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What is a Medicare Value-Based Care Center?
Value-Based Care Centers offer Medicare patients quality outcomes and the chance to share in savings to the federal Medicare program. As part of a demonstration project that encourages improvements in efficiency and quality of care provided to Medicare beneficiaries, five regional health systems – including Hillcrest – were designated as Value-Based Care Centers. The project is designed to support a more integrated approach to treating – and paying for – common orthopedic problems such as hip/knee replacement. HMC is the only hospital in the state selected to participate in the orthopedic demonstration.
How does this program work?
If you are covered by basic Medicare, you may qualify to receive a special incentive payment when you elect to have certain orthopedic procedures performed at HMC.
As part of the demonstration project, Value-Based Care Centers provide services to Medicare beneficiaries at special rates. To help offset Medicare co-payments, CMS will share up to 50 percent of their savings with beneficiaries in the form of incentive payments. The payments to beneficiaries cannot exceed the annual Part B premium of $699.
What are the qualifying procedures?
There are 9 orthopedic inpatient surgical services and procedures included in the demonstration. Some of the procedures include:
- Hip and knee total joint replacements
- Revisions of hip and knee total joint replacements
How did HMC receive this special designation?
Participating hospitals were selected based on many factors, including experience performing the covered procedures, outcomes and ongoing quality improvement efforts. In addition to providing select services at discounted rates, Value-Based Care Centers were also required to demonstrate a commitment to improving efficiency and delivering patient-centered, coordinated care.
How soon after the procedure will I receive my incentive payment?
You should receive your check approximately three months after your procedure.
How much will I receive?
The incentive payments vary by procedure and range from $171 to $699, which is the maximum of your Part B premium.
As a Medicare patient, can I receive inpatient care at HMC if I normally use another hospital?
Are other hospitals in Tulsa participating in this program?
No. HMC is the only hospital in Tulsa offering this unique program to Medicare beneficiaries.
What if I have a Medicare Advantage or a supplemental plan, do I still qualify for this offer?
This program is only for those with basic Medicare coverage. If you have a supplemental plan, you may still qualify as long as your primary coverage is basic, fee-for-service Medicare. Medicare Advantage members and those with dual eligibility for Medicare and Medicaid are not eligible to participate in CMS shared savings.
Do I have to sign up to participate in the program?
No. If you are covered by basic Medicare, you may automatically qualify.
How can I receive more information?
Call Angela Peterson at (918) 579-5203.