NAUH Comments on Proposed Joint Replacement Program

Earlier this summer the Centers for Medicare & Medicaid Services (CMS) and the Center for Medicare and Medicaid Innovation proposed a new “Comprehensive Care for Joint Replacements Model” (CCJR) program designed to foster better coordination of services and efficiency in the delivery of knee and hip replacements.

NAUH LogoIn a formal comment letter to CMS, the National Association of Urban Hospitals expressed support for the concept underlying the program but expressed concern about five specific aspects of the proposed program:

  • the program’s savings assumptions
  • the assignment of virtually all risk to hospitals
  • the breadth of services for which hospitals would be at risk
  • the program’s lack of socio-economic risk adjustment
  • the inclusion of non-elective joint replacement procedures


Medicare Unveils New ACO Program

The federal Center for Medicare and Medicaid Innovation is launching a new accountable care organization (ACO) model through which providers can join together to serve Medicare patients.

The “Next Generation ACO” seeks to build on the experience, insight, and feedback gained through the Medicare Shared Savings Program and the Pioneer ACO model and give providers more tools for managing care and resources while also enabling them to take on more financial risk and earn greater financial rewards for doing so successfully.

A broader objective is to move Medicare closer to its stated goal of paying most providers based on the quality of care they deliver rather than on the quantity of services they provide.

The new model will have two risk tracks, one of which will be close to 100 percent risk, and a choice of four payment methodologies that will seek to facilitate a transition from fee-for-service to capitated reimbursement.  Those four payment systems are fee-for-service, fee-for-service with a monthly infrastructure payment, population-based payments, and capitated payments.

The Center for Medicare and Medicaid Innovation has created a number of resources through which interested parties can learn more about the new model:  a news release, a post on the blog of the Centers for Medicare & Medicaid Services (CMS), and a new web page devoted to the Next Generation ACO.

Parties interested in applying to become a Next Generation ACO must submit a letter of intent to the innovation center by May 1.

Innovation Center Introduces “Transforming Clinical Practices” Initiative

The federal Center for Medicare and Medicaid Innovation has launched a new, $840 million program designed to help clinicians achieve large-scale health transformation.

According to the agency’s news release, its “Transforming Clinical Practices” initiative

…will fund successful applicants who work directly with medical providers to rethink and redesign their practices, moving from systems driven by quantity of care to ones focused on patients’ health outcomes, and coordinated health care systems. These applicants could include group practices, health care systems, medical provider associations and others. This effort will help clinicians develop strategies to share, adapt and further improve the quality of care they provide, while holding down costs.

Stock PhotoThe Center for Medicare and Medicaid Innovation was created as part of the Affordable Care Act and allocated $10 billion to spend on innovations in the delivery and financing of health care.  It expects to spend $840 million on this program over the next four years in increments of $2-50 million on “practice transformation networks” and “support and alignment networks.”  Hospitals, health systems, and large group practices are eligible to participate.

Letters of intent must be submitted by November 20 and the deadline for applications is January 6.

For further information about the program, see this news release announcing the initiative and go here for the program’s web site and additional program and application information.

CMS Seeks to Jump-Start Medicaid Innovation

A new federal program seeks to encourage states to work faster to find ways to improve care and improve the health of their Medicaid patients and to reduce health care costs through payment and service delivery reforms.

The Center for Medicare & Medicaid Services’ (CMS) new Medicaid Innovation Accelerator Program is a collaboration between the Center for Medicaid and CHIP Services, the Center for Medicare and Medicaid Innovation, the Medicare-Medicaid Coordination Office, and other federal agencies and centers.  According to a CMS fact sheet, the program

…aims to jumpstart innovation in key areas while supporting states in their efforts to improve health, improve health care, and lower costs. In consultation with states and stakeholders, the IAP will develop strategically targeted functions aimed at advancing delivery system and associated payment reforms, aligned with transformation efforts underway in Medicare and the commercial market.

The program will develop resources to support innovation through four key functions:  identifying and advancing new models of care delivery and payment; data analytics; improving quality measurement; and state-to-state learning, rapid-cycle improvement, and federal evaluation.

Learn more about the launch of the Medicaid Innovation Accelerator Program from this CMS fact sheet and go here for a more detailed description of the program and a summary of the resources surrounding it.