/ en Sat, 26 Apr 2025 17:55:33 -0500 Thu, 27 Mar 25 15:35:32 -0500 /news/headline/2025-03-27-aha-provides-recommendations-ptac-improve-participation-population-based-total-cost-care-primary-and <p>The AHA March 27 made a series of <a href="/lettercomment/2025-03-27-aha-comments-ptac-total-cost-care-model-proposal">recommendations</a> to the Physician‐Focused Payment Model Technical Advisory Committee to address barriers to participating in population-based total cost-of-care and primary and specialty care models. The AHA urged the committee to adopt common principles that would support the implementation of alternative payment models. The AHA also recommended the removal of high and low revenue thresholds that inappropriately prevent certain providers from entering primary and specialty care models. <br><br>The AHA urged an extension of advanced alternative payment model incentive payments as well as more sustainable reimbursement to better support the transition to value-based care. </p> Thu, 27 Mar 2025 15:35:32 -0500 Current & Emerging Payment Models <div class="container"><div class="row"><div class="col-md-8"><p>The Centers for Medicare and Medicaid Services Innovation Center (CMMI) issued <a href="https://www.cms.gov/newsroom/press-releases/statement-cms-innovation-center-aligning-portfolio-statutory-obligation">guidance</a> yesterday to update timelines for certain alternative payment models. The agency will shorten timelines for four models and will no longer pursue two additional models that were previously announced. CMMI estimates that these modifications will result in $750 million in cost savings.</p><p>CMMI will end the following models by Dec. 31, 2025.</p><p><strong>Maryland Total Cost of Care Model (MDTCOC).</strong> MDTCOC began on Jan. 1, 2019, as an evolution of the Maryland all-payer model and was previously scheduled to end on Dec. 31, 2026, providing a one-year transition period for the state as it moved to participate in the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model, scheduled to begin on Jan. 1, 2026.</p><p><strong>Primary Care First (PCF).</strong> PCF began on Jan. 1, 2021, as an evolution of the Comprehensive Primary Care Plus (CPC+) model and was previously scheduled to end on Dec. 31, 2026. There are currently over 1,800 practices and 17 payers participating in PCF across 26 regions. </p><p><u></u></p><p><strong>End Stage Renal Disease (ESRD) Treatment Choice (ETC).</strong> ETC began on Jan. 1, 2021, and was previously scheduled to end on Dec. 31, 2027. The agency indicated it will propose formal rulemaking to end this program early.</p><p><u></u></p><p><strong>Making Care Primary (MCP).</strong> MCP began on July 1, 2024, and was previously scheduled to end Dec. 31, 2034. There are currently over 118 participants across eight states.</p><p><u></u></p><p>CMMI also will no longer pursue the following models, in accordance with President Trump’s rescission of Executive Order 14087:</p><ul><li>Medicare $2 Drug List Model</li><li>Accelerating Clinical Evidence Model</li></ul><p>Participants in models identified for early termination will receive additional information about technical assistance and wind-down periods. The agency also stated it found that the other active models meet statutory criteria as is or with future modification. CMMI also plans to announce a new strategy in the coming days.</p><h2>FURTHER QUESTIONS</h2><p>If you have further questions, please contact Jennifer Holloman, AHA’s senior associate director of payment policy, at <a href="mailto:jholloman@aha.org">jholloman@aha.org</a>. </p></div><div class="col-md-4"><a href="/system/files/media/file/2025/03/cms-innovation-center-announces-portfolio-changes-regulatory-advisory-3-13-2025.pdf"><img src="/sites/default/files/inline-images/cover-cms-innovation-center-announces-portfolio-changes-regulatory-advisory-3-13-2025_0.png" data-entity-uuid="8c76af74-beb7-4617-84fb-4d853f30a193" data-entity-type="file" alt="Regulatory Advisory" width="679" height="878"></a></div></div></div> Thu, 13 Mar 2025 14:52:18 -0500 Current & Emerging Payment Models /lettercomment/2024-12-09-aha-comments-medpac-re-physician-fee-schedule-payments-apm-incentives-and-medicare-advantage-network <p>December 9, 2024</p><p> </p><p>Michael Chernew, Ph.D.