While the Patient-Centered Medical Home (PCMH) model has increasingly been embraced by providers and payers as a way to improve health care and lower costs, many questions remain about its effectiveness. Definitions of medical homes vary, but they are generally known as a model that aims to transform primary care through increased coordination and communication among a team of providers. Recent medical home initiatives have encouraged primary care practices to invest in capabilities such as patient registries and electronic health records, and to achieve medical home recognition. Health plans offer to pay more to the practices that achieve recognition.
Congress is as close as it has ever been to scrapping the Medicare sustainable growth rate (SGR) for an alternative system of paying doctors based on the quality – rather than the quantity – of services.
Healthier and Wealthier, or Sicker and Poorer? Prospects for Medicare Beneficiaries Now and in the Future
Although Medicare reform is not currently a front-burner issue, proposals to reduce Medicare spending appear regularly on the policy agenda. Various Medicare savings proposals have recently emerged in the context of efforts to control the national deficit and debt, and could arise in the next few months when Congress considers how to modify Medicare’s physician payment policy to avoid a precipitous reduction in physician fees. The recently passed bipartisan budget deal delayed a reduction in Medicare payments to physicians until April, and any effort to permanently replace the existing system by which Medicare pays physicians will be costly.
Increasingly, hospitals are “observing,” instead of admitting, Medicare beneficiaries, even when they are there for more than 48 hours.
Many employers have begun to adopt a strategy known as “reference pricing” to help reduce health care costs. Under this benefit design, employees get insurance plans that set price caps on certain services and procedures. Enrollees are allowed to use any provider. But if they use providers with fees higher than the “reference price,” they must pay the difference between the reference price limit, determined by the employer or insurer, and the actual charge.
Health care policy leaders are counting on public and private initiatives, such as paying for performance, to improve value in the health care equation in which cost and quality at times seem to be at odds.
The pace of health care consolidation is accelerating. Over half of hospitals were exploring a possible merger in 2013, and half were also planning to purchase physician practices. The dollar value of those acquisitions declined, however, as recent purchases have been less about megamergers and more about smaller entities as the newer targets of acquisition.
More than a third of Pioneer ACOs succeeded in reducing costs in Medicare in their first year, according to a recent Centers for Medicare and Medicaid Services (CMS) report. The program initially saved Medicare about $87 million and cut Medicare spending by 0.5 percent.
Medical malpractice reform has been a contentious area of debate among health care policymakers. The resources in this new Toolkit, co-written by Shane Durkin and Erin Buchanan of the Alliance, will help you understand why this has been a partisan debate throughout the years and describe the research behind traditional tort reform. It will also help you understand the more innovative approaches being tested and what we should look forward to in the effort to reform the medical liability system.
Beginning on Oct. 1, 2012, hospitals for the first time faced a financial penalty for readmitting a Medicare patient whom they had already cared for in the past month. Data shows that readmissions have already fallen, although the policy remains controversial.
The federal government has launched demonstration projects to test whether patient-centered medical homes (PCMHs) can tackle some of the biggest problems facing the nation’s health care system. Advocates are holding out hope that medical homes will help to slow the growth of health care spending while improving the quality of care. The medical home is a model that aims to transform the organization and delivery of primary care. The PCMH model focuses on personalized care, teamwork, and coordination of care to ensure that patient needs are met effectively and efficiently. The Patient Protection and Affordable Care Act (ACA) provides opportunities for the PCMH model by supporting nationwide medical home demonstration projects administered by the Center for Medicare and Medicaid Innovation (CMMI).
Health spending in the U.S. climbed to $2.7 trillion and constituted 17.9 percent of the nation’s gross domestic product (GDP) in 2011. A recent report released by actuaries at the Centers for Medicare and Medicaid Services (CMS) found that health spending as a share of GDP remained steady at 17.9 percent from 2009 through 2011. Despite that stability, some analysts warn that, as the economy improves and the population ages, cost increases could again accelerate. Effects of cost constraining provisions in the Patient Protection and Affordable Care Act (PPACA) are largely unknown, since major provisions will not be implemented until 2014.
Electronic devices are pervasive throughout our culture. Still, they are a relatively new phenomenon in the physician’s office, even though electronic health records (EHRs) can help consumers stay connected with their care managers, monitor their health, and get reminders that it’s time to take their medicine. They can also help to better coordinate care, avoid duplication of services and eliminate medication errors.
There is widespread agreement that the current health care delivery system is fragmented. Your primary care physician may be the last to know what your cardiologist is doing, or your radiologist or pharmacist, for that matter. Though the providers may be well trained and supplying good care, they are part of a system that is less than efficient, a problem that could only get worse as the population ages and chronic conditions become more prevalent.
A consumer walks down the street using a smartphone – but rather than texting a friend, calling home or checking email, she is reporting data that will inform a clinician about the status of her asthma management. Is this scenario real or fantasy? As Americans grow more and more comfortable with technology in daily life – at work, at home and at play – one wonders why personal technology isn’t more widely used in health care. Patients are frustrated that they can’t access many of their providers through email; that they have to fill out paper forms multiple times, even in the same office; and that they must endure an office visit to their provider to have their progress monitored when they can visit their relatives across the ocean through Skype.
Urgent care centers and retail clinics are rapidly emerging within the health care system — a partial response to rising health care costs and a possible flood of new demand for care as the Patient Protection and Affordable Care Act is fully implemented. The number of patient visits to retail health clinics grew by 1,000 percent in just the last two years, according to a RAND Health study.