FutureFocus April 4, 2018 Redistribute Post-Acute Payments Based on Patient Condition

Lisa Remington

In this week’s FutureFocus, is important information about the future of post-acute payments. MedPAC, the committee that reports to Congress on Medicare, is recommending prior to the implementation of the PAC PPS in 2019, that blending the relative weights of the setting-specific payment systems and the unified PAC PPS be considered. We provide the details. This is a must read. In our Washington Report, we provide insight into two alternative payment models for advanced illness recommended by HHS.

Lisa Remington, President, Remington Health Strategy Group

Read the details of the The Coalition to Transform Advanced Care offered the Advanced Care Model (ACM) and the American Academy of Hospice and Palliative Medicine (AAHPM) PACSSI model.

ACM Model

The Coalition to Transform Advanced Care offered the Advanced Care Model (ACM). The ACM has shared savings and risk with payment tied to metrics like evidence of advanced care planning and a care team visit with 48 hours of hospital discharge.

The Advanced Care Model provides a population health management approach for the advanced illness population, focused on the last year of life. “The expected impact for ACM beneficiaries are improvements in:

(1) patient and family engagement,

(2) shared-decision making among patients, families and their physicians,

(3) coordinated care that aligns with patient preferences,

(4) symptom management,

(5) prevention of avoidable and unwanted hospitalizations or low-value treatment, and

(6) prevention of unwanted futile care at the end of life,” the 69-page proposal Abstract states.

The ACM target population is comprised of fee-for-service Medicare beneficiaries with advancing chronic condition(s), with: One or more chronic conditions; Recurrent or extensive disease, acute care utilization, functional decline and/or nutritional decline; and, High 1-year mortality risk.

The ACM offers a new advanced APM. “By creating an integrative model that is focused on a high-cost and high-need population, the ACM provides a mechanism to risk-stratify a broader Medicare population, specifies effective care interventions, and creates additional financial incentives for existing APMs.”

AAHPM PACSSI Model

“Too many patients and caregivers do not receive palliative care and support services, in large part because of barriers that exist under current payment systems,” states the 82-page proposal Overview of the American Academy of Hospice and Palliative Medicine (AAHPM). The Patient and Caregiver Support for Serious Illness (PACSSI) APM “would address these barriers by allowing for the delivery of community-based palliative care medical home services to high-need patients who are not eligible for or ready to elect hospice care.”

“This model would provide tiered monthly PACSSI care management payments to support interdisciplinary palliative care teams (PCTs) as they deliver community-based palliative care to patients who meet eligibility criteria that include a diagnosis of a serious illness or multiple chronic conditions, functional limitations, and health care utilization. PACSSI care management payments would replace payment for evaluation and management (E/M) services,” states the proposal Abstract.

PCTs “would be held accountable for performance on cost and quality metrics” under two tracks: Payment Incentives; or, Shared Savings and Shared Risk. “We expect participation from a diverse group of palliative care teams serving urban, suburban and rural populations, and structured within small community-based practices, larger provider organizations, academic health centers, integrated health systems, and hospices.”

The 11-member Committee meets periodically to review physician-focused payment model proposals and to prepare recommendations regarding whether such models meet criteria established through rulemaking by the HHS Secretary. The HHS Office of the Assistant Secretary for Planning and Evaluation provides technical and operational support for the Committee.