<br>Chairman<br>Medicare Payment Advisory Commission<br>425 I Street, NW, Suite 701<br>Washington, D.C. 20001</p><p>Dear Chairman Chernew: </p><p>On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations; our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the ���������� Association (AHA) appreciates the opportunity to share our comments regarding the Medicare Payment Advisory Commission (MedPAC) November meeting sessions related to physician fee schedule payments, advanced alternative payment model (A-APM) incentives and Medicare Advantage (MA) network adequacy.</p><p>In particular, we:</p><ul><li><strong>Directionally support updates to physician reimbursement that are tied to the Medicare Economic Index (MEI) but maintain that the discussed factor of MEI minus 1 is not nearly sufficient to make up for the existing shortcomings in physician reimbursement. </strong></li><li><strong>Oppose penalizing facility-based providers by reducing their reimbursement rates. Doing so is not only inappropriate, but also would create an even greater incentive for physicians to seek out employment from other entities, such as private equity firms and health insurers (which have acquired the vast majority of physician practices during the last five years)</strong>.</li><li><strong>Support an extension of the A-APM incentive payments.</strong></li><li><strong>Encourage the commission to examine the impact of the inadequate MA post-acute care network requirements on beneficiaries’ access to care.</strong></li></ul><p>Our detailed comments on these issues follow.</p> Mon, 09 Dec 2024 12:26:50 -0600 Current & Emerging Payment Models /2024-10-30/aligning-payers-and-partners-value-based-care <div> </div>header.jumbotron {display:none} <div> /* center_body */ .center_body { /*margin-top:50px;*/ /* margin-bottom: 50px;*/ } .center_body h3 {} .center_body p { font-size: 16px } p.center_Intro { color: #002855; line-height: 1.2em; font-size: 30px; margin: 10px 0 25px 0; font-weight: 700; font-size: 2em; } @media (max-width:768px) { p.center_Intro { line-height: 1.2em; font-size: 23px; font-size: 1.45em; } } .center_body .center_Lead { color: #63666A; font-weight: 300; line-height: 1.4; font-size: 21px; } /* center_body // */ /* Banner_Title_Overlay_Bar */ .Banner_Title_Overlay_Bar { position: relative; display: block; overflow: hidden; max-width: 1170px; margin: 0px auto 25px auto; } .Banner_Title_Overlay_Bar h1 { position: absolute; bottom: 40px; color: #003087; background-color: rgba(255, 255, 255, .8); width: 100%; padding: 20px 40px; font-size: 3em; box-shadow: 0 3px 8px -5px rgba(0, 0, 0, .6); } @media (max-width:991px) { .Banner_Title_Overlay_Bar h1 { bottom: 0px; margin: 0px; font-size: 2.5em; } } @media (max-width:767px) { .Banner_Title_Overlay_Bar h1 { font-size: 2em; text-align: center; text-indent: 0px; padding: 10px 20px; } } @media (max-width:530px) { .Banner_Title_Overlay_Bar h1 { position: relative; background-color: #63666A22; } } /* Banner_Title_Overlay_Bar // */ <header class="Banner_Title_Overlay_Bar"><img src="/sites/default/files/2024-10/KnowEx_CorroHealthh_Medicaid_banner_1170x250.png" alt="Banner Image" width="1170" height="250"><div><h1>Aligning Payers and Partners for Value-based Care</h1></div></header>/* CntMenuSub */ .CntMenuSub{ margin:20px 0px; padding-bottom: 5px; color: #afb1b1; letter-spacing: 1.5px; font-weight: 400; font-size: .7em; } .CntMenuSub .CntMenuBar{ border-bottom: 1px solid lightblue; } .CntMenuSub .CntMenuBar a:after{ content: "|"; padding: 0 3px 0 6px; color: #555; } .CntMenuSub .CntMenuBar a:last-child:after{ content: ""; } .CntMenuSub .CntMenuSubHome, .CntMenuSub .CntMenuSubParent{ text-transform: uppercase; color: #555; opacity: .9; } .CntMenuSub .CntMenuSubParent{ } .CntMenuSub .CntMenuSubChild{ } .CntMenuSub .CntMenuSubCurrent{ opacity: .7; } .CntMenuSub .CntMenuSubHome:hover, .CntMenuSub .CntMenuSubParent:hover{ text-transform: uppercase; color: #d50032; } /* CntMenuSub // */ <div class="container CntMenuSub"><div class="col-md-1"> </div><div class="col-md-10 row CntMenuBar"><a class="CntMenuSubHome" href="/education-events/aha-virtual-executive-dialogues">AHA Knowledge Exchange</a> <span class="CntMenuSubChild" id="CntMenuSubChild">Aligning Payers and Partners for Value-based Care</span></div><div class="col-md-1"> </div></div><div class="row spacer"><div class="col-sm-3"><div><a href="#DownloadFile" target="_blank"><img src="/sites/default/files/2024-10/KnowEx_CorroHealthh_Medicaid_cover_910x1220.jpg" alt="AHA Knowledge Exchange | Aligning Payers and Partners for Value-based Care" width="100%" height="100%"></a></div></div><div class="col-sm-9 center_body">.sponsortype { color: #9d2235; font-size: 1.5em; margin: 0px; font-weight: 700; } <p class="sponsortype">AHA Knowledge Exchange</p> xxxxxx </p> --> Intro.............. </p> --><h2>Hospitals and payers are compelled to align goals and expectations across the care continuum</h2><p>As the health care field adopts value-based care models, hospitals, providers and payers are compelled to align goals and expectations across the care continuum to increase access to evidence-based, preventive and equitable care. Regulatory and market changes are impacting organizations’ value-based care strategies, calling attention to both challenges and opportunities. Data and analytics measure how initiatives influence consumer experience, patient satisfaction, quality and cost of care. This Knowledge Exchange e-book provides insights on how hospital and health system leaders are investing and partnering in this evolving landscape to create sustainable value for their communities.</p><div class="row">@media (min-width:768px){ .EDsponsorFloat{ float:right; } } @media (max-width:767px){ .EDLinkFloat{ position:relative; left:27%; } .EDsponsorFloat { text-align:center } } <div class="col-sm-6"><a class="btn btn-wide btn-primary EDLinkFloat" href="#DownloadFile" title="AHA Knowledge Exchange | Aligning Payers and Partners for Value-based Care" data-view-context="top-level-view">Download the Report</a></div><div class="col-sm-6"><div class="EDsponsorFloat">Sponsored by: <a href="https://corrohealth.com/" target="_blank" rel="noopener nofollow"><img src="/sites/default/files/2024-07/CorroHealth_logo_transparent_834x313.png" alt="CorroHealth Logo" width="100%" height="100%"></a></div></div></div></div></div>.sp_CTA5_holder { margin-top:0px; border-bottom: solid 1px #555; 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font-size: 28px; } .sp_CTA5_section{ margin-top: 25px } .sp_CTA5_ImgShadow { /*background-color:green;*/ /* just a visual */ text-align: center } .sp_CTA5_ImgShadow { padding-bottom:75px; /* must match the padding on the img*/ margin: 0px; } .sp_CTA5_ImgShadow img{ width: calc(100% - 35px - 15px); -webkit-box-shadow: 50px -75px 0px 0px rgba(185, 217, 235, 1); -moz-box-shadow: 50px -75px 0px 0px rgba(185, 217, 235, 1); box-shadow: 50px -75px 0px 0px rgba(185, 217, 235, 1); position: relative; top: 75px; max-width: 490px; } @media (max-width:990px){ .sp_CTA5_ImgShadow img{ max-width: 350px;} } @media (max-width:990px){ .sp_CTA5_ImgShadow { padding-bottom:75px; /* must match the padding on the img*/ margin: 0px; margin-right: 40px } } <div class="row spacer sp_CTA5_holder sp_CTA5_holder_last"><div class="col-md-12"><h3>8 steps hospital and health system leaders are taking toward value-based care</h3><div class="sp_CTA5_section"><ul><li>Determine areas that could benefit from value-based models such as those with lower outcomes, higher costs, and unwarranted variation in process or supplies.</li><li>Align on outcomes measures and benchmarks and carefully formulate and define accountability across systems and partners in value-based contracting.