Medicare’s investment in primary care shows progress
by Dr. Patrick Conway
Today, the Centers for Medicare & Medicaid Services (CMS) announced the Comprehensive Primary Care (CPC) initiative’s second round of shared savings results, with nearly all practices (95 percent) meeting quality of care requirements and four out of seven regions sharing in savings with CMS. These results reflect the work of 481 practices that served over 376,000 Medicare beneficiaries and more than 2.7 million patients overall in 2015.
CMS Finalizes the New Medicare Quality Payment Program
Today, the Department of Health and Human Services (HHS) finalized its policy implementing the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM) incentive payment provisions in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), collectively referred to as the Quality Payment Program. The new Quality Payment Program will gradually transform Medicare payments for more than 600,000 clinicians across the country, and is a major step in improving care across the entire health care system.
The final rule with comment period offers a fresh start for Medicare by centering payments around the care that is best for the patients, providing more options to clinicians for innovative care and payment approaches, and reducing administrative burden to give clinicians more time to spend with their patients, instead of on paperwork.
Accompanying today’s announcement is a new Quality Payment Program website http://qpp.cms.gov, which will explain the new program and help clinicians easily identify the measures most meaningful to their practice or specialty.
How Tiny Are Benefits From Many Tests And Pills? Researchers Paint A Picture
by Jay Hancock
Mammograms are said to cut the risk of dying from breast cancer by as much as 20 percent, which sounds like an invincible argument for regular screening.
Two Maryland researchers want people to question that kind of thinking. They want patients to reexamine the usefulness of cancer exams, cholesterol tests, osteoporosis pills, MRI scans and many other routinely prescribed procedures and medicines.
Falls and Fall Injuries Among Adults Aged ≥65 Years - United States, 2014
by Gwen Bergen, PhD; Mark R. Stevens, MA, MSPH; Elizabeth R. Burns, MPH
Falls are the leading cause of fatal and nonfatal injuries among adults aged ≥65 years (older adults). During 2014, approximately 27,000 older adults died because of falls; 2.8 million were treated in emergency departments for fall-related injuries, and approximately 800,000 of these patients were subsequently hospitalized.* To estimate the numbers, percentages, and rates of falls and fall injuries among older adults by selected characteristics and state, CDC analyzed data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) survey. In 2014, 28.7% of older adults reported falling; the estimated 29.0 million falls resulted in 7.0 million injuries. Known effective strategies for reducing the number of older adult falls include a multifactorial clinical approach (e.g., gait and balance assessment, strength and balance exercises, and medication review). Health care providers can play an important role in fall prevention by screening older adults for fall risk, reviewing and managing medications linked to falls, and recommending vitamin D supplements to improve bone, muscle, and nerve health and reduce the risk for falls.
U.S. Health-Care System Ranks as One of the Least-Efficient
by Lisa Du, Wei Lu
America is number 50 out of 55 countries that were assessed.
America was 50th out of 55 countries in 2014, according to a Bloomberg index that assesses life expectancy, health-care spending per capita and relative spending as a share of gross domestic product. Expenditures averaged $9,403 per person, about 17.1 percent of GDP, that year — the most recent for which data are available — and life expectancy was 78.9. Only Jordan, Colombia, Azerbaijan, Brazil and Russia ranked lower.
The U.S. has lagged near the bottom of the Bloomberg Health-Care Efficiency Index since it was created in 2012. Hong Kong and Singapore — consistently at the top — are smaller countries with less diverse populations. Their governments also play a stronger role in regulating and providing care, with spending per capita averaging $2,386 and longevity averaging about 83 years.
Falls are leading cause of injury and death in older Americans
Every second of every day in the United States an older adult falls, making falls the number one cause of injuries and deaths from injury among older Americans.
In 2014 alone, older Americans experienced 29 million falls causing seven million injuries and costing an estimated $31 billion in annual Medicare costs, according to a new report published by the Centers for Disease Control and Prevention in this week’s Morbidity and Mortality Weekly Report (MMWR).
The Department of Health and Human Services highlighted findings from a few new studies that show Americans are experiencing slower growth in health care premiums, increased access to coverage, and higher quality of care.
More Affordable: The average premium for families with employer-sponsored health plans grew just 3.4 percent in 2016, according to the Kaiser Family Foundation and Health Research and Educational Trust survey, extending a period of unusually slow growth since 2010. The White House Council of Economic Advisers calculates that the average family premium is $3,600 lower in 2016 than if premiums had grown at the same rate as the pre-ACA decade.
The independent analysis released this morning by the Kaiser Family Foundation finds that the average family premium for the 150 million Americans with employer-sponsored health plans increased by only 3.4 percent in 2016.
Average Medicare payments for a lower extremity joint replacement hospitalization and 90-day post-discharge period declined $1,166 more for hospitals participating in the first 21 months of the Bundled Payments for Care Improvement initiative than for comparison hospitals that did not participate, according to a study published online today by the Journal of the American Medical Association. The lower Medicare payments were primarily due to reduced use of institutional post-acute care, the authors said. Claims-based quality measures, including unplanned readmissions, emergency department visits and mortality, were not statistically different between the BPCI and comparison populations. “Further studies are needed to assess longer-term follow-up as well as patterns for other types of clinical care,” the authors said. Separately, the Centers for Medicare & Medicaid Services today released a report on first-year results for Models 2 to 4 of the initiative, which include retrospective and prospective bundled payments that may or may not include the acute inpatient hospital stay for a given episode of care.
Employer-sponsored insurance covers over half of the non-elderly population; approximately 150 million nonelderly people in total. To provide current information about employer-sponsored health benefits, the Kaiser Family Foundation (Kaiser) and the Health Research & Educational Trust (HRET) conduct an annual survey of private and nonfederal public employers with three or more workers. This is the eighteenth Kaiser/HRET survey and reflects employer-sponsored health benefits in 2016.
Better Patient Care at High-Quality Hospitals May Save Medicare Money and Bolster Episode-Based Payment Models
by Thomas C. Tsai, Felix Greaves, Jie Zheng, E. John Orav, Michael J. Zinner, and Ashish K. Jha
Researchers looked at how much Medicare pays for five major surgical procedures, from the time patients are admitted to the hospital through 90 days after discharge. Patients who had their surgeries at high quality hospitals—that is, those with low mortality rates and high patient satisfaction scores—were found to cost Medicare less than patients at low-quality hospitals. The majority of the savings achieved can be attributed to lower use of skilled nursing facilities and other postacute care services.
Now that ICD-10 is in full swing, we are seeing a lot of activity with providers, payers, consultants and regulators who need to understand how Acute Inpatient and Long Term Care Hospital claims "behave" when the claim is coded in ICD-10. This includes both prospective and retrospective review of claims scenarios to understand MS-DRG grouping. This article offers a basic primer on MS-DRG grouping logic, and research techniques for using related MediRegs Coding Suite tools. If you'd like a personalized training on these tools, or a demonstration of them in action to see if they are a good fit for your research scenarios, please let us know!
OVERVIEW OF THE FY 2016 IPPS FINAL RULE: SUMMARY OF CALCULATION ELEMENTS
New Health Analytics, a national healthcare software developer and data analytics firm, is pleased to announce that it has released a special report with an concise review of the FY 2016 Hospital Inpatient Prospective Payment System (IPPS) Final Rule recently posted by the Centers for Medicare & Medicaid Services.