HHS Sets Goals and Timeline for Medicare Payments Based on Quality Rather Than Quantity

quality over quantity 2On January 26, 2015, Health and Human Services (HHS) Secretary Sylvia M. Burwell, announced that measurable goals and a timeline have been established to transition Medicare payments to a system focused on the quality of healthcare received as opposed to the quantity of healthcare received. The announcement followed a meeting that involved more than two dozen healthcare industry leaders representing consumers, insurers, and providers who provided input on what actions HHS can take to facilitate a move to quality based Medicare reimbursement.

Secretary Burwell announced that HHS has set goals of using alternative payment models such as Accountable Care Organizations (ACOs) and bundled payment systems to tie 30 percent of traditional (fee for service) Medicare payments to the quality of care delivered by the end of 2016 and tie 50 percent of Medicare payments to the quality of care delivered by the end of 2018. In addition, Secretary Burwell announced the goal of tying 85 percent of Medicare payments to quality or value by 2016 and 90 percent by 2018 through initiatives like the Hospital Value Based Purchasing and the Hospital Readmissions Reduction programs.

In addition to the goals and timeline that were set for Medicare payments, Secretary Burwell announced the creation of the Health Care Payment Learning and Action Network which will work with private payers, consumer groups, employers, providers, and state Medicaid programs to encourage the expansion of the idea of value based payments outside of the Medicare program. Value-Based purchasing is the latest iteration of provider risk-sharing with payers (Medicare and commercial), as well as so-called “pay-for-performance” and patient-focused outcomes. For the past couple of years AOPA has “Alternative Payment Models” established as one of our six AOPA Survival Imperatives to advance planning and efforts in these areas, as well as a related initiative of Prosthetics 2020, to anticipate and respond to demands for evidence-based findings on prosthetic care.

AOPA’s Take on this announcement is that there is a valuable opportunity to show the proven positive impact that quality O&P care has on the overall health of Medicare patients. Through its strategic partnership with the research firm Dobson DaVanzo, LLC, AOPA now has data that shows that the provision of lower limb prostheses and orthoses in general, actually saves money for the Medicare program through a reduction in overall healthcare expenditures for patients who receive O&P care. This data along with AOPA’s efforts to get the word out there through creation of the Mobility Saves website, positions AOPA at the forefront of the discussion regarding how the provision of quality O&P care by properly trained and educated clinicians benefits both the Medicare patient community as well as program itself.

For more information on the valuable compendium of data on the cost effectiveness available only to AOPA members, please click on the following link and provide your AOPA username and password.


To visit the Mobility Saves website, please click on the following link.


AOPA’s Take. Where you go….when you need to know!