</li><li>Build sufficient volume to support the necessary data analytics, organizational structure and case management function.</li><li>Change workforce culture to support wellness and support care delivered effectively and efficiently outside the hospital.</li><li>Identify clinical champions and incentivize physicians and other providers to improve outcomes and standardize clinical care.</li><li>Engage patients in supporting their own health; work with other community leaders to support a healthier population.</li><li>Strive to better meet the expectations of your patients and the entire community, learning from data and conversations how your hospital is viewed now, and what they wish could be better.</li><li>Identify and use robust analytic strategies and risk-based stratification to understand the critical opportunities to improve community health.</li></ul></div></div></div><h2>Participants</h2>/* people */ .people { margin-top: 50px; } .people img:nth-child(1) { border-radius: 200px; -moz-border-radius: 200px; -webkit-border-radius: 200px; margin-bottom: 10px; max-width:200px; /* for Transformation Talks */ display:block; /* for Transformation Talks */ margin:auto; /* for Transformation Talks */ } .people img:nth-child(1):hover { opacity: .7 } @media (max-width:991px) { .people { margin: auto; } .people p { text-align: center } } .ci_profile { margin-bottom: 30px; display: block; text-align:center /* this is for the "Executive Dialogue" page */ } @media (max-width:991px) { .ci_profile { text-align: center } } .ci_profile p { margin: 0 0 7px 0 } .ci_profile_name { font-weight: 700; font-size: 20px; } p.ci_profile_name { font-size: 1.5em; line-height:1.2em; margin-top:10px } .ci_profile_title { font-style: italic; line-height: 1.3em } .ci_profile_company { font-size: 1em; } p.ci_profile_award { font-size: .8em; text-align:center; color:#55555599; font-weight: 700 } .ci_profile_social { width: auto; } .ci_profile_social i { padding-right: 25px; font-size: 20px } .ci_profile_social a:last-of-type i { padding-right: 0px; } #ci_footer-social { font-size: 1.5em; padding-top: 0px; width: 100%; text-align: right; } @media (max-width:991px) { .ci_logo { margin-top: 25px } .ci_social p { text-align: center !important; } #ci_footer-social { text-align: center } } @media (min-width:769px){ .people .rowEqual_768 { display: -webkit-box; display: -webkit-flex; display: -ms-flexbox; display: flex; flex-wrap: wrap; } .people .rowEqual_768>[class*='col-'] { -ms-flex: 3; /* IE 10 */ flex: inherit; /*flex*/ width: calc((100% / 3) - 2px) /*Adjust % for the number per row, will override the bootstrap - Also needed for Safari*/; } } @media (max-width:767px) and (min-width:361px){ .people .rowEqual_768 { display: -webkit-box; display: -webkit-flex; display: -ms-flexbox; display: flex; flex-wrap: wrap; } .people .rowEqual_768>[class*='col-'] { -ms-flex: 1; /* IE 10 */ flex: auto; width: calc((100% / 2) - 2px) /*Adjust % for the number per row, will override the bootstrap - Also needed for Safari*/; } } p.ci_profile_name { font-size: 1.5em; line-height:1.2em; margin-top:10px } .people .ci_profile_combined{ font-size:14px; line-height: 18px; } .people .ci_profile_combined span{ font-style: italic; } .people .ci_profile_combined:before{ content:""; border-bottom: solid 1px #55555522; display: block; clear: both; width: 85%; margin: 5PX auto 10px; } <div class="people"><div class="row rowEqual_768"><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Blaber_Reginald_300x300.png" alt="Reg Blaber" width="300" height="300"><p class="ci_profile_name">Reg Blaber, M.D., MBA</p><p class="ci_profile_title">Executive Vice President and Chief Clinical Officer</p><p class="ci_profile_company">Virtua Health</p></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Burwell_David_300x300.png" alt="David Burwell" width="300" height="300"><p class="ci_profile_name">David Burwell, M.D., MBA</p><p class="ci_profile_title">Vice President of Medical Affairs and Chief Quality Officer</p><p