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Payment Models

  • CMS' Proposed Home Health Payment Model Alarms Providers. Would It Boost Access for Medically Complex Patients? Modern Healthcare by Harris Meyer —The CMS has proposed the largest overhaul of Medicare home health payment in many years, out of concern that the current reimbursement system discourages providers from serving patients with clinically complex or chronic conditions. Critics say Medicare's system now gives home health providers incentives to select patients who need higher-paying therapy services, such as joint replacement, rather than those needing help with traumatic wounds or poorly controlled chronic conditions or who are dually eligible for Medicaid and Medicare. Under the proposed home health groupings model, Medicare payment would be based on patient characteristics rather than number of visits for various forms of therapy. The new system would boost payment for skilled-nursing and home health aide visits for medically complex patients.

  • Providers Find Success in CMS's Multipayer Model Modern Healthcare by Virgil Dickson — In 2012, Clark and her practice began their journey to transform how practitioners delivered care. When the practice was accepted into the CMS's Comprehensive Primary Care Initiative, it moved from the standard care pattern to one that put more emphasis on preventive screenings and follow-ups. Not only did she notice an overall improvement in quality of care, her practice also achieved notable savings under the model. Clark's practice reduced average monthly patient costs by about 40 percent, from more than $1,200 a month to $725 by the time the initiative ended in 2016. The practice also had marked reductions in emergency department utilization and hospitalizations for chronic illnesses. The program helped them decrease costs associated with congestive heart failure by almost 50 percent. 

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