Posts in Category: Centers for Medicare & Medicaid Services

CMS Delays Cardiac Bundled-Payment Program  

The Centers for Medicare and Medicaid Services (CMS) has pushed back the implementation date for its bundled payments for cardiac care from July 1 until Oct. 1, according to Cardiovascular Business. It also suggested it could further delay the model until Jan. 1, 2018.

CMS announced the delay of the program, titled the Cardiac Rehabilitation Incentive Payment Model, this week in the Federal Register.

The bundled-payment program would allow approximately 1,120 acute care hospitals in 98 designated markets to hold on to the savings they achieve if they spend less than the target price for a 90-day episode of care for bypass and heart attack patients. However, hospitals that exceed the target price must repay Medicare -- and target prices will be determined retrospectively.

CMS previously predicted that the program - which also covers knee and hip replacement - would save the federal government as much as $159 million between now and 2021. In 2014, the CMS said, heart attack treatment for 200,000 patients cost Medicare more than $6 billion.

The new Secretary of Health & Human Services, Tom Price, has been a critic of the program, objecting to the mandatory nature of the initiative. Seema Verma, the new CMS administrator, said during her confirmation hearing in February that she preferred a gradual expansion of new payment models, Cardiovascular Business reported.

The CMS announcement said an additional three-month delay is necessary to allow time for additional review, "to ensure that the agency has adequate time to undertake notice and comment rulemaking to modify the policy if modifications are warranted, and to ensure that in such a case participants have a clear understanding of the governing rules and are not required to take needless compliance steps."

CMS added that participants would have more time to prepare for these models with the delay and that it would be preferable for payment periods to align with the calendar year. As a result, the CMS said, it is seeking comment on delaying the bundles until January 2018.

 

From one hospital to another, the cost of treating heart attack patients varies by as much as 50 percent. Does your hospital have a plan to meet the target prices for bypass and heart attack patients? LUMEDX's Cardiovascular Performance Program can help. Click here to find out how.

Meet Seema Verma, Trump's nominee to head CMS 

President-elect Donald Trump’s nomination of Seema Verma to head the Centers for Medicare and Medicaid has been largely overshadowed by his choice of Rep. Tom Price for director of the Department of Health and Human Services. But for those reading the tea leaves about the future of healthcare, especially the Affordable Care Act, Verma’s selection is well worth examining.

Verma, a healthcare consultant who runs a national health policy consulting company, has extensive experience with Medicaid. As president, CEO and founder of SVC, she was involved in expanding Medicaid in Indiana under then-Gov. Mike Pence, the Vice president-elect. SVC also assisted in formulating Medicaid expansion plans in Iowa, Kentucky, Michigan and Ohio. Here are a few more things to know about her:

  • She is an advocate of making patients more financially responsible for their healthcare, and supports freezing coverage for those who don’t pay their premiums, even those living below the poverty line.
  • She worked across party lines to push the Pence administration’s positions into the Indiana Medicaid expansion, known as the Healthy Indiana Plan, or HIP.
  • She supports requiring that Medicaid enrollees look for work, and that they reapply for coverage on time. Those who don’t, she maintains, could lose coverage for up to a year.
  • Patient advocacy groups predict she may call for a replacement of the Affordable Care Act before agreeing to its repeal. Her potential push-back might help mitigate the loss of coverage for those who received coverage through Medicaid expansions in the ACA—about 12 million people.
  • Indiana Rep. Charlie Brown, a Democrat, opposed many of Verma’s positions during debate over the Healthy Indiana Plan, but told National Public Radio that she is “a smooth operator, and very, very persuasive.”
  • The Indianapolis Star reported in 2014 that Verma was paid millions by Indiana for her work on the Indiana Medicaid expansion, and was also paid by Medicaid vendor Hewlett-Packard, which was paid more than $500 million by the state.
  • The American Medical Association, American Hospital Association and America's Essential Hospitals support Verma’s nomination, which—like Price’s—must be approved by Senate.

Parts of Obama's Healthcare Legacy Will Likely Continue Under Trump 

President-elect cites popular provisions he'd like to keep

As the dust settles after the presidential election, it appears that Donald Trump is already softening some of his positions, especially his position on Obamacare. Media outlets have speculated that President Obama pushed hard for the continuance of his signature healthcare program when he met with Trump at the White House following the election.

