Starting in January, there will officially be an additional 123 accountable care organizations (ACOs) in the Medicare Shared Savings Program. As providers and hospitals transition to this emerging care model, there is mixed opinion over its longevity.
Starting in January, there will officially be an additional 123 accountable care organizations (ACOs) in the Medicare Shared Savings Program. As providers and hospitals transition to this emerging care model, there is mixed opinion over its longevity.
Marc Manley, MD, the vice president, population health management for the Insurance Services Division at the University of Pittsburgh Medical Center says that while the industry has entered “an era of big transition” to a value-based system, it is still competing with volume-based incentives.
“The bad news is that we’re operating two systems at the same time: Payment is still being done on volume while some reward is being offered for delivering higher value care and cost savings,” he says. “. “Many hospitals still believe that getting more people into the ER is a good thing financially, but payers don’t agree. That’s a sign that the financial incentives are not aligned. The physicians may already realize that they could offer longer clinic hours instead of forcing patients to use the ER. That’s another sign that incentives are misaligned.”
Medical groups choosing to participate in ACOs have an opportunity to earn financial bonuses for meeting quality benchmarks, including those which enhance the patient experience and improve care for at-risk populations. Several groups have even chosen to rejoin an ACO after initially leaving the Pioneer program over the summer. An estimated 1.5 million additional Medicare beneficiaries are expected to benefit from the recent influx in participation.
“This is a great example of the Affordable Care Act rewarding hospitals and doctors that work together to help our beneficiaries get the best possible care,” HHS Secretary Kathleen Sebelius said in a statement.
Around the Web
HHS Adds 123 Medicare ACOs, With About 1.5 Million Beneficiaries [Modern Healthcare]
Managing the Shift from Volume to Value [Healthcare Finance News]
Covering antiobesity medications like semaglutide could save Medicare around $500 million annually; preliminary CDC data showed a 3% decline in the number of US overdose deaths last year; the Biden administration recently announced the first national maternal mental health strategy.
Read More
CMS Medicare Final Rule: Advancing Benefits, Competition, and Consumer Protection
May 7th 2024On this episode of Managed Care Cast, we're talking with Karen Iapoce, senior director of government products and programs at ZeOmega, about the recent CMS final rule on Medicare Part D and Medicare Advantage.
Listen
Panel Addresses Minority Physician Shortage, Maternal Health at Senate Committee Hearing
May 15th 2024The senate hearing held by the US Senate Committee on Health, Education, Labor, and Pensions, led by Sen. Bernie Sanders (I, Vermont), chairman of the committee, and ranking member Sen. Bill Cassidy, MD, (R, Louisiana), addressed the critical issue of physician and health care worker shortages, as well as the maternal health crisis, in the US.
Read More
A new study highlights significant disparity in reimbursement rates across states between hospitals and Medicare; the first patient to receive a genetically modified pig kidney has died; research examines outcomes of over 500 patients receiving medication abortion pills by mail.
Read More
Covering antiobesity medications like semaglutide could save Medicare around $500 million annually; preliminary CDC data showed a 3% decline in the number of US overdose deaths last year; the Biden administration recently announced the first national maternal mental health strategy.
Read More
CMS Medicare Final Rule: Advancing Benefits, Competition, and Consumer Protection
May 7th 2024On this episode of Managed Care Cast, we're talking with Karen Iapoce, senior director of government products and programs at ZeOmega, about the recent CMS final rule on Medicare Part D and Medicare Advantage.
Listen
Panel Addresses Minority Physician Shortage, Maternal Health at Senate Committee Hearing
May 15th 2024The senate hearing held by the US Senate Committee on Health, Education, Labor, and Pensions, led by Sen. Bernie Sanders (I, Vermont), chairman of the committee, and ranking member Sen. Bill Cassidy, MD, (R, Louisiana), addressed the critical issue of physician and health care worker shortages, as well as the maternal health crisis, in the US.
Read More
A new study highlights significant disparity in reimbursement rates across states between hospitals and Medicare; the first patient to receive a genetically modified pig kidney has died; research examines outcomes of over 500 patients receiving medication abortion pills by mail.
Read More
2 Commerce Drive
Cranbury, NJ 08512