Dobson | DaVanzo’s new evaluation of Medicare Shared Savings Program Accountable Care Organizations (ACOs) found greater savings than the Centers for Medicare and Medicaid Services (CMS) benchmark savings estimate. With the addition of 2016 data, we update our estimate and find that MSSP ACOs saved CMS $2.66B from 2013 to 2016 with net savings of $665.8M after accounting for incentive payments made by and to the program participants. Once again, these findings stand in contrast to the CMS savings calculation based on programmatic benchmarks. View the full report here. This study includes new data to make update our earlier report of PY2013-PY2015 results. These studies use standard evaluation techniques typically employed by CMS in its evaluations of the Next Generation ACO (NGACO) model, Pioneer ACOs, and other programs that do not rely on the benchmark method to estimate program effects.
Dobson |DaVanzo’s Alex Hartzman and Kimberly Rhodes participated in a webinar presentation sponsored by the National Association of ACOs (NAACOS) last month. The audience included NAACOS member representatives from Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs).
During their presentation, Alex and Kimberly provided ACOs with an overview of the company’s Benchmark Comparative And Performance Analysis (B-CAPA) product (developed in collaboration with NAACOS) which contains a multitude of useful strategic and operational information that allows ACOs to compare their performance to peer groups of similar ACOs. These peer groups include ACOs with similar HCC risk scores, ACOs with similar benchmarks, and ACOs in the same CMS region.
Alex and Kimberly also provided a high-level summary of 2017 MSSP ACO performance, sharing insights about segments of ACOs (such as those who shared savings vs. those that did not, and ACOs that contain facilities vs. those containing only physicians), as well as programmatic results in aggregate – namely that 2017 was the first performance year in which ACOs achieved net savings to Medicare relative to benchmarks (though this measure may undercount ACO savings).
Following Alex and Kimberly’s portion of the presentation, leaders within two MSSP ACOs shared specific examples of how executives use B-CAPA to guide decision making and make operational adjustments to increase quality and efficiency. The webinar closed with an engaging question and answer session, in which participants and presenters discussed additional use-cases for the product and future enhancements to B-CAPA.
In a blog post for The Commonwealth Fund, Dobson | DaVanzo discusses how the work requirements placed on Medicaid enrollees in the Commonwealth of Kentucky would negatively impact hospital finances and increase the number of uninsured individuals in Kentucky.
This study, performed by Dobson | DaVanzo’s Randy Haught, Al Dobson, Ph.D., and Phap-Hoa Luu, M.B.A., indicates that beginning in 2019, the Kentucky Medicaid 1115 waiver (Kentucky HEALTH) would result in a significant number of enrollees losing Medicaid coverage. Other findings are that Medicaid work requirements would reduce safety-net hospital revenues while increasing uncompensated care costs thereby reducing hospital operating margins.
Dr. Al Dobson, PhD, President of Dobson DaVanzo & Associates, LLC (Dobson | DaVanzo), gave the keynote address at National Association of Long Term Hospitals' (NALTH) fall meeting on October 18th. His talk focused on the shifting political and regulatory climate, Alternative Payment Models (APMs) and the role of long term care hospitals (LTCHs) in the changing healthcare landscape.
Becker's Hospital CFO Report reports on a recent Dobson | DaVanzo study commissioned by The Integrated Health Care Coalition on the impact of the Centers for Medicare and Medicaid Services (CMS) outpatient site neutral off-campus provisions. Our analysis showed the 200 with the largest impact account for 73 percent of the total impact of the change in payment due to off-campus site neutral payments. Our report was submitted as part of the Outpatient Prospective Payment System (OPPS) notice of proposed rulemaking (NPRM) comments to CMS by The Integrated Health Care Coalition.
Dobson | DaVanzo’s evaluation of Medicare Shared Savings Program Accountable Care Organizations (ACOs) found greater savings than the Centers for Medicare and Medicaid Services (CMS) benchmark savings estimate. The Dobson | DaVanzo study found positive net savings of $542 million for performance years (PY) 2013-2015 using a difference-in-differences analysis while the CMS benchmark calculations resulted in negative net savings of $344 million for PY2013-PY2015. Our study uses standard evaluation techniques typically employed by CMS in its evaluations of the Next Generation ACO (NGACO) model, Pioneer ACOs, and other programs that do not rely on the benchmark method to estimate program effects. View the full report and NAACOS press release.
Dobson | DaVanzo was recently commissioned by the American Association for Homecare (AAHomecare) to conduct a survey amongst stakeholders experiencing consequences of the recent expansion of competitive bidding for durable medical equipment (DME).