During the presidential campaign, Trump disparaged the Affordable Care Act and called for its repeal, although he didn't spell out what he would put in its place. A wholesale repeal of the ACA could leave as many as 22 million people without health insurance--a prospect that industry insiders consider unlikely.

Healthcare attorney Michael P. Strazzella told FierceHealthcare that Trump will focus on the ACA on the first day of his presidency, but that he doesn't expect anything dramatic to happen immediately. (Strazzella is co-head of Buchanan, Ingersoll & Rooney's District of Columbia office.)

"Repeal is good campaign language, but it's a 2,000-plus page bill and not everything can be repealed," Strazzella pointed out. To actually repeal all of Obamacare would require a 60-vote Senate supermajority, which Trump could not get unless some Democrats crossed party lines.
Other factors to consider:

  • The Republican Party is far from united under Trump, whom some GOP leaders have distanced themselves from, so the new president may not be able to count on the party's backing his every move.
  • Republicans may be wary of taking away well-liked provisions of Obamacare, especially if that doesn't play well with their constituencies.
  • The ACA's mandate that patients must not be denied coverage due to pre-existing conditions is very popular with voters, as is the act's provision for young people to be kept on their parents' insurance plans till age 26.*

What other aspects of healthcare might change under the Trump presidency? The future of pilot programs such as the Accountable Care Organizations under the Medicare Shared Savings Programs--like so many other Obama administration healthcare provisions--is murky. But many in the healthcare industry maintain that value-based care is here to stay. 

The credit ratings and research company Fitch Ratings issued this prediction: "The shift toward linking pricing to patient outcomes will continue as patients and health insurers grapple with the growing burden of healthcare costs over the longer term." 

*UPDATE: Trump recently told "60 Minutes" that he is in favor of keeping at least two provisions of Obamacare: the requirement that insurance companies accept patients with pre-existing conditions, and the provision that allows young adults to stay on their parents' health insurance plans until they reach the age of 26. He also signaled that he would not end Obamacare without having some other program in place.

Will the election of Trump impact your organization? Share your thoughts in our comment section below.

Early Reaction to MACRA Rule Mostly Positive 

Last weekend was a busy one for those trying to parse the new MACRA rule released on Friday. At 2,202 pages, the Medicare Access and CHIP Reauthorization Act rule wasn't exactly beach reading, and it gave the health IT community plenty to talk about on social media and in policy statements.

The dust is still settling, but it appears that early reaction to the rule was mostly positive. Healthcare organizations praised the CMS for being responsive to concerns they had raised during the comment period leading up to the rule's finalization. In fact, about 80 percent of the 2,000+ pages are comments CMS received and its responses.
The American Medical Association was pleased with the permanent elimination of the Sustainable Growth Rate (SGR) formula. "The new law," according to the AMA's press release, "gives many physicians the opportunity to be rewarded for the improvements they make to their practices and for delivering high-quality, high-value care to Medicare patients."
Other features that drew favorable reactions included:

  • The rule's overarching theme that improving the organization and payment models for medical care must stress quality over quantity.
  • Greater reporting flexibility for clinicians, as well as support for innovation in the delivery of care.
  • The formal adoption of a transition year during 2017, which makes major changes to the Quality Payment Program (QPP) reporting requirements, and provides a longer time frame for those transitioning to the QPP.
  • Emphasis on helping clinicians educate themselves about the rule.
  • Easing of the policy defining the Advanced Alternative Payment Model (APM), which will allow additional programs to quality.

But the rule is not without its detractors. "It's disappointing that the flexibility provided for quality reporting in 2017 largely disappears in 2018 and beyond," the Medical Group Management Association said in a policy statement.
Other organizations complained that the nominal risk standard defining the Advanced APM remains too high.

Want to know more? Healthcare Dive has a great breakdown of the rule changes you need to know. And for even more information on the new rule, click here. 
What's your take on the final MACRA rule? Share your thoughts in our comment section below.

