medicare Archives - Digital Health Wire

Americans aren’t getting any younger, but a pair of new studies in the Annals of Family Medicine offer a deceptively simple way for providers to stay afloat in the Silver Tsunami: optimize the workflows hiding in plain sight.

In case anyone’s new here, the U.S. doesn’t have enough physicians to meet today’s patient demand, let alone the needs of a Medicare population that’s adding 10k seniors every day.

New tech and AI-driven efficiencies might eventually balance the equation, but small changes at scale can still make a noticeable difference in the meantime.

Optimizing care means optimizing visits. Immediate concerns frequently overshadow preventive care, and that’s easy to see during Medicare annual wellness visits. The first study tested a straightforward solution by combining wellness visits with problem-based visits – and extending them from 20 to 40 minutes – at a five-office family medicine department.

Completion rates for annual wellness visits skyrocketed 6x over nine months (8.4% to 50.8%), and the combined appointments had nearly half as many no-shows as traditional wellness visits (11.9% vs. 19.6%).

Giving providers extra time to address new issues without derailing the agenda also boosted screenings across the board – depression, hemoglobin A1c, and a long list of cancers.

Pre-visit preparation pays off. The second study out of Mayo Clinic focused on getting more out of existing appointments with pre-visit test ordering.

Researchers sent automated portal messages to 3,500 Medicare patients listing the tests they were due for in the next six months, along with a self-scheduling link and a nudge to review results in a wellness visit.

About 27% of patients followed through on the message. Physicians appreciated being able to order follow-ups ahead of time, and patients loved discussing results during their regular visit.

The Takeaway

Combined appointments and pre-visit testing won’t stop a Silver Tsunami, but these studies show that they’re practical changes that might at least make some decent floaties.

CMS just released the Medicare Shared Savings Program results for 2022, and the report managed to drum up some serious debate on the effectiveness of MSSP despite last year’s record performance.

MSSP saved Medicare $1.8B in 2022, marking the sixth consecutive year of savings and the second-highest total since the program launched in 2012.

The program generates savings by working with accountable care organizations, or groups of providers who collaborate to cut down on avoidable utilization, duplicative care, and medical errors.

The ACOs that effectively improve care quality and reduce total spend are then able to share in that success, and 63% of participating ACOs were compensated in 2022.

Standout performers included Aledade (four of the top ten ACOs for overall savings rates) and Privia (delivered expenditures 8% lower than the median MSSP ACO), although results were mixed for other high profile participants like CVS.

CMS called out the fact that low-revenue ACOs comprised mostly of primary care physicians generated $294 per capita in net savings (vs. $140 per high-revenue ACO), underscoring the importance of primary care to the overall program.

Although at first glance those numbers make 2022 one of MSSP’s best years to-date, it’s worth noting that the total cost of Medicare over that time frame was a mammoth $747B.

That means that MSSP, the crown jewel of CMS value-based care programs that includes 482 ACOs equipped with some of the best care delivery tools in the industry, delivered an overall savings of just 0.24%.

That’s not to say that $1.8B is anything to scoff at, but it highlights the sheer size of the task at hand, and CMS devoted a healthy portion of the press release to proposed MSSP updates that would include more people who receive care from NPs / PAs and encourage ACOs to care for more medically complex beneficiaries.

The Takeaway

MSSP had a great 2022 by almost every metric, and the ACOs participating in the program are the tip of the spear for improving the country’s fractured health system. That said, it’s a long journey to lower overall costs even with $1.8B steps, and there’s still plenty of work to be done to help get there faster.

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