Health Law Monitor
HHS Sets Clear Goals and Timeline to Transition From Volume to Value-Based Medicare Reimbursement
February 3, 2015
By: Rachel D. Ludwig
On January 26, 2015, the United States Department of Health and Human Services (“HHS”) Secretary Sylvia M. Burwell (the “Secretary”) reiterated the government’s commitment to move Medicare from fee-for-service (FFS) payments to value-based reimbursement. The Secretary published measurable goals and a timeline for the Medicare program to pay providers based on quality rather than quantity.
The Medicare timeline and goals are as follows:
|
Year |
Percentage of Medicare FFS payments tied to quality or value through programs such as the Hospital Value Based Purchasing and the Hospital Readmissions Reduction Programs |
Percentage of all Medicare payments tied to quality or value through alternative payment models such as Accountable Care Organizations and bundled payment arrangements |
|
2016 |
85% |
30% |
|
2018 |
90% |
50% |
The Secretary also announced her intent to work with states and private payors to support the adoption and achievement of these goals beyond the Medicare program and throughout the healthcare system. The creation of the Health Care Payment Learning and Action Network (the “Network”), which includes private payers, employers, consumers, providers, states and state Medicaid programs, and others, will enable HHS to work with all stakeholders to expand alternative payment models into their programs. The first meeting of the Network is scheduled for March, 2015.
Just two days later on January 28th, the development of the Health Care Transformation Task Force (the “Task Force”) and its goals were publicized. Members of the Task Force include large health systems such as Ascension Health, Trinity Health, Partners Healthcare, and Advocate Healthcare, insurance companies including Aetna and Health Care Services Corp, as well as Caesars Entertainment and the Pacific Business Group on Health. The goal of the Task Force is to shift 75% of the participants’ business to contracts with quality and cost incentives by 2020.
The value-based reimbursement initiatives seek to improve health, lower cost, and provide a better patient experience by incentivizing providers to deliver higher quality services, to control costs appropriately, and to be held accountable if the goals are not achieved. The recent initiatives and goals make it clear that value-based reimbursement will dominate the future healthcare landscape. Providers must prepare for and embrace the goals associated with the alternative payment models to ensure future sustainability.
This article was authored by Lindsay Darling Petrosky and Rachel D. Ludwig, Jackson Kelly PLLC.