The Best of Cardio and Health IT News: Week of 3/7/16 

Readmissions, Obamacare, and more

CMS targets hospital readmissions after CABG 

A proposed rule from the Centers for Medicare & Medicaid Services (CMS) would penalize hospitals that perform an index coronary artery bypass graft (CABG) and then have an unexpected 30-day readmission, even if the patient was discharged from a different hospital. "The proposed CABG 30-day readmission measure includes Medicare beneficiaries who are 65 years old or older who at the time of the index admission had been enrolled in a Medicare fee-for-service program for at least 12 months," Cardiovascular Business reports. "CMS intends to add CABG to its readmissions reduction program in 2017."

Most support keeping, building on Obamacare

The Affordable Care Act (Obamacare) continues to have public support, with 36 percent of those surveyed saying it should be expanded, according to the latest Kaiser Health Tracking Poll. That's the position advocated by presidential candidate and former Secretary of State Hillary Clinton. Nearly a quarter of respondents would like to see a single government plan, as advocated by Vermont Sen. Bernie Sanders, while 16 percent would repeal the ACA and not replace it. Repealing the act and replacing it with a Republican alternative was favored by 13% of respondents.

Analysis: U.S. health spending wouldn't be substantially decreased by price transparency

"Menu-izing the costs of care doesn’t turn the average American into a skilled healthcare shopper, but don’t blame the consumer," says Health Exec. "While some 43 percent of U.S. healthcare spending does indeed go into 'shoppable,' non-emergent care—everything from flu shots and blood tests to colonoscopies and electively timed surgeries—only around 7 percent of out-of-pocket spending goes to such services. The result, according to a new analysis from the Health Care Cost Institute, is that the healthcare system as a whole wrings little cost benefit out of the push for price transparency."

Cardiovascular risk increases with heavy alcohol consumption

Drinking alcohol is associated with higher cardiovascular risk immediately after consumption, according to systematic review and meta-analysis. "After 24 hours, there was a lower risk for moderate drinkers," Cardiovascular Business reports. "But the risk increased in heavy drinkers for the following day and week."

Major markets could see mega-regional healthcare systems

Consolidation is a trend expected to continue in the healthcare industry, according to Fierce Healthcare. The trend, with increased leverage and revenues, has led to the creation of super-regional system in several large markets. "In Chicago, consolidation reached a crescendo in 2014 when fully integrated health system Northwestern Memorial HealthCare and Winfield, Illinois' Cadence Health finalized a merger, with Northwestern expanding to include four hospitals under the deal," reported Becker's Hospital Review. Since then, Northwestern has expanded its reach, finalizing a deal with KishHealth in Dekalb, Illinois. The system now boasts six hospitals and more than 4,000 workers.

The Best of Cardio and Health IT News: Week of 2/15/16 

Don't miss out on this week's top stories


CMS and health insurers announce alignment and simplification of quality measures

The Centers for Medicare & Medicaid Services (CMS) and America's Health Insurance Plans (the health plans' trade group)  announced that they have agreed on seven sets of clinical quality measuresThe standardized measures are designed to help payers and consumers shopping for high-quality care. "These measures support multi-payer alignment, for the first time, on core measures primarily for physician quality programs," according to the CMS. This work is informing the CMS’s implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Supreme Court: What will happen to healthcare cases after Justice Scalia's death?

A number of healthcare-related cases are in limbo following the death of conservative U.S. Supreme Court Justice Antonin Scalia, who died on Feb. 12. "The court is weighing a case about data sharing with potential implications for insurers and state healthcare reform efforts," Modern Healthcare reports. "Another case has the potential to reduce—or increase—the number of False Claims Act suits brought against healthcare providers and other companies." Also before the court is a case involving the contraception mandate in the Affordable Care Act. 

CMS anticipates giving out $7.7 billion in ACA reinsurance payouts

Healthcare insurance companies could receive as much as $7.7 billion as part of the Affordable Care Act's reinsurance program. Reflecting data from the 2015 benefit year, the payouts are to be issued this year. "The Affordable Care Act created the temporary, three-year reinsurance program to protect insurers during the early years of the new individual marketplaces," according to Modern Healthcare"Insurers pay into the reinsurance pool, and those funds are then paid out to health plans that had members with extremely high medical claims." 

