Becker's Hospital Review

64 64 REVENUE CYCLE MANAGEMENT Less Than 25% of Hospitals on Track to Hit CMS' Value-Based Payment Goal By Kelly Gooch H ospitals are slowly progressing toward CMS' goal of transitioning half of payments to value-based care models by 2018, a recent survey of healthcare executives from Health Catalyst reveals. Here are seven findings from the survey. 1. Fewer than a quarter of U.S. hospitals are on track to hit Medicare's 2018 goal. 2. e survey revealed that only 3 percent of health systems today meet the target set by CMS. 3. Only 23 percent of health systems expect to meet Medicare's target by 2019, a year aer CMS had hoped that half of all Medicare reimbursements would be value- based. 4. e majority of health systems — 62 percent — have either zero or less than 10 percent of their care tied to the type of risk- based contracts identified by CMS as "value- based," including Medicare accountable care organizations and bundled payments, according to the survey. 5. Small hospitals with fewer than 200 beds comprised the majority of those reporting no risk-based contracts. e survey notes that a contributing factor to this may be that smaller hospitals are five times less likely than larger organizations to have access to sufficient capital to make risk-based contracting work. 6. Although healthcare organizations may lag behind the federal government's goal, healthcare executives across the board intend to steadily increase value-based care and risk-based contracts, the survey found. In the next three years, all but 1 percent of survey respondents expect their organizations to be engaged in risk-based contracts. Sixty-eight percent expect risk- based contracts to account for less than half their total care in that time frame. Only 23 percent expect value-based care to account for more than half of their care in the next three years. Eight percent of respondents could not predict the answer. 7. In the survey, healthcare executives at small and large hospitals cited analytics as the most important organizational element needed for success with risk- based contracting. In fact, 52 percent of respondents cited the prime importance of analytics, more than double the second most-selected answer: a culture of quality improvement. Twenty-four percent of respondents cited cultural alignment on quality as having the most impact on value- based care success. Survey results reflect the opinions of 78 healthcare professionals who responded to an online survey by Health Catalyst last May. More than half of the respondents (51 percent) were CEOs or CFOs of large hospital-owned physician groups and hospitals ranging in size from 15 acute care beds to more than 1,000 beds. e remaining respondents all held executive roles, including several CMIOs, CMOs and CNOs. Organizations represented include many well-known multi-hospital and multi- state health systems with a cumulative 756 inpatient and outpatient facilities and 20,416 acute care beds. n Feds: Carolinas HealthCare Forced Steering Restrictions in Top Payer Contracts By Ayla Ellison T he Department of Justice and North Carolina Attorney General have filed an antitrust lawsuit against Carolinas HealthCare System, alleging the Charlotte, N.C.-based system drove up costs in the region by imposing steering restrictions in contracts with commercial health insurers. Carolinas HealthCare is the dominant system in the Charlotte area, controlling about 50 percent of the market. e lawsuit alleges the system used its market power to require steering restrictions in its contracts with every major insurer in the area, including Blue Cross and Blue Shield of North Carolina, Aetna, Cigna and UnitedHealthcare. For example, the complaint states that some of the contracts give CHS the right to terminate their agreements if the insurers attempted to steer business from the system, according to the Charlotte Observer. "For years, insurers have tried to negotiate the removal of steering restrictions from their contracts with CHS, but cannot because of CHS' market power," the lawsuit states, according to the Charlotte Observer. e steering provisions have prevented insurers from introducing health plans that encourage patients to use providers that offer lower priced, higher quality services than Carolinas, according to the DOJ. e lawsuit also alleges that CHS prevented insurers from providing truthful information to consumers about the cost and quality of CHS' services compared to its competitors. CHS said it is committed to fair competition, and its arrangements with insurers are similar to those in place between health systems and insurers across the country. n

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