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- Gorman Health Group on Industry Ducks Bullets in 2016 Medicare Advantage Rate Proposal
- Jessica K on Industry Ducks Bullets in 2016 Medicare Advantage Rate Proposal
- Daniel on 2016 CMS Applications: Highlights and Basics
- Bruce Bell on Why Medicare Advantage is Here to Stay
- Vern Smith on A Bad Couple Weeks for ObamaCare
Topic: Star Ratings
When it comes to healthcare, two truism’s are that medical costs are going up along with demand for healthcare services. And when it comes to organic growth of healthcare volume and expenses, government programs represent a major driver, particularly when considering that on a daily basis thousands of baby boomers age into Medicare. During the last several years CMS has published a number of demonstration programs which are intended to improve the quality of Medicare patient outcomes while promoting financial efficiency on a unity cost or per procedure basis.
The Medicare Payment Advisory Commission (MedPAC ), the nonpartisan blue-chip Congressional uber-nerds on our favorite entitlement program, met this week and the staff report presented a couple bombshells on retention rates in Medicare Advantage (MA).
Last week, in a surprise move, the Centers for Medicare and Medicaid Services (CMS) reversed its threat to terminate all Medicare Advantage and Part D health plans with 3 or fewer Stars for more than 3 consecutive years. Roughly a dozen health plans were lined up in front of the firing squad as an example to the industry for months — and then CMS issued squirt guns to the executioners.
Last week, the tenth of 32 Medicare Pioneer ACOs dropped out of the program. Others are expressing reservations about entering or continuing given the experience of Pioneers and the hundreds participating in the Medicare Shared Savings Program (MSSP). To be clear, it’s not all bad news…but most ACOs will need an exit strategy, fast.
This week, another Medicare Pioneer Accountable Care Organization Demonstration site, longtime GHG client Sharp Healthcare in San Diego announced it was dropping out. It was the tenth Pioneer to quit the trail, and not for lack of trying. Many of the Pioneers did great on improving quality and reducing costs — the issue is not the performance of Pioneers. It’s CMS’ methodology, with its requirement for Pioneers to bear risk in the third year, and benchmarks calculated to make any gainsharing impossible.