class="ci_profile_company">UPMC</p></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Casey_Susan_300x300.png" alt="Susan Bleasdale Casey" width="300" height="300"><p class="ci_profile_name">Susan Bleasdale Casey, M.D., FACP, FIDSA</p><p class="ci_profile_title">Vice President and Chief of Quality and Safety</p><p class="ci_profile_company">University of Maryland Medical Center</p></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Chessare_John_300x300.png" alt="John Chessare" width="300" height="300"><p class="ci_profile_name">John Chessare, M.D., MPH</p><p class="ci_profile_title">President and CEO</p><p class="ci_profile_company">GBMC HealthCare</p></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Chung_Jimmy_300x300_0.png" alt="Jimmy Chung" width="300" height="300"><p class="ci_profile_name">Jimmy Chung, M.D., MBA, FACS, CPE</p><p class="ci_profile_title">Chief Medical Officer</p><p class="ci_profile_company">Advantus Health Partners<br>Bon Secours Mercy Health</p></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Fattig_Marty_300x300.png" alt="Marty Fattig" width="300" height="300"><p class="ci_profile_name">Marty Fattig</p><p class="ci_profile_title">CEO</p><p class="ci_profile_company">Nemaha County Hospital</p></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Hino_Raymond_300x300.png" alt="Raymond Hino" width="300" height="300"><p class="ci_profile_name">Raymond Hino</p><p class="ci_profile_title">CEO</p><p class="ci_profile_company">Southern Coos Hospital & Health Center</p></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Kao_Cheng_300x300_0.png" alt="Melinda Muller" width="300" height="300"><p class="ci_profile_name">Cheng-Kai Kao, M.D.</p><p class="ci_profile_title">Chief Medical Information Officer</p><p class="ci_profile_company">UChicago Medicine</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Ketelsen_Carey_300x300_1.png" alt="Carey Ketelsen" width="300" height="300"><p class="ci_profile_name">Carey Ketelsen, RHIA, CRC</p><p class="ci_profile_title">Senior Vice President, Coding Solutions</p><p class="ci_profile_company">CorroHealth</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Koekkoek_Doug_300x300%20%281%29.png" alt="Doug Koekkoek" width="300" height="300"><p class="ci_profile_name">Doug Koekkoek, M.D., FACP, SFHM</p><p class="ci_profile_title">Chief Physician and Clinical Executive</p><p class="ci_profile_company">PeaceHealth</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Merz_Steve_300x300.png" alt="Stephen Merz" width="300" height="300"><p class="ci_profile_name">Stephen Merz, FACHE</p><p class="ci_profile_title">Chief Operating Officer</p><p class="ci_profile_company">Sheppard Pratt Solutions</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Morrissey_Jerilyn_300x300.png" alt="Jerilyn Morrissey" width="300" height="300"><p class="ci_profile_name">Jerilyn Morrissey, M.D.</p><p class="ci_profile_title">Chief Medical Officer</p><p class="ci_profile_company">CorroHealth</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Muna_Esther_300x300.png" alt="Esther Muña" width="300" height="300"><p class="ci_profile_name">Esther Muña, Ph.D., MHA, FACHE</p><p class="ci_profile_title">CEO</p><p class="ci_profile_company">Commonwealth Healthcare Corp.</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Nester_Brian_300x300.png" alt="Brian Nester" width="300" height="300"><p class="ci_profile_name">Brian Nester, D.O., MBA</p><p class="ci_profile_title">President and CEO</p><p class="ci_profile_company">Lehigh Valley Health Network</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Ogden_Lesley_300x300.png" alt="Lesley Ogden" width="300" height="300"><p class="ci_profile_name">Lesley Ogden, M.D., MBA</p><p class="ci_profile_title">CEO</p><p class="ci_profile_company">Samaritan North Lincoln and Pacific Communities Hospitals</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Wilson_James_300x300.png" alt="Jim Wilson" width="300" height="300"><p class="ci_profile_name">Jim Wilson, MBA</p><p