Bundled Payments Fall Short Of Expectations In Cutting Spending, Improving Quality
The federal government, hospitals and physicians have been gravitating toward bundled payments, but new studies challenge the belief that they help achieve cost savings. Meanwhile, CMS is proposing changes to Medicare Advantage payments for 2021, including an increase in the percentage of patient "encounter data" used to calculate payments.
Bundled Payments Cut Spending Only For Joint Replacements
Medicare's voluntary bundled-payment program for hip and knee replacements reduced spending by 1.6% from 2013 to 2016 — less than previously estimated — with no overall change in quality, according to a new study in Health Affairs. Another new Health Affairs study reported that lower extremity joint replacement is the only type of clinical episode in Medicare bundled-payment programs that has produced savings so far. The meta-analysis found no evidence of reduced spending or quality improvement for other clinical episodes. (Meyer, 1/6)
CMS May Put Providers Over Insurers In Calculating Medicare Advantage Risk Adjustment
CMS wants to give health provider assessments of patients' conditions more weight than private Medicare plans' own reports when deciding how much financial assistance is owed to insurers with sicker customers. The proposal, released on Monday as part of a notice of possible Medicare payment changes for 2021, involves the higher rates that Medicare Advantage plans get from the government if they can show their enrollees have a chronic or serious illnesses. (Luthi, 1/6)
Medicare Advantage Payments May Be Tied To Patient Data
The agency said it plans to continue phasing in the use of diagnoses from encounter data to determine patient risk scores, which are used to adjust insurer payments from the federal government, despite complaints from the insurance industry that the data is often inaccurate and incomplete. Encounter data is detailed information about the patient based on visits with clinicians. (Livingston, 1/6)