Stakeholders take their time with alternative payment model

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Friday, October 28, 2016

WASHINGTON – Industry stakeholders have begun developing drafts for an alternative payment model for respiratory care, but they’re taking it one step at a time.

“We want to have buy-in from everybody,” said Tom Ryan, president and CEO of AAHomecare. “We want to bring other groups into the discussion, but until we have a couple of models, we are still in the initial discussion phase.”

AAHomecare kick-started the effort earlier this year, after surveying members and other respiratory stakeholders to gauge support.

A workgroup, comprised of AAHomecare HME/Respiratory council members, is drafting several patient-centered models using existing clinical standards, like those set out by the Global Initiative for Chronic Obstructive Lung Disease or GOLD Initiative. One possible model could leverage the Outcome and Assessment Information Set (OASIS), a quality performance indicator that CMS has used for home health agencies since 1999, said Ryan.

“We’re using what has been out there,” he said. “Part of that is the CMS Center for Innovation’s triple aim to increase patient satisfaction, increase healthcare outcomes and, at the end of the day, save money.”

Although the industry had discussed creating an alternative payment model several years ago, just ahead of Medicare’s competitive bidding program, it didn’t get off the ground—“I think we got ahead of ourselves,” said Ryan.

But times are changing. Over the past few years, the healthcare system has been shifting away from fee-for-service toward outcome-based models, like those aimed at preventing COPD readmissions within 30 days, says Ryan.

Commercial payers are certainly interested in seeing what stakeholders come up with, says Laura Williard, senior director of regulatory affairs and contracting for AAHomecare.

“They have been trying to figure this out and they are interested in the conversation and how the HME industry can be involved and bring that to the table,” she said.