What We're Watching: May 7, 2019

WE MENTIONED THIS LAST WEEK

CMS recently announced the most significant movement from Medicare fee-for-service to date. There are five new voluntary payment models under two paths – Primary Care First (PCF) and Direct Contracting (DC). Direct Contracting is the next evolution of risk-sharing arrangements, building on lessons learned from the Medicare Shared Savings Program (MSSP) and the Next Generation ACO (NGACO) model.

What we’re saying: Join our webinar on Monday, May 13, to discuss the latest details on these models and Premier’s view on how best to navigate them. These models will be available for the 2020 performance year and we expect more to come in the future.

SPEAKING OF SHARING RISK

CMS is accepting applications for the 2020 Bundled Payments for Care Improvement Advanced (BPCI Advanced) model through June 24, 2019.

What we’re saying: We anticipate bundled payments to be mandatory in the foreseeable future. Furthermore, we see the financial benefits will be greatest in the short term. Premier’s Bundled Payment Collaborative members have consistently outperformed their peers in achieving performance-based payments. Participating in the BPCI Advanced model can help health systems stay ahead of the shift to risk-based payment models, as well as increase revenue, manage margins and get better reimbursement.

PAYMENT POLICY PROPOSALS

On April 23, CMS released its proposed rule describing fiscal year 2020 policies and rates for Medicare’s prospective payment systems for acute care inpatient hospitals (IPPS) and the long-term care hospital prospective payment system (LTCH PPS). The payment rates and policies described in the IPPS/LTCH proposed rule would impact Medicare’s operating and capital payments for short-term acute care hospital inpatient services and services provided in long-term care hospitals. The proposed rule also sets forth rate-of-increase limits for inpatient services provided by certain “IPPS-Exempt” providers, such as cancer and children’s hospitals, and religious nonmedical health care institutions, which are paid based on reasonable costs.

What we’re saying: Joni our webinar on Wednesday, May 8, to discuss the new payment and quality policies hospitals will face under the proposed rule. Topics of discussion include operating and capital payment rate updates, wage index methodology changes, Medicare DSH payments, value-based payment program updates and more.

EXCITING NEWS!

Premier announced our work with Ballad Health, a newly-merged health system serving four Southeastern states, to support its integration efforts and drive operational excellence.

What we’re saying: Ballad Health chose Premier because they see us as a trusted partner that can help them deliver greater connectivity across their people, processes, technologies and patients. We look forward to helping them strategically manage margins in tandem with today’s value-based payment environment.

IN CASE YOU MISSED IT

• Ballad Health and Premier Inc. Partner on Enterprise-wide Performance Improvement Initiative
• Pfizer And Others Join Working Group To Use Blockchain Protocol For Supply Chain Management
• Basic Social Needs Are Driving Future Care Models
• Premier Inc. Promotes Michael J. Alkire, Craig S. McKasson to New Leadership Roles
• Statement on the House Judiciary Committee Markup of Legislation to Address Drug Pricing
• Is That a Bundle Behind Your ACO?
• Four Methods to Ensure Physicians are Engaged in Transformation Initiatives
• Preparing for the Future with BPCI Advanced: Five Things to Know

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. Check out last week's update.