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July 20, 2017

ACO roundup: ACOs participating in Medicare won't say how they pay physicians, study finds

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  • Health provider home visits linked to reduced 30-day readmission rate. Visits by a physical therapist or nurse to the homes of older patients within one week of their discharge from a skilled nursing facility is associated with a reduced risk of 30-day readmission, according to a new study in the Journal of Post-Acute and Long-Term Care Medicine. For the study, researchers assessed outcomes among 1,543 older adults recently discharged from a skilled nursing facility. They found that while a home health visit was linked to a reduced risk of 30-day readmission, a patient's visit to an outpatient facility was not.

  • Hospitals with low quality scores received value-based purchasing bonuses, GAO finds. CMS should revise its methodology used to calculate total performance scores—particularly when a hospital is missing some quality data—under Medicare's Value-Based Purchasing (VBP) program, according to a Government Accountability Office (GAO) report published last month. GAO found about 20 percent of hospitals that have received value-based bonuses under the VBP program since FY 2015 had quality scores below the median for all hospitals. According to the report, "Some hospitals with high efficiency scores received bonuses, despite having relatively low quality scores, which contradicts CMS' stated intention to reward hospitals providing high-quality care at a lower cost."

  • Many Medicare ACOs unwilling to disclose doctor payment incentives. The majority of ACOs (91 percent) that participated in Medicare in 2015 said they would not disclose their physician payment incentives, according to a new study in the American Journal of Public Health. CMS mandates that all federally funded managed care organizations disclose their physician payment incentives. However, ACOs, which are financially rewarded for reducing patients' unnecessary use of care, are exempt from the requirement, which some critics of the exemption worry  could encourage ACOs to pressure their doctors to withhold needed care from patients. For the study, researchers at Montefiore Medical Center, the City University of New York at Hunter College, and Public Citizen queried all 426 ACOs that participated in Medicare in 2015 about their physician payment incentives, and heard back from only 9.2 percent of them.

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