Archive for the ‘Affordable Care Act’ Category

4 Ways CMS 2018 Quality Payment Program Supports ‘Patients Over Paperwork’ Pledge

November 6th, 2017 by Patricia Donovan

“Patients Over Paperwork” is committed to removing regulatory obstacles that get in the way of providers spending time with patients.

Year 2 of the CMS Quality Payment Program promises continued flexibility and reduced provider burden, according to the program’s final rule with comment issued by the Centers for Medicare and Medicaid Services (CMS) last week.

The Quality Payment Program (QPP), established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), is a quality payment incentive program for physicians and other eligible clinicians that rewards value and outcomes in one of two ways: through the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

A QPP Year 2 fact sheet issued by CMS highlights 2018 changes for providers under the QPP’s MIPS and APM tracks. The Year 2 fact sheet noted that stakeholder feedback helped to shape policies for QPP Year 2, and that  “CMS is continuing many of its transition year policies while introducing modest changes.”

In keeping with the federal payor’s recently launched “Patients Over Paperwork” initiative, QPP Year 2 reflects the following changes:

    • More options for small practices (groups of 15 or fewer clinicians). Options include exclusions for individual MIPS-eligible clinicians or groups with less than or equal to $90,000 in Part B allowed charges or less than or equal to 200 Part B beneficiaries, opportunities to earn additional points, and the choice to form or join a virtual group.
    • Addresses extreme and uncontrollable circumstances, such as hurricanes and other natural disasters, for both the 2017 transition year and the 2018 MIPS performance period, by offering hardship exception applications and limited exemptions.
    • Includes virtual groups as another participation option for Year 2. A virtual group is a combination of two more taxpayer identification numbers (TINs) made up of solo practitioners and groups of 10 or fewer eligible clinicians who come together ‘virtually’ (no matter specialty or location) to participate in MIPS for a performance period of a year. A CMS Virtual Groups Toolkit provides more information, including the election process to become a virtual group.
    • Makes it easier for clinicians to qualify for incentive payments by participating in Advanced APMs that begin or end in the middle of a year. Updated QPP policies for 2018 further encourage and reward participation in APMs in Medicare.
  • CMS describes its Patients Over Paperwork effort as “a cross-cutting, collaborative process that evaluates and streamlines regulations with a goal to reduce unnecessary burden, increase efficiencies and improve the beneficiary experience. This effort emphasizes a commitment to removing regulatory obstacles that get in the way of providers spending time with patients.”

    President Trump Halts CSR Payments, Signs Executive Order on ACA Components

    October 12th, 2017 by Melanie Matthews

    The Trump Administration has called for the discontinuation of cost-sharing reductions (CSR) payments to health insurance companies based on a legal opinion from the Attorney General. President Trump also signed three executive orders directing the appropriate federal agencies to examine three Affordable Care Act (ACA) components: association health plans (AHPs), short-term, limited-duration insurance (STLDI), and health reimbursement arrangements (HRAs).

    “CSR payments are prohibited unless and until a valid appropriation exists,” said HHS Acting Secretary Eric Hargan, referring to the legal opinion from the Attorney General’s Office regarding CSR payments.

    According to August 2017 estimates from the Congressional Budget Office and the Joint Committee on Taxation on the impact of ending CSR payments, the number of people uninsured will be approximately 1 million higher than under the baseline in 2018 but about 1 million lower in each year starting in 2020. In 2018, under the policy, the largest effect on coverage would derive from the drop in the number of insurers participating in the non-group market.

    The CBO and JCT also estimated that by 2020, the effect on coverage would stem primarily from the increases in premium tax credits, which would make purchasing non-group insurance more attractive for some people. As a result, a larger number of people would purchase insurance through the marketplaces, and a smaller number of people would purchase employment-based health insurance.

    President Trump also signed Executive Orders that direct the:

    • Secretary of Labor to consider expanding access to AHPs;

    • Departments of the Treasury, Labor, and Health and Human Services to consider expanding coverage through low cost STLDI; and

    • Departments of the Treasury, Labor, and Health and Human Services to consider changes to HRAs.

    Each of these components will be subject to the federal government’s rulemaking process and will not have an impact on this year’s open enrollment period under ACA.

    Industry reaction was mixed to the Executive Orders:

    • “Health plans remain committed to certain principles. We believe that all Americans should have access to affordable coverage and care, including those with pre-existing conditions. We believe that reforms must stabilize the individual market for lower costs, higher consumer satisfaction, and better health outcomes for everyone. And we believe that we cannot jeopardize the stability of other markets that provide coverage for hundreds of millions of Americans. We will follow these principles – competition, choice, patient protections and market stability – as we evaluate the potential impact of this executive order and the rules that will follow. We look forward to engaging in the rulemaking process to help lower premiums and improve access for all Americans,” said Kristine Grow, Senior Vice President, Communications, America’s Health Insurance Plans (AHIP).