Still stalled: Federal healthcare rule that ties Medicare, Medicaid payments to disaster-preparedness plans

A proposed federal rule that would require healthcare facilities and hospitals to create emergency-preparedness plans in order to receive Medicare and Medicaid funding is stalled in the Office of Management and Budget, undergoing a legally required review. It would affect more than 68,000 providers, according to a New York Times news analysis."Industry groups have been critical of the time and expense they said would be involved in steps such as test backup power generators more frequently and for longer periods, or to pay staff overtime during drills," according to FierceHealthcare.com.

Harvard researchers say PCI readmission metric could be model

A model for improving the quality and value of cardiology care may be found in a pilot program from the Centers for Medicare and Medicaid Services and the National Cardiovascular Data Registry (NCDR), according to Harvard researchers. The program evaluated and reported risk-adjusted 30-day readmission rates after PCI. "The researchers noted that preventing readmissions could improve the quality of care and reduce costs for cardiology patients," according to CardiovascularBusiness.com.

 

The Best of HealthIT News: Week of 2/8/16  

Population health, Obamacare, and cost containment

Did you have a chance to check out the latest news from the healthIT community? Let us help keep you up to date on the stories you won't want to miss.

Companies Form New Alliance to Target Healthcare Costs

Hoping to hold down the cost of healthcare benefits, 20 large companies—including American Express, Macy’s  and Verizon—have come together to use their collective data and market power. Members of the new alliance will share data about employee healthcare spending and outcomes, possibly using the data to change how they contract for care. "Some members say they could even form a purchasing cooperative to negotiate for lower prices, or try to change their relationships with insurance administrators and drug-benefit managers," Yahoo news reports.

Federal Insurance Marketplace Signs Up Millions of New Obamacare Users

The Obama administration reports that approximately 12.7 million new patients signed up for health insurance under the Affordable Care Act, or automatically renewed their policies during Obamacare's third annual open enrollment season. Sylvia Mathews Burwell, the secretary of the Department of Health and Human Services, told the New York Times that the signups show that “marketplace coverage is a product people want and need.” Most of the plan selections were for people in the 38 states—more than 9.6 million—who used the federal website, HealthCare.gov, the Times reported. The other 3.1 million people were enrolled in states that run their own marketplaces.

Healthcare Economics: Court Allows Some Hospitals to Save Money by Classifying Themselves as Both Rural and Urban

While an earlier Health and Human Services (HHS) rule had barred both urban and rural classifications at once, a new federal appeals court ruling removed the barrier for dual hospital classification. The recent court decision applies only to hospitals within the 2nd U.S. Circuit Court of Appeals, but some hope that—combined with an earlier similar decision in a different circuit—the 2nd Circuit Court's ruling will inspire HHS to change the regulation across the country. "The Center for Medicare & Medicaid Services allows hospitals to classify themselves as rural (which providers typically leverage for discounts on drug purchases) while also classifying themselves as urban, (an important factor to attract qualified clinicians)," according to Reuters. 

Population Health: Hospital-based Wellness Centers Are Changing the Healthcare Model

Wellness centers housed in hospitals are helping communities prioritize preventive care and management of chronic conditions. The centers are part of the population health management model that focuses on preventing illnesses rather than simply treating them when and if they occur. The idea is to get patients to seek treatment before their conditions worsen, thus easing the burden on emergency rooms and acute care centers—and saving money.

Cost Control: Surgical Safety Checklists Can Save Lives and Reduce Hospital Stays

Surgical safety checklists—if implemented correctly—can save time, lives, and money. After the checklists were implemented, one study found, the average length of a hospital stay dropped from 10.4 days to 9.6 days. In addition, the checklists led to a 27 percent drop in the risk of death following surgery. Proper and consistent implementation is critical, however, for the checklists to work.

The Best of Cardio and Healthcare News for the Week of 2/1/16 

Trending topics in HealthIT

Leave the researching to us! LUMEDX surveys the top healthcare and health IT stories of the week.

Healthcare economics: Basing healthcare decisions on Medicare data might not be best practice

A recent study found that the correlation between total spending per Medicare beneficiary and total spending per privately insured beneficiary was 0.14 in 2011, while the correlation for inpatient spending was 0.267. “What that suggests is that policy for Medicare doesn’t necessarily make better policy for the privately insured,” one researcher told Health Exec.

