Medicolegal Issues

SHM, Hospitalists Play Key Roles in CMS Innovation


 

“A auick glance at the CMMI website didn’t provide much detail beyond uplifting language about the promise that the center represents.” —Policy Corner, January 2011

Alittle over a year ago, this column made the above statement about the launch of the Center for Medicare and Medicaid Innovation (CMMI) and its charge under the Affordable Care Act (ACA) to test ways to reduce costs while preserving or enhancing the quality of healthcare. A lot has happened in the past year at CMMI, and many details can now be filled in. Some of those details directly relate to the work of hospitalists.

The first and most-often-cited action taken by CMMI is the launch of the Pioneer ACO initiative. The Pioneer ACO model is designed specifically for groups of providers with experience working together to coordinate care for patients. The initiative is designed to test the effectiveness of several payment models and how they can provide better care for beneficiaries, work in coordination with private payors, and reduce Medicare cost growth.

In December 2011, 32 Pioneer ACOs were announced; a performance period began on Jan. 12. Thus, Pioneer ACOs are a reality, and several hospitalists have informed SHM that their institutions are participating.

Also on the ACO front, CMMI has made an effort to answer one of the most-cited barriers to ACO formation: start-up funding. In trying to answer this concern, CMMI has established the Advance Payment ACO Model. It is designed to provide support to rural and physician-owned organizations whose ability to successfully start an ACO would be improved with additional access to capital. This program will provide upfront payments and monthly payments to ACOs based on certain criteria. The first application period ended Feb. 1, so we should soon know which organizations are taking advantage of the opportunity.

CMMI has made an effort to answer one of the most-cited barriers to ACO formation: start-up funding. The Advance Payment ACO Model will provide upfront payments and monthly payments to ACOs based on certain criteria.

A final example of CMMI activity is a $1 billion investment in the Partnership for Patients, an initiative to reduce preventable hospital-acquired conditions by 40% and hospital readmissions by 20% by 2013. The partnership has chosen 26 Hospital Engagement Networks to help identify solutions that already are working and spread those solutions to other hospitals and healthcare providers. Because the goals of the program cover areas in which hospitalists have both expertise and success, SHM is partnering with Hospital Engagement Networks to help achieve the goals of the program.

This update is by no means comprehensive. CMMI has started quite a few other programs over the past year, and all of them can be viewed in detail at http://innovations.cms.gov/.

Please let us know if you are involved with any of these initiatives. Your experience and insight could be helpful in advocating for the needs of hospitalists, and might also be useful to others who find themselves involved in the near future.

Joshua Boswell, interim senior manager, government relations

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