March 11, 2016

HHS Surpasses Value Based Payment Goals

The Department of Health and Human Services (HHS) reached its goal in January 2016 of tying at least 30 percent of Medicare payments to alternative payment models. The achievement comes 11 months ahead of schedule.

As noted in a March 3 news release, the objective and timeline were originally set by HHS Secretary Silvia Burwell in January 2015. She challenged the Centers for Medicare & Medicaid Services (CMS) to orchestrate the movement of at least 30 percent of Medicare payments from its traditional fee-for-service systems to quality- and value-based alternative payment models, such as Accountable Care Organizations (ACOs) and bundled payment arrangements, by the end of 2016. She set an additional goal of tying 50 percent of Medicare payments to these models by the end of 2018.

CMS acknowledged 121 new ACOs and increased health care provider participation in other models contributed to reaching its 30 percent goal. Overall, 477 Medicare ACOs are participating in its Shared Savings Program and the Pioneer ACO Model. These programs generated total net savings of $411 million in 2014, CMS said.

ACOs accounted for about three quarters of the progress toward reaching the 30 percent goal. CMS estimates these gains will continue to increase over the course of this year, with additional momentum generated by the start of the Comprehensive Care for Joint Replacement Model and the Oncology Care Model.

Ten alternative payment models were identified as contributing towards the goal of tying 30 percent to quality or value. They include:

  • Medicare Shared Savings Program (MSSP)
  • Pioneer ACOs
  • Next Generation ACOs
  • Comprehensive End Stage Renal Disease (ESRD) Care Model
  • Comprehensive Primary Care Model
  • Multi-Payer Advanced Primary Care Practice
  • End Stage Renal Disease Prospective Payment System
  • Maryland All-Payer Model
  • Medicare Care Choices Model
  • Bundled Payment Care Improvement

The American College of Radiology has been at the forefront of efforts to advise CMS and the College’s members on how to successfully integrate radiology into such alternative models and to select suitable quality measures to assess the performance of radiologists, medical physicists and radiation oncologists. See the ACR Alternative Payment Models Resources Page for more information.