Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

At-Home Service Value-Based Care Model Saves Medicare $10M

CMS reduced Medicare spending using a value-based care model designed to reduce costs and improve quality for at-home primary care.

By Jacqueline Belliveau

- A value-based care model designed to deliver at-home primary care services to patients who suffer from multiple chronic diseases has continued to improve beneficiary outcomes and reduce Medicare spending.

Medicare saved $10 million through at-home services value-based care model

Medicare saved $10 million during the second performance year of the Independence at Home Demonstration, CMS announced on its website. The program saved an average of $1,010 per beneficiary.

“The Independence at Home Demonstration is a patient-centered model that supports providers in caring for chronically ill patients in their own homes,” said Patrick Conway, MD, CMS Acting Deputy Administrator and Chief Medical Officer. “These results continue to support what most patients already want – the ability to have high quality care in the home setting.”

The three-year alternative payment model aims to test the effectiveness of providing primary care services to Medicare beneficiaries at home. Participating healthcare providers are expected to deliver timely and appropriate care in efforts to decrease the risk of hospitalization, improve patient and caregiver satisfaction, boost patient outcomes, and reduce Medicare spending.

Participants can earn value-based incentives through the Independence at Home Demonstration by reporting and improving care quality based on six quality measures. Practices also qualify for incentive payments if they are able to generate Medicare savings that meet a minimum requirement under a shared savings agreement.

In its second performance year, CMS awarded $5.7 million in value-based incentive payments to seven participating practices for reducing overall healthcare costs and improving the quality of care.

While only seven practices received incentive payments, CMS noted that all 15 participants improved care quality from the first performance year in at least two quality measures used to calculate reimbursements. Four of the practices also met performance measures for all six of the quality measures.

The federal agency also reported that most of the 10,000 Medicare beneficiaries covered by the Independence at Home Demonstration experienced the following in the second performance year:

• Follow-up contact from their provider within 48 hours of a hospital admission, hospital discharge, and emergency department visit

• Fewer hospital readmissions within 30 days

• Medication reviews and identifications by providers within 48 hours of a hospital discharge

• Preferences documented by their provider

• Reduction in the use of inpatient hospital and emergency department services for conditions, including diabetes, high blood pressure, asthma, and urinary tract infections

Additionally, the alternative payment model also underwent several changes to its shared savings methodology. During the second performance year, CMS found several potential issues under the regression-based methodology, which calculates shared savings by comparing beneficiaries in the program to similar Medicare beneficiaries who do not receive at-home primary care.

“CMS conducted many analyses concerning the comparability issues,” the accompanying fact sheet stated. “Revisions for the second performance year were made to the variables describing beneficiaries that are used for matching and the selection of beneficiaries treated by Independence at Home practices for analysis.”

The federal agency also modified the detailed health characteristics and other variables used for matching beneficiaries to the program. The changes particularly affected beneficiaries that were included in the first performance year, but did not meet criteria to continue into the second performance year.

Through the alternative payment model, CMS intends to help reach the Administration-wide goal of linking Medicare payments to value-based reimbursement structures.

“The Independence at Home Demonstration is part of the Administration’s broader strategy to improve the healthcare system by paying practitioners for what works, unlocking health care data, and finding new ways to coordinate and integrate care to improve quality,” stated the press release.

In July, four Senators introduced a bill that would expand the Independence at Home Demonstration nationwide and make it a permanent Medicare alternative payment model.

“It’s time to turn the successful experiment that is Independence at Home into a nationwide practice,” said Senator Edward Markey (D-MA) on his website. “We can design Medicare so that it works smarter, not harder for its beneficiaries. Independence at Home allows teams of doctors and nurses to continue to care for severely ill Medicare patients in the home, bringing the house calls of yesteryear into the 21st century.”

The Senate has not voted on the bill yet, but it has referred it to the Committee on Finance.

Dig Deeper:

Preparing the Healthcare Revenue Cycle for Value-Based Care

Medicare Spending Up, Medicare Shared Savings Requires Risk

Continue to site...