The CMS is expected to release more new payment models soon. While we wait, they provided insights on the recently released Emergency Triage, Treat, and Transport (ET3) Model, which will pay ambulance suppliers and providers to deliver treatment in place (either on-the-scene or through telehealth) and transport to alternative destination sites, such as primary care doc offices, FQHCs or urgent-care clinics. The CMS clarified that there will be a separate payment – in addition to the ambulance payment – for qualified health practitioners that deliver treatment either on-site or via telehealth.
What we’re saying: While there needs to be a greater focus on primary care management, Premier encourages the CMS to continue to invest in models that align incentives across the care continuum to prevent avoidable and costly visits to the ED. We look forward to the imminent new models, including a new NextGen ACO model, potentially mandatory bundled payment programs and a new capitated primary care model. Premier members and staff have been meeting with the CMS with the goal of helping to shape the direction of these models.
SPEAKING OF EMERGENCIES…
A recent study found that primary care physician (PCP) office visits for acute care dropped precipitously between 2002 and 2015. At the same time, ED visits increased by a modest 12%. While the study did not identify the causes for the shift, the authors suggest that contributing factors could be low reimbursement, the rise of part-time PCPs, increasing difficulties in episodic care, and greater use of alternative acute care sites such as retail clinics, urgent care centers, and telemedicine. The authors recommend that future payment models need to incent greater integration and coordination across care sites as acute care delivery shifts away from PCPs.
What we’re saying: These findings dovetail with an analysis Premier published in February revealing that ED visits for people with at least 1 of 6 chronic conditions contributed to nearly 50% of all annual ED visits in 2017 across ≈750 hospitals. More than a third of these visits were potentially preventable and equated to an estimated $8.3 billion. In working with ACOs, we’ve also seen that 30% of ED visits were for issues that could have been treated in outpatient settings. Preventable visits from these patients are often due to a lack of knowledge around how to management their condition, improper use of medications, inability to engage in self-care, low adherence rates and lack of access.
WE READ 724 PAGES SO YOU DON’T HAVE TO
You may recall that last month the Office of the National Coordinator for Health IT (ONC) and CMS released significant new proposed rules on implementing provisions of the 21st Century Cures Act and patient access to data and interoperability.
What we’re saying: This Wednesday afternoon (3/6) we’ll be hosting a webinar covering ONC and CMS’ proposed rules on information blocking, interoperability, Certification of Health IT, patient access to data and changes to the Medicare hospital Conditions of Participation. You can register by clicking here.
IN CASE YOU MISSED IT
What We’re Watching is a weekly blog focused on the current events Premier is following and their relevance to the work of Premier and its members.