Reducing readmissions among minorities: 7 population health strategies

A new guide from Medicare gives hospitals methods for addressing ethnic and racial healthcare disparities in readmissions. The guide comes amid increasing concerns about racial and ethnic disparities in healthcare outcomes, and frustration about federal penalties that some say unfairly punish providers in high-risk communities. 

Sharing of medical-claim data would be allowed under proposed #CMS rule

"Some medical data miners may soon be allowed to share and sell Medicare and private-sector medical-claims data, as well as analyses of that data, under proposed regulations the CMS issued," Modern Healthcare reports. "Quality improvement organizations and other 'qualified entities' would be granted permission to perform data analytics work and share it with, or sell it, to others, under an 86-page proposed rule that carries out a provision of the Medicare Access and CHIP Reauthorization Act of 2015" (#MACRA). 

Federal gender pay equity rule: What will it mean for healthcare industry?

Nearly 80 percent of hospital employees are women. How might they be affected by President Obama's recent announcement that the Equal Employment Opportunity Commission will begin requiring companies that employ 100 or more people to report wage information that includes gender, race, and ethnicity?

The price of healthcare miscommunication: $1.7B and nearly 2,000 lives

New research shows that healthcare miscommunication has cost nearly 2,000 lives, and was a contributing  factor in 7,149 cases (30 percent) of 23,000 medical malpractice claims filed between 2009 and 2013. Communication failures were also to blame for 37 percent of all high-severity injury cases.

Physical fitness can decrease mortality risk following first heart attack

Being physically fit may not only help to reduce the risk of heart attacks, but may also decrease the risk of mortality following a first heart attack, according to a new study. The study used multivariable logistic regression models to assess how exercise affected the risk of mortality at 28, 90, and 365 days after a heart attack.

 

Best of Health IT News: Week of 07/23/15 

Did you have a chance to check out the latest healthcare IT news stories around the Web? We’ve captured the top industry news stories from this week that you won’t want to miss.

CMS Updates Hospital Star Ratings, More than 500 Earn Top Marks 

The Centers for Medicare and Medicaid Services has published its latest patient satisfaction survey results, which shows that the number of hospitals earning a 5-star rating has more than doubled. 548 hospitals earned a 5-star rating for the reporting period between October 2013 and September 2014. 

Health Specialists Call for $2 Billion Global Fund for Vaccines 

Several global health experts have written a paper calling for the creation of a $2 billion global fund to support vaccine development. The fund would come from governments, foundations and the pharmaceutical industry, and would be used to develop new shots against high priority diseases such as Ebola, MERS and the West Nile virus. 

AMA Docs Fed Up with EHR Woes 

At a recent American Medical Association Town Hall, physicians expressed their frustrations over EHR challenges and experiences. According to AMA President Steven J. Stack, MD: "They have so much potential to improve healthcare, improve quality, improve our efficiency, improve patient engagement, and yet that's not the current state of reality." 

Best of Health IT News: Week of 06/18/15 

Did you have a chance to check out the latest healthcare IT news stories around the Web? We’ve captured the top industry news stories from this week that you won’t want to miss.

An Ideal Transition: Multi-Campus Rollout of Echo CVIS at Orlando Health 

Download the latest case study from Diagnostic & Interventional Cardiology to learn how Orlando Health has successfully implemented a physician structured reporting solution and PACS system for cardiac echo across five of its campuses. 

Interoperability, Telehealth Key to Chronic Disease Management 

Health IT Analytics reports on a recent letter that the College of Healthcare Information Management Executives (CHIME) has written to Congress, stating that the healthcare industry should focus on improving health data interoperability, raising patient engagement, and championing telehealth. 

Healthcare Increasingly Requires a Tech-Savvy Workforce 

According to Fierce Health IT, as the use of technology in healthcare continues to rise, healthcare providers must hire doctors and nurses who are tech-savvy. Hospital executive teams also increasingly include a chief analytics officer, a chief transformation officer, or a chief information security officer. 

ICD-10 Testing Lags Among Providers

According to a survey by the eHealth Initiative, healthcare providers continue to lag behind when it comes to testing in preparation for the transition to ICD-10. Only half of all respondents said that they had conducted test transactions using the new ICD-10 codes, and 19% stated that they had no plans to conduct end-to-end testing. 

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