class="ci_profile_title">Chief Financial Officer</p><p class="ci_profile_company">Mayo Clinic Health System</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-04/Hoppszallern_Suzanna_300x300%20%281%29.png" alt="Suzanna Hoppszallern" width="300" height="300"><p class="ci_profile_name">Moderator:</p><p class="ci_profile_name">Suzanna Hoppszallern</p><p class="ci_profile_title">Senior Editor, Center for Health Innovation</p><p class="ci_profile_company">���������� Association</p></div></div></div><div class="raw-html-embed"> .SponsorMarketoForm { background-color: ; padding: 5px 25px; border: solid 2px #307FE2; margin: 50px 15px 0px !important; display: inline-block; width: 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center_callout_3invert"><div class="col-md-1"> </div><div class="col-md-10"><h2>AHA Knowledge Exchange</h2><p>Gain insights from the C-suite and health care leaders on the most pressing issues and transformational strategies.</p><p><a class="btn btn-wide btn-primary" href="/education-events/aha-virtual-executive-dialogues" data-view-context="top-level-view">Explore the Series</a> </p></div><div class="col-md-1"> </div></div><div class="row spacer"><h2>Latest Knowledge Exchange</h2><div class="feedEmbedImg"> .feedEmbedImg .views-element-container { background-color: #f6f6f6; ; padding: 20px } .feedEmbedImg .views-element-container h2 { margin-top: 0px; color: } .feedEmbedImg .views-element-container .views-field.views-field-created { color: } .feedEmbedImg .views-element-container .views-field.views-field-title a { font-size: 20px; color: #002855 } .feedEmbedImg .views-element-container .views-field.views-field-body { font-size: 16px; color: ; } .feedEmbedImg .views-element-container 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class="resource-wrapper"> <div class="resource-view"> <div class="article views-row"> <div class="views-field views-field-field-page-title-background"> <div class="field-content sed-thumb"> <a href="/member-knowledge-exchange/2024-12-11/resilient-health-system-operating-model" hreflang="en"><img loading="lazy" src="/sites/default/files/styles/small_200x200/public/2024-12/VED_Accenture_Governance_620x381.jpg?itok=viVBuq-l" width="200" height="123" alt="VED_Accenture_Governance_620x381-image" /> </a> </div> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2024-12-10T16:11:13-06:00">Dec 10, 2024</time> </span> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/member-knowledge-exchange/2024-12-11/resilient-health-system-operating-model" hreflang="en">The Resilient Health System Operating Model</a></span> </div><div class="views-field views-field-body"> <div class="field-content">Health system leaders are building a robust governance and resilient operating model to transform health care delivery models for the future.</div> </div></div> <div class="article views-row"> <div class="views-field views-field-field-page-title-background"> <div class="field-content sed-thumb"> <a href="/member-knowledge-exchange/2024-12-06/optimize-your-hospitals-revenue-cycle-efficient-patient-centered-operations" hreflang="en"><img loading="lazy" src="/sites/default/files/styles/small_200x200/public/2024-12/KnowEx_RI_RevenueCycle_620x381_rev1.jpg?itok=42C41VMq" width="200" height="123" alt="KnowEx_RI_RevenueCycle_620x381_rev1" /> </a> </div> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2024-12-05T14:26:53-06:00">Dec 5, 2024</time> </span> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/member-knowledge-exchange/2024-12-06/optimize-your-hospitals-revenue-cycle-efficient-patient-centered-operations" 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views-field-created"> <span class="field-content"><time datetime="2024-10-29T15:17:14-05:00">Oct 29, 2024</time> </span> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/2024-10-30/aligning-payers-and-partners-value-based-care" hreflang="en">Aligning Payers and Partners for Value-based Care</a></span> </div><div class="views-field views-field-body"> <div class="field-content">As value-based care models grow, hospitals, providers and payers need to align goals and incentives to improve patient outcomes and reduce costs.