Posts in Category: Hospital Value-Based Purchasing Program

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.

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.

The Best of Health IT News: Week of 3/21/16 

Interoperability, EHRs, McKesson layoffs and more

EHRs: Interoperability is all the rage. Why don't we have it?

Health & Human Services Secretary Sylvia Mathews Burwell recently announced that HHS is behind a major push to achieve interoperability of Electronic Health Records (EHRs). "Companies that provide 90 percent of EHRs used by U.S. hospitals, including Epic and athenahealth, have agreed to increase patient access, no information blocking, and adoption of federally recognized interoperability standards," reports Healthcare Dive. But will those goals improve patient care and EHR workflow?

McKesson announces layoffs, to shed 1,600 U.S. employees

McKesson plans to lay off about 1,600 employees, or about 4 percent of its U.S. workforce. The restructuring move is predicted to cost the company $300 million to $330 million.

AHIMA petitions White House on national patient identifier

The American Health Information Management Association (AHIMA) is petitioning the White House to recognize the need for a national patient identifier. "The petition asks that legislative language be removed that stops the Department of Health and Human Services from funding efforts to find a national patient ID solution," reports FierceHealthIT. "AHIMA also wants leaders in the government to work with the private sector and security experts on a path to a voluntary patient safety ID."

Another legal defeat for faith-based health systems with pension plans

Federal appeals courts continue to side against faith-based health systems, which may soon be forced to contribute millions into underfunded employee pension plans. The issue of whether those pension plans are subject to federal protections involves major health systems including Dignity Health, Presence Health and Catholic Health Initiatives. It could end up in the U.S. Supreme Court.

5 ways artificial intelligence is changing the face of healthcare

A recent report by Frost & Sullivan predicts the Artificial Intelligence (AI) market in healthcare will reach $6 billion by 2021, up from just $600 million two years ago. With the shift to a value-based reimbursement model, hospitals and providers are looking for new ways to increase efficiencies and improve patient outcomes, according to Healthcare Dive. "Cognitive solutions such as IBM’s Watson system can assess huge amounts of patient data, provide guidance and decision support, and improve clinical workflow."

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 1/25/16 

ERHs, ACOs, healthcare hackers, and more

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.

 

Healthcare execs advised to focus on consolidations, emergency preparedness, value-based care for 2016

Healthcare trends to watch this year include hospital consolidations and the continued shift away from fee-for-service payment models to value-based care, say hospital executives surveyed by FierceHealthcare. “'Providers will come together in a range of affiliations/partnerships as part of growth and cost reduction strategies, short of full-on mergers and acquisitions,’ according to Chris Van Gorder, CEO and president of Scripps Health in San Diego.”

Ambulatory EHRs should gain steam through 2020

There are many reasons to shift toward ambulatory inpatient electronic health records, according to a new report by Frost & Sullivan. The report predicts that low returns and on-premise EHR limitations will motivate healthcare providers to explore cloud-based, affordable products in their quest to achieve population health goals. The new records systems would benefit both patient-centered medical homes and Accountable Care Organizations as they negotiate the continuum of care for their patients. 

5 healthcare IT enemies to watch out for

A new report calls out five types of healthcare hackers and categorizes them based on their targets and other characteristics. Some are unsophisticated “script kiddies,” while others have the finesse of nation states, according to a Critical Infrastructure Technology report. They’re after everything from patient records to employee personnel files, and any records that can help them steal identities, the report says.

Out-of-network integration, interoperability among problems facing ACOs

Interoperability and integration problems plague Accountable Care Organizations (ACOs) despite the fact that many systems have made health IT a major focus, according to a survey. Integrating data from out-of-network providers is the most daunting challenge they face, according to 80 percent of ACO representatives surveyed.

Give patients control of their data, researchers argue

Hospitals should make changing to a patient-controlled records system a priority, say researchers at Boston Children's Hospital in the New England Journal of Medicine. They argue that the benefits of patient-controlled records are far-reaching, and that the technology needed to make the shift is already in place. They admit, however, that the incentives to make the change are lacking. 

The Best of Cardio and Healthcare News for the Week of 1/4/16 

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

2016 may bring slower patient growth, higher wages, more expensive drugs

Late 2015 data support health systems' anticipation that the demand surge from patients newly insured under the Affordable Care Act would fade this year. Economists with the Altarum Institute say spending acceleration from the coverage expansion may have peaked last February. 

FDA clears Biotronik's peripheral stent 

The FDA has cleared Biotronik's Astron Peripheral Self-Expanding Nitinol Stent System, a device for improving luminal diameter in patients with iliac atherosclerotic lesions. The stent system is described as a self-expanding stent loaded on an over-the-wire delivery system. 

Patients increasingly turning to mobile health apps

More than 30 percent of consumers last year said they have at least one health app on their smartphones, and 60 percent are willing to have a video visit with a doctor through a mobile device, according to an online survey of 1,000 U.S. adults. An increased use of telehealth apps is one of the predictions for 2016 from the PwC Health Research Institute.

Diagnostic errors, measuring performance among top healthcare quality issues for New Year

Zeroing in on individual doctor performance, reducing diagnostic errors, standardizing performance measures, and rethinking the patient experience may be among the top agenda items for healthcare quality and safety leaders this year. There could also be a greater focus on individual doctor performance as it relates to value-based payment and quality reporting.

Family satisfaction increases when ICUs relax their visiting hours

A survey published in the American Journal of Critical Care shows patients benefit when families visit throughout the day and night. "These findings support open and patient-centered visitation guidelines in critical care settings," the researchers wrote.
 

  • RSS

Statistics

  • Entries (212)
  • Comments (365)

Categories