The trend toward alternative payment systems continues as CMS announces the Comprehensive Primary Care Plus (CPC+) model
Efforts by Medicare officials to move providers away from fee-for-service payments and onto other models of reimbursement continue to move forward. This is one of several goals for a new primary care program that Medicare is about to launch in coming months.
Medical laboratories and pathology groups might feel an impact from this new program the Centers for Medicare and Medicaid Services (CMS) is testing. Announced in April, 2016, the program is called Comprehensive Primary Care Plus (CPC+). The CPC+ program is a five-year model that is designed to strengthen primary care, through establishing what are called “medical homes,” where patients experience more coordinated care. (more…)
Medicare’s latest payment rules for joint replacement surgeries is another step forward on the path toward bundled payments and similar value-based reimbursement models
By now, most clinical laboratory managers and pathologists know about an ambitious new Medicare program that essentially brings a value-based reimbursement model to joint replacement surgeries. The program has already commenced in a number of regional markets across the United States.
This new program was instituted by the U.S. Department of Health & Human Services (HHS). It is mandatory program and reimburses providers for hip and knee replacements using a reimbursement model that further ties Medicare payments to quality or value metrics. This program was launched in 67 metropolitan areas.
Called the Comprehensive Care for Joint Replacement (CJR) model, it establishes a 90-day episode of care from the date of the replacement procedure. Hospitals remain accountable for all charges related to recovery and rehabilitation within this window.