</div> </div></div> <div class="article views-row"> <div class="views-field views-field-field-page-title-background"> <div class="field-content sed-thumb"> <a href="/2024-09-26/transforming-behavioral-health-journey" hreflang="en"><img loading="lazy" src="/sites/default/files/styles/small_200x200/public/2024-09/Iris-Telehealth-banner-620x381.jpg?itok=QQ9C-7Mp" width="200" height="123" alt="Iris-Telehealth-banner-620x381" /> </a> </div> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2024-09-25T14:49:38-05:00">Sep 25, 2024</time> </span> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/2024-09-26/transforming-behavioral-health-journey" hreflang="en">Transforming the Behavioral Health Journey</a></span> </div><div class="views-field views-field-body"> <div class="field-content">Transforming the behavioral health journey with strategic initiatives to build a sustainable and coordinated behavioral health services continuum.</div> </div></div> </div> </div> <div class="more-link"><a href="/aha-knowledge-exchange-archive">View All: AHA Knowledge Exchange</a></div> </section> </div> </div></div> Tue, 29 Oct 2024 15:17:14 -0500 Current & Emerging Payment Models /news/headline/2024-10-23-cms-anticipates-later-start-date-mandatory-organ-transplant-payment-model <p>The Centers for Medicare & Medicaid Services recently <a href="https://www.cms.gov/priorities/innovation/innovation-models/iota">announced</a> that they anticipate a later start date for the Increasing Organ Transplant Access Model. The agency stated that it is “continuing to work on the final rule and is consequently anticipating a later start date for the model than the proposed start date of January 1, 2025.” The mandatory payment model would test whether performance-based incentive payments paid to or owed by participating kidney transplant hospitals would increase kidney transplant access while preserving or enhancing the quality of care and reducing Medicare expenditures. In July, the AHA informed the Center for Medicare and Medicaid Innovation that the IOTA model would add unnecessary disruption and uncertainty to the transplant ecosystem, potentially incentivize sub-par matches given the heavy emphasis on volume and would be discordant with other regulatory requirements. </p><p>"Complex (not to mention successful) payment model implementation requires significant time, resources and staffing by hospital participants," <a href="/lettercomment/2024-07-16-aha-letter-cms-increasing-organ-transplant-access-iota-model">AHA wrote</a>. "But, CMMI has proposed an IOTA start date of Jan. 1, 2025 — less than six months from now and an even briefer time from when the rule will be in its final form. It would notify participants of their mandatory participation with as little as three months’ notice. Given the organ transplant system’s transformation already occurring as mentioned above, this aggressive timeline is untenable."</p> Wed, 23 Oct 2024 15:27:52 -0500 Current & Emerging Payment Models /news/headline/2024-10-17-cms-requests-team-participants-complete-id-form-issues-voluntary-opt-team-bpci-cjr-model-participants <p>The Centers for Medicare & Medicaid Services Oct. 17 issued a reminder that participants in the mandatory <a href="https://www.cms.gov/priorities/innovation/innovation-models/team-model">Transforming Episode Accountability Model</a> should have a representative complete the <a href="https://forms.office.com/pages/responsepage.aspx?id=we3c-6lwS0G_pcMGP8M5Xi8gVQPpbxJCnEg9aNzRLOxUNjI4Wkc2VE0yQ0RUQzYxRE5NRjVLSVdGNy4u&route=shorturl">TEAM Primary Point of Contact Identification Form</a>. The form identifies two individuals to serve as primary contacts for TEAM-related updates and communication with CMS. Hospitals can check the <a href="https://www.cms.gov/team-model-participant-list">list</a> of participants that CMS published in order to verify whether they were selected for the model. <br><br>In addition, CMS reiterated a one-time voluntary opt-in opportunity for hospitals participating in the Bundled Payments for Care Improvement Advanced Model until Dec. 31, 2025 and those participating in the Comprehensive Care for Joint Replacement Model until Dec. 31, 2024. Eligible and interested hospitals must submit a written participation election letter to CMS between Jan. 1-31, 2025. CMS said it would provide details about the form and submission process closer to the date.