    • The American Hospital Association (AHA) said while the “Executive Order will allow health insurance plans that cover fewer benefits and offer fewer consumer protections. No one can predict future health care needs with complete certainty and such plans could put patients at risk when care is needed most.”

      In addition, said the AHA, these provisions could destabilize the individual and small group markets, leaving millions of Americans who need comprehensive coverage to manage chronic and other pre-existing conditions, as well as protection against unforeseen illness and injury, without affordable options. And, regarding consolidation, respected economic studies demonstrate that the hospital field’s trajectory has resulted in both cost savings and quality improvements. The AHA is encouraging the Administration to achieve the goal of ensuring that individuals and small businesses have affordable, comprehensive healthcare coverage options without sacrificing critical consumer protections by stabilizing the individual and small group markets.

    Infographic: Large Healthcare Gains for Women Under ACA

    October 9th, 2017 by Melanie Matthews

    The number of working-age U.S. women without health insurance has been cut nearly in half since the Affordable Care Act (ACA) was enacted, according to a new infographic by the Commonwealth Fund.

    The infographic also examines other ACA impacts on healthcare for women.

    Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry Not in recent history has the outcome of a U.S. presidential election portended so much for the healthcare industry. Will the Trump administration repeal or replace the Affordable Care Act (ACA)? What will be the fate of MACRA? Will Medicare and Medicaid survive?

    These and other uncertainties compound an already daunting landscape that is steering healthcare organizations toward value-based care and alternative payment models and challenging them to up their quality game.

    Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry, HIN’s 13th annual business forecast, is designed to support healthcare C-suite planning during this historic transition as leaders prepare for both a new year and new presidential leadership.

    Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

    Have an infographic you’d like featured on our site? Click here for submission guidelines.

    Chronic Care Plus for the Chronically Homeless: ‘Recuperative Care on Steroids’

    September 28th, 2017 by Patricia Donovan

    Chronic Care Plus is designed for ‘Joe,’ a prototypical vulnerable client and frequent hospital user who for some reason has not connected to either his community or healthcare system.

    Illumination Foundation’s joint venture pilot, which began as an ER diversion project, now offers community-based stabilization following a hospital stay for medically vulnerable chronically homeless patients. Here, Illumination Foundation CEO Paul Leon describes the origins of Chronic Care Plus (CCP), which has been associated with a $7 million annual medical cost avoidance at all hospitals visited by the 38 CCP clients.

    Back in 2008 when we first started, we began to realize that housing was healthcare. With many of the patients we were seeing, although we experienced great success, we ended up discharging them many times back into a shelter or into an assisted living or sober living situation. And although these options were better than being in the hospital or being discharged to the street, we knew we could improve on this.

    So, in 2013, we implemented the Chronic Care Plus (CCP) program. Basically, CCP was recuperative care on steroids. It was recuperative care with more tightly wrapped social services and a longer length of stay. At that time, we began a pilot program in conjunction with UniHealth and St. Joseph’s Hospital in which we took the 28 most frequent users and kept them in housing for two years. We also brought these individuals through recuperative care, and wrapped them tightly with social services.

    These efforts would eventually lead us to create our ‘Street2Home’ program, which we’re working on now. It implements more bridge housing and permanent supportive housing that is supplied not only by us but by collaboratives in the community. We are able to link to these collaboratives to take our individual, our ‘Joe,’ from a street to eventual permanent housing.

    Source: Homelessness and Healthcare: Creating a Safety Net for Super Utilizers with Medical Bridge Housing

    home visits

    Homelessness and Healthcare: Creating a Safety Net for Super Utilizers with Medical Bridge Housing spotlights a California partnership that provides medical ‘bridge’ housing to homeless patients following hospitalization. This recuperative care initiative reduced avoidable hospital readmissions and ER visits and significantly lowered costs for the collaborating organizations.

    2017 ACO Snapshot: As Adoption Swells, Social Determinants of Health High on Accountable Care Agenda

    June 29th, 2017 by Patricia Donovan

    Nearly two-thirds of 2017 ACO Survey respondents attribute a reduction in hospital readmissions to accountable care activity.

    Healthcare organizations may have been wary back in 2011, when the Department of Health and Human Services (HHS) first introduced the accountable care organization (ACO) model. The HHS viewed the ACO framework as a tool to contain skyrocketing healthcare costs.

    Fast-forward six years, and most resistance to ACOs appears to have dissipated. According to 2017 ACO metrics from the Healthcare Intelligence Network (HIN), ACO adoption more than doubled from 2013 to 2017, with the number of healthcare organizations participating in ACOs rising from 34 to 71 percent.

