How Maryland’s Total Cost Of Care Model Has Helped Hospitals Manage the COVID-19 Stress Test (Health Affairs Blog, October 7, 2020)
By Chris L. Peterson and Dale N. Schumacher
As the COVID-19 pandemic emerged, hospitals have been the centers of care for patients. Maryland’s unique Total Cost of Care model has helped hospitals manage the peaks and troughs of care and reimbursement. “We believe the COVID-19 pandemic represents an important opportunity to assess this global budget model under stress—with implications for future health care financing.”
“How Maryland’s Total Cost Of Care Model Has Helped Hospitals Manage The COVID-19 Stress Test,” Health Affairs Blog, October 7, 2020.DOI: 10.1377/hblog20201005.677034
By Dale N. Schumacher, MD, MPH
The Maryland Total Cost of Care (TCOC) program, one of the nation’s most innovative advanced alternative payment (APM) models, has entered year two. Finance leaders across the nation can benefit from a closer look at how this state-level program works and its implications for the future direction of healthcare financing nationwide.
Under the TCOC program, for the first time, a state under a global budget is accountable for the total cost of care of all Medicare fee-for-service beneficiaries. The program warrants finance leaders’ attention because the innovative way it addresses the challenge of reining in the rising costs of nation’s healthcare system: All Medicare fee-for-service beneficiaries must be attributed to primary care physicians and/or a hospital —whether or not the beneficiary has received services that year. Competing hospitals and systems form geographically based networks to ensure regional and statewide coverage. The Medicare performance adjustment (MPA) tracks each hospital’s total cost of care with a 1% upside or downside incentive. To the extent the program is successful, it could provide a basis for future Medicare reform nationwide.
With its second year, the program has seen its first round of annual update factors and annual performance adjustments. Here we provide a review of the essential elements of this major financing and policy initiative, which is a transformation from Maryland’s earlier hospital All-Payer Model (svee the sidebar on page 54 for details on the evolution of the TCOC Program).
See additional details of essential TCOC elements in full blog article.
In 2017 Rockburn Institute partnered with Wolters Kluwer to study the effectiveness of Lippincott Solutions and Lippincott Advisor – two evidence-based clinical decision support tools for nurses at the point-of-care. The study looked at the many aspects of the Value Based Purchasing (VBP) measure used to assess hospitals care of Medicare beneficiaries. We analyzed three years of data for approximately 3,000 hospitals.
By Dale N. Schumacher and Fern E. Nerhood
“Medicare spending per beneficiary (MSPB) performance rates can have a dramatic impact on a healthcare organization’s financial picture… Hospitals that have deteriorating MSPB scores are missing out on up to 25 percent of their potential VBP incentive payments.”
We analyzed four years of MSPB data to determine which hospitals have sustained improvement or deterioration for 1, 2, or 3 years. Do you know where your hospitals fall on the graph?
By Dale N. Schumacher
Decodes two years of a hypothetical hospital’s MSPB data and discusses how to use CMS reports to find opportunities.
By Dale N. Schumacher, M.D., Len Felgner, Eric D. Dobkin, M.D., Fern E. Nerhood, Margaret W. Paroski, M.D.
A hospital can achieve both clinical and financial performance improvements by decoding its MSPB data. Hospitals can use the MSPB data provided to them by CMS to improve their performance. The process of decoding and analyzing MSPB data involves:
- Analyzing MSPB measures by patient, major diagnostic category, and physician
- Understanding the technical aspects of the data
- Creating MSPB 30-day care pathways to identify episode variations and opportunities for joint clinical and financial scrutiny
Rockburn Institute 410-796-4554