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June 22, 2017

ACO roundup: Value-based pricing might not be effective, study says

Daily Briefing
  • Our 10 takeaways on the MACRA proposed rule. Advisory Board's Dennis Weaver shares his 10 initial takeaways on the 1,058-page proposed rule to implement MACRA's Quality Payment Program. First, Weaver says two overall trends are clear: Payment and delivery system reforms are moving ahead, and the administration wants to reduce the regulatory burden of MACRA on providers. Weaver also points out that the rule exempts about 134,000 providers from participating in QPP altogether—mostly those in small practices, rural regions, or in areas designated as Health Professional Shortage Areas—and eases Merit-based Incentive Payment System (MIPS) burdens, among other insights. 

  • Value-based pricing might not be effective, study says. Hospitals participating in the Affordable Care Act's Medicare Hospital Value-Based Purchasing Program did not do better on multiple performance measures than non-participating hospitals, according to a new study published in the New England Journal of Medicine. Specifically, the researchers did not find significant performance differences between participating and non-participating hospitals on measures of clinical process, patient experience, and 30-day risk-standardized mortality rates for heart attack and heart failure patients. However, the researchers did find that the mortality rate for pneumonia patients at participating hospitals was notably lower than the rate at non-participating hospitals. 

  • AHA urges CMS to suspend overall star ratings program. In a letter last week, the American Hospital Association called on CMS Administrator Seema Verma to suspend the Overall Hospital Quality Star Ratings program, calling the metric "deeply flawed." AHA in the letter contended that a flawed methodology and "substantive errors ... made in executing" that methodology resulted in "far too many hospitals [being] incorrectly classified into star rating categories that are different than those that should have been assigned." According to Becker's Hospital Review's Molly Gamble, CMS earlier this month said it would not update the star ratings in July as originally scheduled, citing data issues with the measures. The next update will be in October, according to CMS.

From Advisory Board:

  • Why the physician network needs to be redefined—and how to do it. In recent years, physician networks have focused primarily on growing market share, improving quality, and preparing for population health. Today's networks, however, must simultaneously accomplish several different goals—and manage inherent tensions along the way. Join us on June 26 to learn how to effectively segment physicians across the network and instill a clear sense of individual purpose to help physicians in the network better advance system strategy.

Register Here

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  • What the 2018 proposed rule means for providers. Join us on July 11 to get an overview of the most important implications of the proposed rule for provider organizations, a review of key changes to the MIPS and APM tracks for the 2018 performance year, as well as guidance on navigating the transition to risk-based payment and the evolution of hospital-physician alignment.

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