    During that same period, the percentage of ACOs using shared savings models to reimburse its providers increased from 22 to 33 percent, HIN’s fourth comprehensive ACO snapshot found.

    And in the spirit of delivering patient-centered, value-based care, ACOs have embraced a whole-person approach. In new ACO benchmarks identified this year, 37 percent of ACOs assess members for social determinants of health (SDOH). In support of that trend, the 2017 survey also found that one-third of responding ACOs include behavioral health providers.

    Since that first accountable care foray by HHS, the number of ACO models has proliferated. The May 2017 HIN survey found that, of current ACO initiatives, the Medicare Shared Savings Program (MSSP) from the Centers for Medicare and Medicaid Services (CMS) remains the front runner, with MSSP participation hovering near the same 66 percent level attained in HIN’s 2013 ACO snapshot.

    Looking ahead to ACO models launching in 2018, 24 percent of respondents will embrace the Medicare ACO Track 1+ Model, a payment design that incorporates more limited downside risk.

    This 2017 accountable care snapshot, which reflects feedback from 104 hospitals, health systems, payors, physician practices and others, also captured the following trends:

    • More than half—57 percent—participate in the Medicare Chronic Care Management program;
    • Cost and provider reimbursement are the top ACO challenges for 18 percent of 2017 respondents;
    • Clinical outcomes are the most telling measure of ACO success, say 83 percent of responding ACOs;
    • Twenty-nine percent of respondents not currently administering an ACO expect to launch an accountable care organization in the coming year;
    • 75 percent expect CMS to try and proactively assign Medicare beneficiaries to physician ACO panels to boost patient and provider participation.

    Download HIN’s latest white paper, “Accountable Care Organizations in 2017: ACO Adoption Doubles in 4 Years As Shared Savings Gain Favor,” for a summary of May 2017 feedback from 104 hospitals and health systems, multi-specialty physician practices, health plans, and others on ACO activity.

    Infographic: A Look Back at Healthcare Steps in Trump’s First 100 Days

    May 15th, 2017 by Melanie Matthews

    In the first 100 days of his administration, President Donald J. Trump has taken a number of actions that could impact healthcare, including filling a Supreme Court seat and taking steps to repeal the Affordable Care Act, according to a new infographic by AJMC.

    The infographic examines some of the most notable healthcare-related happenings in Trump’s first 100 days in office.

    Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry Not in recent history has the outcome of a U.S. presidential election portended so much for the healthcare industry. Will the Trump administration repeal or replace the Affordable Care Act (ACA)? What will be the fate of MACRA? Will Medicare and Medicaid survive?

    These and other uncertainties compound an already daunting landscape that is steering healthcare organizations toward value-based care and alternative payment models and challenging them to up their quality game.

    Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry, HIN’s 13th annual business forecast, is designed to support healthcare C-suite planning during this historic transition as leaders prepare for both a new year and new presidential leadership.

    Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

    Have an infographic you’d like featured on our site? Click here for submission guidelines.

    Infographic: U.S. Public Opinion on Healthcare Reform

    April 7th, 2017 by Melanie Matthews

    Both Democrats and Republicans give top priority to lowering out-of-pocket costs for healthcare as a key tenet needed in healthcare reform, according to a new infographic in the Visualizing Health Policy series by the Kaiser Family Foundation and the Journal of the American Medical Association.

    The infographic details other health reform priorities by the U.S. population in general and by political affiliation.

    Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry Not in recent history has the outcome of a U.S. presidential election portended so much for the healthcare industry. Will the Trump administration repeal or replace the Affordable Care Act (ACA)? What will be the fate of MACRA? Will Medicare and Medicaid survive?

    These and other uncertainties compound an already daunting landscape that is steering healthcare organizations toward value-based care and alternative payment models and challenging them to up their quality game.

    Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry, HIN’s 13th annual business forecast, is designed to support healthcare C-suite planning during this historic transition as leaders prepare for both a new year and new presidential leadership.

    Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

    Have an infographic you’d like featured on our site? Click here for submission guidelines.

    American Health Care Act Fails to Deliver for U.S. House of Representatives’ Vote

    March 27th, 2017 by Melanie Matthews

    The American Health Care Act, designed to repeal and replace parts of the Affordable Care Act (ACA), was pulled from a vote by the U.S. House of Representatives on Friday, March 24th, by House Speaker Paul Ryan.

    With mounting opposition to the bill from the House Freedom Caucus and Democrats, the bill did not have the votes to pass.

    Healthcare industry groups, including the American Medical Association, the American Hospital Association and AHIP had also voiced concern over key aspects of the legislation (see Healthcare Reacts to AHCA: Providers ‘Cannot Support Legislation As Drafted’).

    The White House has indicated it will now take a wait and see approach to health reform.

