Government office predicts that Medicare trends will force tax increases, federal spending reduction
Due to the increase in life expectancy and baby-boomers reaching the age of 65, Medicare spending will likely skyrocket so much that the federal government will have to either reduce spending or increase taxes, according to a new Congressional Budget Office (CBO) report.
The report, which outlined a study that used data from the Master Beneficiary Summary File from 1999 to 2012, projected that the U.S. population age 65 or older will grow from almost 15 percent in 2015 to more than 21 percent by 2040. Currently, the population that is 95 years old is almost 100 percent dependent on Medicare, and with human life expectancy increasing each year, the number of those in the population living longer will increase. However, the increase in life expectancy, according to the report, is not the lone reason behind the shift in age.
Draft CDC Guideline for Prescribing Opioids for Chronic Pain
Improving the Way Opioids are Prescribed for Safer Chronic Pain Treatment
The Problem: Existing guidelines vary in recommendations, and primary care providers say they receive insufficient training in prescribing opioid pain relievers. It is important that patients receive appropriate pain treatment, and that the benefits and risks of treatment options are carefully considered.
Trends in Hospital Readmissions for Four High-Volume Conditions, 2009-2013
by Kathryn Fingar, Ph.D., M.P.H., and Raynard Washington, Ph.D.
Hospital readmissions can have negative consequences for patients and the hospitals at which they are treated, and also are costly for both public and private payers. In 2011, Medicare paid for 58 percent of all readmissions, followed by private insurance (20 percent) and Medicaid (18 percent). Readmissions are a significant portion of Medicare spending—37 percent of total Medicare spending is for inpatient care, and 18 percent of all inpatient admissions paid by Medicare are readmitted within 30 days, accounting for $15 billion in costs annually. In addition to these costs, repeat hospitalizations place patients at greater risk for complications, hospital acquired infections, and stress. Because the majority of readmissions are for nonsurgical services, it is unlikely that readmissions are profitable for hospitals.
AMA Calls for Ban on Direct to Consumer Advertising of Prescription Drugs and Medical Devices
Responding to the billions of advertising dollars being spent to promote prescription products, physicians at the Interim Meeting of the American Medical Association (AMA) today adopted new policy aimed at driving solutions to make prescription drugs more affordable.
Physicians cited concerns that a growing proliferation of ads is driving demand for expensive treatments despite the clinical effectiveness of less costly alternatives.
CMS finalizes model to bundle payments for hip and knee replacements
The Centers for Medicare & Medicaid Services late today finalized a new payment model that will bundle payment to acute care hospitals for hip and knee replacement surgery. CMS delayed the start of the Comprehensive Care for Joint Replacement model until April 1, 2016; the program will still conclude Dec. 31, 2020. The agency finalized its proposal that the hospital in which the joint replacement takes place be held accountable for the quality and costs of the entire episode of care from the time of the surgery through 90 days after discharge. In a statement, AHA President and CEO Rick Pollack said the rule “takes several positive steps to provide the support hospitals need to be successful” as they redesign the way care is delivered to increase value and better serve patients. Although the final rule itself does not include waivers of any fraud and abuse laws, CMS and the Department of Health and Human Services Office of Inspector General issued a joint statement waiving the Anti-kickback, physician self-referral, and civil monetary penalty laws with respect to certain financial arrangements and beneficiary incentives under the CJR model. In addition, CMS will waive the skilled nursing facility three-day rule in certain instances; the “incident to” rule, which would allow a CJR beneficiary to receive post-discharge visits in his or her home or place of residence any time during the episode; and geographic and originating site requirements that limit telehealth payments. AHA is pleased CMS and OIG “recognized the importance of assuring that participating hospitals can pursue the program’s goals without running afoul of fraud and abuse laws,” Pollack said. “These legal protections are critical to hospitals’ ability to coordinate care among all caregivers.” CMS will use a retrospective payment methodology with one-sided risk in the first year of the program – meaning no hospital will be penalized in year one – and two-sided risk in subsequent years. While the agency did not limit the program to elective joint replacements only as urged by the AHA, it will risk stratify based on a beneficiary’s hip fracture status. CMS will tie each hospital’s level of incentive or penalty to a composite quality score based on three measures – elective hip/knee arthroplasty complications within 90 days, the Hospital Consumer Assessment of Healthcare Providers and Systems survey, and a voluntarily submitted patient-reported outcome measure. The composite quality score will take into account significant performance improvements in the complications and HCAHPS measures. The CJR model will be in 67 geographic areas and most hospitals in those regions will be required to participate. AHA members tomorrow will receive a Special Bulletin with further details.
