March saw the HHS come out with details on their goal to tie 30 percent of Medicare payments to alternative payment models (APM). These are meant to award quality over quantity of care services coming in from the beneficiaries. The target was realized a year before schedule, which proved that it is definitely welcoming, while still surprising many, given the track record of the agency, which adheres to deadlines. This makes over 10 million Medicare patients who have been getting care that mainly ties in with quality.
The goal was first set in January last year, and envisioned 30 percent of the payments being tied to quality by 2017, and 50 percent by 2018. The feat marks a beginning of the crossover from fee-for-service (FFS) Medicare payments, through the use of APMs and Accountable Care Organizations system (ACO) or bundled payments. Lawmakers have contended over the need to move these payments and others, away from the volume based system for reimbursement, to something that is driven by the value of care the patients can access. This is one of the reasons for increased Federal action in this area over the past few years, and the current announcement shows that this has been showing results.
ACOs are one of the prominent examples of APMs, being systems where practices and care organizations band together under accountability for the health and cost of providing care for the large population of patients. If this means they have to meet some quality thresholds and lower the total cost of the care they provide patients, the ACO has the option of sharing the difference with Medicare. Another example of APMs is bundle payments, where providers agree to accept an overall payment, which will cover all, or most of the services involved in the episode of care for a specific patient. Almost 20 percent of payments would be made through these programs after the announcement of the goal, which was in early 2015.
The models brought forth are intended to achieve addressing of many problems being faced by patients and physicians; through the creation of a more efficient system that can address patient frustrations arising from the fragmented nature of care through more than one provider, and also any lost or misplaced medical information such as medical charts, duplicated procedures and tests, and other difficulties.