2010: there were 1.3 million fewer adverse events between 2011 and 2013 than there would have been if the rate of such events had remained unchanged, and an estimated 50,000 deaths were averted," she noted. "Still, far too many hospitalized patients -- nearly 1 in 10 -- have adverse events while hospitalized, and many people do not receive care that they should receive, while others receive care that does not benefit them."
 
And while growth healthcare spending inflation is at historic lows, with Medicare spending per beneficiary increasing  2 percent per year from 2010 to 2014, it will "take additional effort to sustain and augment the positive changes we have seen so far."
 
 
Topic:
Reimbursement