News Item - 11/16/2015
Initial Findings from Verizon Protected Health Information Data Breach Report Suggest Securing Patient Data is an Expansive Undertaking
by Janet Brumfield
Verizon Enterprise Solutions unveiled select initial findings from its inaugural Protected Health Information (PHI) Data Breach Report at the Connected Health Summit in Washington, D.C. The 2015 report examines how PHI breaches happen, how long it takes to discover a breach, how PHI breaches affect the doctor-patient relationship, and how to mitigate the risks. For this report, PHI is defined as personally identifiable health information on an individual covered by one of the state, federal or international data breach disclosure laws.
A New Centers for Disease Control and Prevention report finds that more Americans are obese and for the first time ever, more women are obese than men.
The report found that nearly 38 percent of adults, up from 32 percent about a decade earlier. Experts said they had no explanation for why the obesity rate appears to be rising.
Obesity rates for men and women had been roughly the same for about a decade. But in the new report, the rate significantly was higher for women, at 38 percent, compared with 34 percent for men.
Obesity — which means not merely overweight, but seriously overweight (with a BMI of more than 30 percent) — is considered one of the nation's leading public health problems. Until the early 1980s, only about 1 in 6 adults were obese, but the rate climbed dramatically until it hit about 1 in 3 around a decade ago.
The new figures come from a regular government survey that involves not only interviewing people about their girth but also actually weighing them. Because of that, it is considered the gold standard for measuring the nation's waistline.
The widening gap between men and women seems to be driven by what's happening among blacks and Hispanics, said the study's lead author, the CDC's Cynthia Ogden.
Obesity rates for white men and white women remain very close. But for blacks, the female obesity rate has soared to 57 percent, far above the male rate of 38 percent. The gender gap is widening among Hispanics, too — 46 percent for women, 39 percent for men.
The report also looked at obesity in children but did not see much change. For young people ages 2 to 19, the rate has been holding at about 17 percent over the past decade or so. In addition, the study found the obesity rate among toddlers was 9 percent.
News Item - 11/12/2015
AHRQ Lives to Fight Another Day
by Tinker Ready
The potential reversal of AHRQ's fortunes was probably driven more by DC budget wrangling than the value of the agency's work. Still, its supporters, some of whom rely mightily on AHRQ grants, made a lot of noise and had some fun tooting the agency's horn.
Bipartisan budget act will likely restore some, if not all of the agency's funding
It looks increasingly like the federal Agency for Healthcare Research and Quality will survive the attempt by Congress to shut it down. But it probably won't be because of the memes supporters sent out on social media.
Trends in Potentially Preventable Inpatient Hospital Admissions and Emergency Department Visits
by Kathryn R. Fingar, Ph.D., M.P.H., Marguerite L. Barrett, M.S., Anne Elixhauser, Ph.D., Carol Stocks, Ph.D., R.N., and Claudia A. Steiner, M.D., M.P.H.
Reducing potentially preventable hospitalizations is important for increasing quality of care and containing hospital costs. Medical conditions such as asthma, urinary tract infections, and complications of diabetes are considered ambulatory care sensitive conditions, meaning that when those conditions are present, primary or preventive health care can reduce the need for emergency department (ED) visits and inpatient hospitalization. From 2000 through 2012, the rate of potentially preventable hospitalizations among adults aged 18 years and older decreased by 25 percent.
Although the decrease in potentially preventable hospitalizations could reflect improvements in access to quality ambulatory care, it also may be an artifact of an overall decrease in inpatient admissions in recent years. The total rate of inpatient hospital stays decreased by 0.3 percent per year from 2003 through 2008 and by 1.9 percent per year from 2008 through 2012. The Great Recession, which officially began in December 2007, was associated with a decrease in inpatient stays as unemployment increased and access to health insurance decreased. For those who had health insurance during the Recession, copayments and deductibles increased.
CMS receives 380+ submissions and commentary about Joint Replacement Program Proposed Regulations.
This proposed rule proposes to implement a new Medicare Part A and B payment model under section 1115A of the Social Security Act, called the Comprehensive Care for Joint Replacement (CCJR) model, in which acute care hospitals in certain selected geographic areas will receive retrospective bundled payments for episodes of care for lower extremity joint replacement or reattachment of a lower extremity. All related care within 90 days of hospital discharge from the joint replacement procedures will be included in the episode of care. We believe this model will further our goals in improving the efficiency and quality of care for Medicare beneficiaries for these common medical procedures.
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.
HHS seeks to have 85 percent of Medicare fee-for-service payments in value-based purchasing categories 2 through 4 by 2016 and 90 percent by 2018
Improving the quality and affordability of care for all Americans has always been a pillar of the Affordable Care Act, alongside expanding access to such care. The law gives us the opportunity to shape the way health care is delivered to patients and to improve the quality of care system-wide while helping to reduce the growth of health care costs.
When it comes to improving the way providers are paid, we want to reward value and care coordination – rather than volume and care duplication. In partnership with the private sector, the Department of Health and Human Services (HHS) is testing and expanding new health care payment models that can improve health care quality and reduce its cost.