</p> Thu, 17 Oct 2024 16:04:01 -0500 Current & Emerging Payment Models Mon, 23 Sep 2024 13:03:15 -0500 Current & Emerging Payment Models /news/headline/2024-09-09-aha-urges-cms-congress-provide-physician-payment-increase-2025 <p>The AHA Sept. 9 <a href="/lettercomment/2024-09-09-aha-comments-cms-physician-fee-schedule-cy-2025-proposed-rule">urged</a> the Centers for Medicare & Medicaid Services to work with Congress on providing a pay increase for physicians in 2025 and develop a long-term plan for sustainable physician payment. AHA expressed its concerns to CMS while commenting on the agency's<a href="https://public-inspection.federalregister.gov/2024-14828.pdf"> calendar year 2025 physician fee schedule proposed rule</a>, in which the proposed payment update would reduce payments approximately 2.8% from CY 2024 levels. Additionally, the AHA shared concerns on CMS' proposed updates to Medicare Parts A and B overpayment policies, saying the agency’s proposed 180-day window to suspend reporting and repayment to complete overpayment investigations is insufficient. The AHA proposed that CMS provide "sufficient exceptions" when complex, multi-year or multi-site investigations require time beyond 180 days. The AHA was pleased to see proposed extensions of several telehealth waivers, including virtual supervision waivers, as well as proposed policies to exclude anomalous spending from Medicare Shared Savings Program financial calculations.<br> </p> Mon, 09 Sep 2024 16:05:45 -0500 Current & Emerging Payment Models /news/headline/2024-09-05-cms-releases-participant-list-proposed-transforming-episode-accountability-model <p>The Centers for Medicare & Medicaid Services Sept. 5 published a <a href="https://www.cms.gov/priorities/innovation/innovation-models/team-model">list of participants</a> for the Transforming Episode Accountability Model. TEAM is a mandatory payment model that will bundle payment to acute care hospitals for five types of surgical episodes. The AHA June 10 <a href="/news/headline/2024-06-10-aha-urges-cms-make-transforming-episode-accountability-model-voluntary">urged</a> CMS to make the model voluntary, however the mandatory model was finalized in the CY 2025 Inpatient Prospective Payment System Final Rule.</p> Thu, 05 Sep 2024 16:04:31 -0500 Current & Emerging Payment Models /news/headline/2024-07-16-aha-urges-cmmi-not-implement-proposed-mandatory-organ-transplant-payment-model <p>The AHA July 16 <a href="/lettercomment/2024-07-16-aha-letter-cms-increasing-organ-transplant-access-iota-model">urged</a> the Center for Medicare and Medicaid Innovation not to implement its newly proposed Increasing Organ Transplant Access Model as currently constructed, expressing concerns about many of its design features. The proposed mandatory payment model would test whether performance-based incentive payments paid to or owed by participating kidney transplant hospitals would increase access to kidney transplants while preserving or enhancing the quality of care and reducing Medicare expenditures. AHA said that IOTA features could exacerbate inequities and negatively impact quality of care. Specifically, AHA said the IOTA model would add unnecessary disruption and uncertainty to the transplant ecosystem, potentially incentivize sub-par matches given the heavy emphasis on volume and would be discordant with other regulatory requirements. </p> Tue, 16 Jul 2024 15:43:01 -0500 Current & Emerging Payment Models