    What’s your take on the failure of the American Health Care Act to achieve the support of the U.S. House of Representatives and the Trump Administration’s steps to repeal and replace the ACA? What aspects of the ACA are working? What needs to be fixed? Share your thoughts in our comments section below.

    Healthcare Reacts to AHCA: Providers ‘Cannot Support Legislation As Drafted’

    March 13th, 2017 by Patricia Donovan

    American Health Care ActLast week’s unveiling of G.O.P. legislation designed to repeal and replace the Affordable Care Act (ACA) triggered a flurry of concerns and criticisms from healthcare industry sectors.

    The proposed American Health Care Act (AHCA) would eliminate Obamacare’s individual mandate and put in place refundable tax credits for individuals to purchase health insurance. It also proposes restructuring Medicaid and defunding Planned Parenthood. However, the bill seeks to maintain protections for individuals with pre-existing conditions and to permit children to remain on their parents’ insurance plans until they reach the age of 26.

    As of last Friday, the proposed American Health Care Act (AHCA) had cleared two committees in the U.S. House of Representatives; a final House vote on the bill is expected the week of March 20.

    In a letter to leaders of the House committees that will mark up the AHCA, the American Medical Association (AMA) rejected the ACA replacement bill. In the letter, AMA CEO and Executive Vice President James L. Madara, MD, stated that his organization “cannot support the AHCA as drafted because of the expected decline in health
    insurance coverage and the potential harm it would cause to vulnerable patient populations.”

    In particular, the AMA, the nation’s largest physicians’ group representing more than 220,000 doctors, residents, and medical students, objected to the bill’s proposed restructuring of Medicaid, claiming it “would limit states’ ability to respond to changes in service demands and threaten coverage for people with low incomes.”

    The AMA’s position was also outlined in a statement issued by Andrew W. Gurman, MD, AMA president.

    Meanwhile, the American Hospital Association (AHA), which counts 5,000 hospitals among its members, also opposed the AHCA. In a news release, Rick Pollack, AHA president and CEO, stated that the AHA “cannot support The American Health Care Act in its current form.” The AHA stated that it would be difficult to evaluate the bill without coverage estimates by the Congressional Budget Office (CBO).

    Echoing AMA apprehension over proposed Medicaid restructuring, Pollack stated that the AHA feared the bill “will have the effect of making significant reductions in a program that provides services to our most vulnerable populations, and already pays providers significantly less than the cost of providing care.”

    Although Pollack lauded recent Congessional efforts to address behavioral health issues, including the growing opioid abuse epidemic, he stressed that “significant progress in these areas is directly related to whether individuals have coverage. And, we have already seen clear evidence of how expanded coverage is helping to address these high-priority needs.”

    Also seeking adequate Medicaid funding in the AHCA was America’s Health Insurance Plans (AHIP), a national association whose 1,300 members provide coverage for healthcare and related services to more than 200 million Americans.

    In a letter to two key House committees, AHIP President and CEO Marilyn Tavenner stated that “Medicaid health plans are at the forefront of providing coverage for and access to behavioral health services and treatment for opioid use disorders, and insufficient funding could jeopardize the progress being made on these important public health fronts.”

    However, AHIP commended the proposed legislation for its “number of positive steps to help stabilize the market and create a bridge to a reformed market during the 2018 and 2019 transition period” and “pledged to work collaboratively to shape the final legislation.”

    “AHIP members are committed to reducing cost growth by using value-based care arrangements and other innovative programs to address chronic illnesses and better manage the care of the highest-need patients,” Tavenner concluded.

    In a statement on Friday, Secretary of Health and Human Services Tom Price, MD, committing his agency to using its regulatory authority to create greater flexibility in the Medicaid program for states, including “a review of existing waiver procedures to provide states the impetus and freedom to innovate and test new ideas to improve access to care and health outcomes.”

    Infographic: Comparing the Affordable Care Act and the House Republican Bill

    March 8th, 2017 by Melanie Matthews

    Comparing the Affordable Care Act and the House Republican BillRepublicans in the U.S. House of Representatives released on Monday legislation to repeal and replace the Affordable Care Act (ACA).

    A new infographic by the New York Times compares the key features of ACA with what has been proposed by the House Republicans.

    Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry Not in recent history has the outcome of a U.S. presidential election portended so much for the healthcare industry. Will the Trump administration repeal or replace the Affordable Care Act (ACA)? What will be the fate of MACRA? Will Medicare and Medicaid survive?

    These and other uncertainties compound an already daunting landscape that is steering healthcare organizations toward value-based care and alternative payment models and challenging them to up their quality game.

    Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry, HIN’s 13th annual business forecast, is designed to support healthcare C-suite planning during this historic transition as leaders prepare for both a new year and new presidential leadership.

    Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today. Have an infographic you’d like featured on our site? Click here for submission guidelines.