American Venous Forum

Good Morning Everyone,

I attended the American Venous Forum (AVF) 27th Annual Meeting last week. For those of you who are not aware of the AVF, here is a short explanation from their website.

The American Venous Forum (AVF), is dedicated to improving the care of patients with venous and lymphatic disease.

Founded in 1987, AVF fosters cutting edge research and clinical innovation and educates health care professionals, patients and policy makers about venous and lymphatic diseases.

As the Executive Director of the US Wound Registry, I dedicate a great deal of time to using data to improve patient care. I was pleased that the AVF has been participating with the Alliance of Wound Care Stakeholders in submitting quality measures for venous ulcer care to CMS.

REIMBURSEMENT OF WOUND CENTERS AND VENOUS TREATMENT BASED ON QUALITY AND VALUE: THE FUTURE IS NOW.

Although the primary purpose of the Affordable Care Act, (ACA), was to provide health care insurance coverage for all Americans, the secondary aim was to reduce the inexorable rising cost of health care.  To achieve this outcome, Medicare and Medicaid, as well as private payers, proposed shifting some of the risk of health care costs to both hospital systems and physicians. The Medicare Shared Savings Program provided the mechanism for provider organizations to become accountable care organizations (ACO), which has been defined as “a clinically integrated group of providers that accepts financial risk for the management of a patient population”. Bundled payments are another mechanism for incentivizing providers, where a contractual agreement between the provider and the payer mandates that the cost of all services for an episode of care be reimbursed in one payment.

In January of this year, CMS announced a shift to transition from a fee-for-service method of reimbursement to a value-based payment system, which was proposed ahead of schedule. In a Perspective published in the New England Journal of Medicine, which announced this proposal, HHS Secretary Sylvia M. Burwell stated “by setting ambitious, but achievable goals for the adoption of these new payment models, we expect that health care providers can move with greater certainty towards these approaches with proven benefits for patients and families.” HHS has designated this project “better, smarter, healthier” healthcare. As an example of HHS’ aggressive goal of bending the healthcare cost curve, they propose the linking of 85% of all payments under traditional Medicare to “value” and quality measures by the end of 2016.  This percentage would rise to 90% by 2018. In this proposal 30% of Medicare payments would be tied to quality or value through alternative payment models by the end of 2016, and 50% of payments by the end of 2018. In these risk models savings are shared with the payer, while deficits are borne to a greater degree by the provider. Quality measures assume a major role. Shared savings are linked to the quality of both physician and hospital performance, so that higher quality provides a larger share of savings and a smaller share of deficits to providers. This makes definition, tracking and achievement of these quality measures critical to physicians’ reimbursement.

This tectonic shift in the way physicians and hospitals are reimbursed has obviously caught the attention of the AVF leadership. They recognize the major impact that this transition will have on the delivery of health care and to its members. As a result, AVF has organized a symposium on this subject to expand upon the already planned presentation on quality measures in wound care.

The Friday afternoon symposium is titled- Reimbursement of Wound Centers and Venous Treatment based on quality and value:  the future is now. Several AVF members will be participating. The session will be moderated by Thomas F. O’Donnell, Jr. M.D., of Tufts Medical Center, Boston, who has had a long time interest in healthcare economics.  He will provide an overview of the area and discuss alternative quality contracts (AQCs) which have been used in Massachusetts by Blue Cross Blue Shield and have demonstrated to reduce health care cost. Peter Lawrence, M.D., Chief of Vascular Surgery at UCLA, will discuss his institution’s experience with ACO’s and wound centers. William Marston, M.D., Chief of Vascular Surgery at University of North Carolina, will address bundled payments for wound care. The final portion of the program will shift from risk sharing and costs to quality measures for wound care. Caroline Fife, M.D., Medical Director of CHI St. Luke’s Health – The Woodlands Hospital Wound Care Clinic in Texas and Marcia Nusgart, R.Ph. of Washington D.C., Executive Director of the Alliance of Wound Care Stakeholders, will discuss quality measures for wound care. The AVF participated with the Alliance in submitting quality measures for venous ulcer care to CMS.