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Archive for August, 2016

CMS Releases Medicare ACO Performance Data

Thursday, August 25th, 2016

On August 25, the Centers for Medicare & Medicaid announced that the Medicare Accountable Care Organizations (ACOs) qualified for more than $466 million in shared savings in 2015 by meeting quality standards and their savings threshold. Eight Pioneer ACOs generated more than $37 million in shared savings, while four generated losses. In addition, 119 Medicare Shared Savings Program ACOs earned $429 million in shared savings. Pioneer ACOs are early adopters of coordinated care and assume greater performance-based financial risk. ACOs with three years of experience in the program were more likely to earn savings (42%) than those participating one (22%) or two years (37%). Pioneer ACOs increased their mean quality score to more than 92%, an increase of more than 21 percentage points since the first year. MSSP ACOs improved on 84% of the quality measures that were reported in both 2014 and 2015.

For more information, go to https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-08-25.html

CDC Releases Vital Signs Report on Sepsis

Tuesday, August 23rd, 2016

According to a Vital Signs report released by the Centers for Disease Control and Prevention, health care providers are key to preventing, recognizing, and rapidly treating sepsis, since seven in ten patients who develop sepsis recently interacted with a health care provider or are likely to due to a chronic condition. The agency is partnering with provider organizations and patients to raise awareness about sepsis, a life-threatening complication of infection that begins outside of the hospital for nearly 80% of patients.

The report can be found at http://www.cdc.gov/mmwr/volumes/65/wr/mm6533e1.htm?s_cid=mm65

Draft 2017 Interoperability Standards Advisory Issued

Tuesday, August 23rd, 2016

The Department of Health and Human Services’ Office of the National Coordinator (ONC) for Health Information Technology has released for public comments the 2017 Draft Interoperability Standards Advisory. The advisory is an updated list and assessment of the standards and implementation specifications available to meet clinical health IT interoperability needs. The advisory is a non-binding document, but the standards and implementation specifications may be considered for rulemaking or other federal requirements. ONC particularly seeks comments on the references to more than one standard or implementation specification for a specific need. Comments are due October 24.

For more information, visit https://www.healthit.gov/standards-advisory/draft-2017  

Value-Based Insurance Design Model Refinements Announced

Wednesday, August 10th, 2016

The Centers for Medicare & Medicaid Services (CMS) has announced refinements to the design of the second year of the Medicare Advantage (MA) Value-Based Insurance Design Model (MA-VBID). The model will test whether giving Medicare Advantage (MA) plans flexibility to offer supplemental benefits or reduced cost sharing to targeted groups of enrollees with certain chronic conditions improves health outcomes and reduces costs. The model will begin in January 2017 in seven states, and in more three states in 2018. In the second year of the model, CMS will adjust the clinical categories for which participants may offer benefits and change the minimum enrollment size for some MA and prescription drug plan participants.

The news release can be found at https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-08-10-2.html

Final FY 2017 Hospital IPPS and LTCH PPS Rule Issued

Tuesday, August 2nd, 2016

On August 2, the Center for Medicare & Medicaid Services (CMS) issued the final rule for fiscal year (FY) 2017 Hospital Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) Prospective Payment System (PPS). CMS estimates a rate increase to acute care hospital of 0.95% for hospitals that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and demonstrate meaningful use of certified electronic health record (EHR) technology. CMS projects total medical spending on inpatient hospital services will increase by about $746 million in fiscal 2017. CMS estimates that LTCH PPS payment will decrease by 7.1%

Key provisions of the 2017 IPPS Final Rule:

The Two Midnight Policy

In the final rule, CMS removed this adjustment for FY 2017, as well as its effects for FYs 2014 through 2016. CMS believes the assumptions underlying the -0.2 percent adjustment were reasonable at the time they were made; however, in light of the unique circumstances surrounding this adjustment, the agency decided to remove it.

Medicare Disproportionate Share Hospital (DSH) Payments

Medicare disproportionate share hospital (DSH) payments will be reduced by 75%, or $49.9 billion, by 2019. CMS will distribute nearly $6 billion in DSH payments in FY 2017, about $400 million less than in FY 2016.

Hospital Inpatient Quality Reporting (IQR) Program

In the final rule, CMS added four new claims-based measures (three clinical episode-based payment measures and one communication and coordination of care measure) starting with the FY 2019 Inpatient Quality Reporting Program (IQR). CMS also removed 15 measures for the FY 2019 payment determination.

Hospital Value-Based Purchasing (VBP) Program

CMS made changes to the Hospital Value-Based Purchasing (VBP) Program by adding two condition-specific payment measures (one for acute myocardial infarction and one for heart failure) beginning with the FY 2021 program year, and a 30-day mortality measure following coronary artery bypass graft surgery beginning with the FY 2022 program year. CMS said the condition-specific payment measures capture payments for all care, including readmissions and subsequent cardiac events, across multiple care settings, services, and supplies during the 30-day episode of care.

Hospital Acquired Conditions (HAC) Reduction Program
CMS made several changes to existing Hospital Acquired Conditions (HAC) Reduction Program policies in the FY 2017 final rule, including changing the program scoring methodology from current decile-based scoring to a continuous scoring methodology.

The final rule was published in the Federal Register on August 22. The rule is effective October 1.

The rule can be found by going to https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-18476.pdf