The report produced by Dobson | DaVanzo describes the current perceptions of three groups of stakeholders: Medicare beneficiaries, home medical equipment (HME) suppliers, and hospital personnel responsible for discharge planning and case management. Each of the three groups described their challenges and experiences in accessing DME since the bid expansion. A recent Government Accountability Office (GAO) report on the same subject suggests that no such effects are apparent but adds that the effects of DME rate adjustments may take longer to appear in the data.
The use of different analytic methodologies and data for reporting on health services issues such are commonplace. Data lags and other structural features can contribute to studies having various findings. The Dobson | DaVanzo study reports on qualitative data collected recently from the field. Further examination of this issue is needed in order to aid the Centers for Medicare and Medicaid (CMS) in releasing regulations that will best serve Medicare beneficiaries in their homecare needs, and industry staff in providing the best possible care to patients in the future.
Dobson | DaVanzo, as a subcontractor to LMI, has been awarded a task order as part of a contract to support the Measure and Instrument Development and Support (MIDS) under the Centers for Medicare and Medicaid (CMS) Center for Clinical Standards and Quality (CCSQ). The MIDS contract has an overall value of $1.6 billion over 10 years. We look forward to working alongside LMI to improve the quality of the Medicare program.
HME News reported that Pacific Research Institute (PRI) referenced a 2016 survey conducted by Dobson | DaVanzo in a new study titled “Reforming CMS’ Competitive Bidding Process to Improve Quality and Sustainability.”
The PRI study suggests that reforms should be made to the competitive pricing bidding process by CMS to encourage transparency and pricing equity in the durable medical equipment market in order to improve health outcomes for patients.
In a recently released report, Dobson | DaVanzo discusses the role generic medicines play in decreasing the rate of increase in drug expenditures. Apart from unique and innovative introductions to the drug market, a conversion to generics has consistently reduced inflationary pressures in the U.S. drug marketplace.
In a study for the Federation of American Hospitals and the American Hospital Association, Al Dobson, Joan DaVanzo, Randy Haught and Phap-Hoa Luu estimated that the cumulative federal payment to hospitals between 2010 and 2028 would exceed $218 billion. The authors identified regulatory changes made by CMS as well as eleven legislative acts passed by Congress that have and will continue to result in these reductions over the specified time period. The study can be accessed here.
MedPAC recently released their June 2018 Report to Congress in which they have acknowledged Al Dobson as a contributor. The Commission publishes two annual reports advising Congress on issues affecting the Medicare program. The latest report can be found here.
In the January 2018 issue of Value in Health, Joan DaVanzo and Randy Haught coauthored an article that presents findings from the first comprehensive study of Medicare spending on wound care. The study found that close to 15% of Medicare beneficiaries had at least one type of wound or infection and estimated the cost of wound care for Medicare beneficiaries to be nearly $32 billion. This study has broad implications given that Medicare expenditures related to wound care are much higher than previously thought, and lays the foundation for future research and the development of more appropriate quality measures and reimbursement models. The article can be accessed here, and the Alliance of Wound Care Stakeholders’ press release about the study can be found here.
Sarmistha Pal (lead author) and Joan DaVanzo co-authored a December 2017 article in Surgery Technology International on the impact of Neuromuscular Electrical Stimulation (NMES) on episode costs and post-acute care utilization in total knee replacement patients with disuse atrophy. NMES is a complement to conventional forms of physical therapy. NMES involves the application of low-level electrical currents to targeted muscles which helps to strengthen the quadriceps muscle, thereby improving surgical outcomes and decreasing complications. The authors found that patients who used NMES had lower costs and a lower probability of readmission. The article can be accessed here.
In a study for The Commonwealth Fund, Al Dobson, Joan DaVanzo, Randy Haught and Phap-Hoa Luu examined how the Affordable Care Act’s Medicaid expansion affected the financial status of safety-net hospitals. Using Medicare Hospital Cost Report data for federal fiscal years 2012 and 2015, the authors analyzed changes in Medicaid inpatient days as a percentage of total inpatient days, Medicaid revenues as a percentage of total net patient revenues, uncompensated care costs as a percentage of total operating costs, and hospital operating margins. The authors found that the operating margins of safety-net hospitals in expansion states improved (in large part due to increased Medicaid revenues and reduced uncompensated care costs) while the operating margins of safety-net hospitals in non-expansion states declined. The study can be accessed here.