Posts in Category: Affordable Care Act

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.

Cardiac Bundled-Payment Program to Go Forward Despite Change in Administration 

The bundled-payment program for cardiac care will go forward despite the Trump administration and the confirmation of new Health & Human Services Secretary Tom  Price, a critic of the program. July 1 remains the start date for the initiative, according to an HHS official who spoke to Modern Healthcare.

Under the bundled-payment model, hospitals in 98 designated markets can keep 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.

The HHS spokesman confirmed that the start of the initiative will not be slowed by the Trump administration, which previously had moved to delay the effective date for a rule that launched it. Nor does it appear that Price will stand in the way of its implementation.

Last fall, Price criticized bundled payments in a letter to then-President Obama. Price objected to the mandatory nature of the initiative, arguing that the Centers for Medicare & Medicaid had exceeded its authority and upset the balance of power between Congress and the president.

CMS predicts that the program--which also covers knee and hip replacement--will 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. 

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.

The Best of Health IT News: Week of 4/18/16 

We've found the stories you won't want to miss!


ACA, population health will be game changers in next three years, say hospital execs

C-suite leaders predict that their most important areas of focus in the next three years will be high-value post-acute care networks and innovative approaches to care delivery, according to Premier Inc.'s spring Economic Outlook. The impact that the Affordable Care Act and population health management will have on care delivery is the reason these areas of focus will be so important, executives say. "About 95 percent said expanding high-value post-acute care networks is crucial to population health efforts," FierceHealthcare reports. "In addition, 94 percent said such networks are one of their greatest challenges."

ACC notifies 1,400 institutions of potential data breach

More than 1,000 institutions have been notified by the American College of Cardiology (ACC) that patient data from the National Cardiovascular Data Registry (NCDR) might have been breached. "After discovering the issue in December, the ACC found that four software development vendors who were testing software had access to NCDR patient data," reports Cardiovascular Business. "The data was copied between 2009 and 2010, and was included in one of more than 250 tables that software developers used in a test environment."

EHR fraud recommendations remain unimplemented, HHS Inspector General says

Warnings from the its Office of Inspector General have yet to prompt the Department of Health and Human Services to adequately address the issue of hospitals failing to employ safeguards and prevent electronic health record fraud and abuse via recommended tools already in place, according to the Inspector General. "The Inspector General's Office says that nearly all hospitals with EHRs had RTI-recommended audit functions in place, but that those functions were not being used to their full extent," FierceHealthcare reports.

The Most Innovative Trends and Technologies from ACC.16

DAIC Editor Dave Fornell takes a tour of some of the trends and interesting new technologies from the vendor booths on the expo floor at the 2016 meeting of the American College of Cardiology (ACC). 

 

 

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.

This Week in Cardio and Health IT News 

EHR developments, top hospitals list, and more

Here are some of this week's top stories in cardiology and health IT.

Big names in healthcare pledge to facilitate interoperability, EHR accessibility

The Obama administration has announced an agreement to increase interoperability by top U.S. health information technology developers and many of their larger customers. Signing on to the pledge--which requires signees to ease patient access to electronic health records--were Allscripts, Athenahealth, and Cerner Corp., among others. About 90 percent of U.S. hospitals use at least one of the vendors who signed on. 

Top 100 Hospital List released by Truven

Truven Health Analytics has released its list of the 100 top hospitals in the United States. In researching the hospitals, Truven discovered a trend toward reduced expense per patient among the majority of top-performing hospitals. This year's trend appeared for the first time in the awards' 23-year history. 

More patients survive when hospitals adhere to cardiac arrest protocol

Hospitals that closely followed recommended care protocols after in-hospital cardiac arrest (IHCA) had the highest survival rates. That's the conclusion of a new study published in JAMA Cardiology, which found that more than 24,000 lives could be saved annually if all hospitals operated at the level of the highest-scoring provider. 

Payer-provider collaborations called key to improved patient outcomes 

Payers and hospitals must overcome their differences to reduce readmissions, according to a special report by FierceHealthcare.com. "As providers increasingly move toward value-based care models, they must work with their counterparts in the payer sector to coordinate care and prevent readmissions," the report says. "But the transition is proving bumpy in some cases due in part to the historic mistrust between payers and providers."

Questioning whether readmission rates are a reliable care quality measure

Hospital readmission rates are not an outcome, but a measure of utilization, says one Harvard School of Public Health professor. He pointed to new federal research demonstrating that hospitals don't use observation status as a way to create the appearance of decreased readmissions, which had been a concern prior to the research. Readmission rates can decline for a number of reasons, including difficulty in being readmitted or better hospital-to-patient communication, he says.

The Best of Cardio and Health IT News: Week of 2/22/16 

Security breach, telehealth, and Obamacare

LUMEDX does the research for you! Here are some of the top stories in healthcare this week.

Security: Hospital pays ransom to get its data back from hackers

Security experts are concerned that a Southern California hospital paid a $17,000 ransom in bitcoins to hackers who infiltrated and disabled its network, saying that agreeing to the ransomers' demands could set a bad precedent. The hackers had encrypted the hospital's computer network and demanded the ransom to provide a digital decryption key to unlock it.

Healthcare could be major issue in presidential race

The future of U.S. healthcare--especially Obamacare, Medicare, and Medicaid--will be determined in this year's presidential election, and the candidates are offering starkly different visions. Democrat Hillary Clinton would uphold and expand the Affordable Health Act, while her primary opponent, Bernie Sanders, would replace it with a single-payer system. Republican Donald Trump expressed support for some facets of the ACA, while Republican Sens. Marco Rubio and Ted Cruz vow to end it.

51 hospitals settle with Justice Department in ICD case

The Department of Justice has reached settlements with 51 hospitals that allegedly improperly implanted implantable cardioverter defibrillators (ICDs) in Medicare patients. The department said it had reached settlements worth a total of more than $23 million with hospitals in 15 states for allegedly improperly implanting the cardiac devices.

Forbes blogger predicts expansion of concierge healthcare model

An opinion piece in  Forbes suggests that hospitals should consider offering concierge healthcare. The concierge model could help financially struggling providers by making them more attractive to wealthier patients who will pay for expedited access to high-caliber physician talent.

Experts call Zika 'the scariest virus since HIV'

As experts learn more about the mosquito-borne Zika virus, they are becoming more alarmed. The American Council on Science and Health referred to Zika as  "possibly the scariest virus since HIV" because it is carried by hard-to-escape mosquitoes and causes serious birth defects.

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.

 

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