Healthcare Snapshot - April 2024
April 01, 2024
PSW CEO, Melanie Matthews, Testifies Before the United States Senate Committee on Finance
Last week, PSW CEO Melanie Matthews testified before the United States Senate Committee on Finance in the Bolstering Chronic Care through Medicare Physician Payment hearing. During her testimony, Melanie emphasized the transformative potential of Accountable Care Organizations (ACOs) and the many benefits that ACOs can provide for people with chronic conditions. Melanie highlighted a few key themes in her testimony:
- Accountable care is working - both for beneficiaries and for Medicare.
- ACOs provide much needed support to people with chronic conditions through team-based, coordinated care.
- More can be done to engage beneficiaries in value-based care and provide incentives for them to manage their health.
Melanie shared impactful stories from PSW's ACO experience and highlighted the need for clear and strong incentives that allow providers to participate in accountable care models.
CMS Announces New Proposed Mandatory Model
Graphic provided by CMS Model Webpage: ACO Primary Care Flex Model (cms.gov)
CMS recently announced a new mandatory episode-based model in the Hospital Inpatient Prospective Payment Systems (IPPS) Proposed Rule. The Transforming Episode Accountability Model (TEAM) is scheduled to being on January 1, 2026.
Hospitals in selected Core-Based Statistical Areas (CBSAs) will be required to participate in TEAM. There will be a glidepath into full financial risk:
- Track 1 – no downside risk and lower levels of reward for the first year
- Track 2 – lower levels of risk and reward for certain hospitals, such as safety net hospitals, for years 2 through 5
- Track 3 – higher levels of risk and reward for years 1 through 5
TEAM will focus on the following surgical procedures:
- Lower extremity joint replacement
- Surgical hip femur fracture treatment
- Spinal fusion
- Coronary artery bypass graft
- Major bowel procedure
Patient Success Story
A PSW patient, who underwent orthopedic lower extremity surgery, has a complex medical history including chronic conditions such as hypertension, heart failure, a pacemaker, and a prior valve replacement. During their stay, they experienced a readmission to the hospital due to an abdominal hematoma and anemia, putting them at increased risk for readmission post-discharge.
The PSW Care Management team worked closely with the Skilled Nursing Facility (SNF) the patient to identify their needs for discharge. Recognizing their interest in improving self-management of cardiac conditions, the PSW Care Management team introduced remote patient monitoring. Within days of discharge, the necessary equipment was delivered, empowering the patient to monitor their health proactively.
In addition to medical needs, PSW's team addressed social determinants of health challenges, including meal support and transportation for follow-up appointments. The team arranged for meal deliveries and transportation services, ensuring continuity of care beyond the clinical setting.
Post-discharge from the SNF, the patient remained engaged with a PSW Registered Nurse through regular follow-up appointments. They were also equipped with a pulse oximeter for home use, complementing their existing blood pressure cuff.
Reflecting on their experience, the patient expressed gratitude for the program, noting an easier transition home and reassurance of ongoing support. Before the SNF discharge, they had experienced 4 emergency department visits in the past 12 months. However, with the successful implementation of supportive services and remote monitoring, the patient has not required any additional ED visits since engagement in the PSW Care Management program.
