What you need to know about the forces reshaping our industry.


September 21, 2017

ACO roundup: Hospitals call on Congress to postpone Medicaid DSH payment cuts

Daily Briefing
  • Hospitals ask Congress to delay Medicaid DSH payment cuts. Hospitals, health systems, and industry groups urged Congress in letters to delay the implementation of Medicaid Disproportionate Share Hospital (DSH) payment cuts. In July, CMS published a proposed rule for implementing $43 billion in Medicaid DSH payment cuts over eight years. In two separate letters, America's Essential Hospitals and a group of nine hospital organizations—including the American Hospital Association and the Children's Hospital Association—urged lawmakers to further delay the cuts, arguing that implementing them would undermine hospitals' ability to care for disadvantaged patients.

  • Older diabetes patients at risk of overtreatment, study finds. Nearly 11 percent of older diabetes patients are overtreated for their condition, according to a new study in the Journal of General Internal Medicine. For the study, researchers assessed the medical records of almost 79,000 Medicare beneficiaries with diabetes in ten states and found that nearly 11 percent had very low blood sugar levels—an indication that they were overtreated. However, of those patients, just 14 percent had their blood sugar medications curbed over the next six months.

  • It's time for more multi-payer Medicare models, some providers argue. Citing success under CMS' Comprehensive Primary Care (CPC) initiative, providers are urging the agency to pursue more multi-payer reimbursement models, arguing such models will better spur an industry shift toward value-based care than single-payer options, Virgil Dickson writes for Modern Healthcare. For instance, Richard Shonk—CMO at Health Collaborative, a not-for-profit that trained practices to participate in CPC—said, "It really doesn't work if there is a single-payer approach, simply because there isn't enough volume of any one payer in a primary-care practice to create the critical mass necessary to transform care." And Kevin Sears, executive director of Cleveland Clinic's market and network services, voiced similar support for multi-payer models over single-payer ones, saying, "It's much harder to [shift from fee-for-service to value-based care] when the expectations are fragmented among different payers."

From Advisory Board:

  • How to reduce avoidable ED utilization. Heightened demand for emergency services and increased consumerism in health care has left emergency departments overburdened with rising costs and volumes. Since the majority of these visits are considered unnecessary, provider organizations can capitalize on the opportunity to cut avoidable emergency department visits.. Join us on Wednesday, Oct. 18, to learn tactics to increase patient access to primary care, inflect patient behavioral change by boosting awareness of alternate care points and self-management strategies, and implement targeted measures for high-risk patients.

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  • Is your Medicare risk strategy MACRA-ready? While the GOP's health reform effort continues to evolve, Medicare payment reform has quietly marched on with bipartisan support. And with MACRA well underway, the new administration has shown no signs of reversing course. As a result, hospital and health system leaders need to develop an intentional Medicare risk strategy. Check out our new research report to learn how to navigate the Medicare ACO programs, expand into the Medicare Advantage market, and ensure the longevity of your Medicare risk strategy by actively cultivating contracts over time.

Get the Report

  • Address patients' non-clinical risk factors in ongoing management. Join us on Thursday, Dec. 7, to learn how to partner with community-based organizations already providing quality non-clinical support for a range of needs, from healthy food access to stable housing, to scale patient management beyond traditional care settings.

Register Here

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