Weekly E-bulletin

CMS Will Re-Open 2 Advanced APMs

CMS announced last week that it will reopen applications for two of the advanced alternative payment models (APMs) for clinicians to enroll for the 2018 performance year – the Comprehensive Primary Care Plus (CPC+) Model and the Next Generation Accountable Care Organization Model.  Both were named already as part of the advanced APMs that can earn participating clinicians a 2017 incentive payment under MACRA’s Quality Payment Program.   About 70,000 to 120,000 clinicians are expected to participate in advanced APMs and qualify for a 5 percent incentive payment in 2017, CMS stated and they expect that number to grow to 125,000 clinicians by 2018.  For more from CMS, click here.

Surveys Say Docs Still Unsure About MACRA, MIPS

A Medscape survey of 189 doctors found widespread ignorance regarding MACRA and MIPS, with 28.6 and 40.2 percent, respectively, saying they had not heard of either. An additional 39.2 percent said they didn’t know a lot about MACRA, with 34.9 saying the same about MIPS. Doctors surveyed also felt moderately-prepared at best for payers’ requirements, with only 19.4 percent saying they “agreed completely” that they had the infrastructure to do what was needed. Another poll from Deloitte illustrates what that infrastructure might be: more data, and more helpful decision support. Click here more.

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h5. 38% of Health Care Dollars Linked to APMs Tied to Quality

An estimated 38 percent of health care dollars flowed through alternative payment models tied to health care quality in 2015, according to a new survey by HHS and several health plans. The surveys showed that while most payments are still made on a fee-for-service basis, a segment of health plans and providers are shifting to quality-linked or population-based models. The report did not gather any data about traditional Medicare. Click here for the detailed report.

Only 50% of Patients Prescribed Appropriate Antibiotics

About half of U.S. patients treated with antibiotics receive the appropriate drug, a factor that is likely contributing to antibiotic resistance, according to a new CDC and Pew study.  The study looked at how physicians prescribed antibiotics for three common conditions for outpatients in 2010 and 2011 – sinus infections, middle ear infections, and pharyngitis.  About 80 percent of patients diagnosed with of the three should have received first-line, narrow-spectrum antibiotics. According to the study, only 52 percent of patients received first-line drugs, making about 30 percent of prescriptions inappropriate. Click here for the study.

CMS Bumps Up Pay for Dialysis

CMS last week finalized a slight increase in 2017 Medicare payments for dialysis facilities treating end-stage renal disease patients. The agency’s final rule estimates that facilities will see a 0.73 percent average increase in payments next year. Hospital-based dialysis facilities should see the biggest bump, at a 0.9 percent increase. Medicare expects to pay about $9 billion total to 6,000 facilities treating the debilitating kidney disease in 2017. The new regulations also alter how Medicare pays for home and self-dialysis training, changing the nurse training time used to calculate the payment rate to 2.66 hours, from one-and-a-half hours. The change raises the training add-on payment adjustment to $95.60, from $50.16. Click here for more the CMS rule.

Dialysis Patient Show Better Outcomes with Bundling and Drug Label Change

A joint FDA-CMS study found that end-stage renal disease patients had better health outcomes following CMS’s 2011 move to bundle payments for dialysis patients and FDA’s calls for more conservative dosing of drugs often used to treat these patients.  The agencies looked at nearly 70,000 Medicare patients over 66 years old for the study. To read the study, click here.

CMS Suspends Acceptance of New Seamless MA Enrollment Proposals

CMS last week sent a memo to Medicare Advantage organizations stating that they had temporarily stopped accepting new proposals from health insurers that want to automatically enroll their commercial or Medicaid patients into Medicare Advantage plans once those individuals turn 65.  The agency has already approved 29 companies, including Aetna, UnitedHealth Group and several Blue Cross Blue Shield plans to utilize the seamless conversion enrollment process. Click here for the memo and here for the list of the 29 companies.

CMS Targets 15 Markets for Exchange Open Enrollment

CMS last week announced 15 target markets for this year’s open enrollment on health exchanges that starts tomorrow. As in previous years, the target markets will be a particular focus for outreach, travel, and collaborations with local partners, also in addition to other nationwide efforts to step up outreach. Here are the markets: Miami-Fort Lauderdale, FL; Dallas-Fort Worth, TX; Atlanta, GA; Houston, TX; Tampa-St. Petersburg, FL: Orlando-Daytona-Melbourne, FL; Northern New Jersey; Chicago, IL; Philadelphia, PA; Charlotte, NC; Detroit, MI; Salt Lake City, UT; Phoenix, AZ; St. Louis, MO; and San Antonio, TX. Click here for details.

  • What to do about ailing health exchanges? A noted health policy expert outlines his recommendations here.

h5. CMS Extends Staffing Extension to Hospice

CMS announced that hospice agencies hit by the ongoing nursing shortage can continue using contracted staff due to “extraordinary circumstances.“  CMS states in a memo sent to state survey agency directors that the Bureau of Labor Statistics forecast that the nursing shortage will persist through 2024, despite “faster than average” job growth rate in the industry.  Regulations typically require that “core services” provided by hospice agencies be carried out directly by hospice employees, except under the “extraordinary circumstances” exemption that will now be extended through Sept. 30, 2018.  A previous exemption was set to run through Sept. 30 of this year. Click here to read the memo.

95 Percent of Kids Have Insurance: Record High

95 percent of American kids have health insurance, a record high, according to a new report from the Georgetown University Center for Children and Families. Between 2013 and 2015, 41 states saw a statistically significant decline in the rate of uninsured children. Just over half of the 3.5 million children who are still uninsured live in seven states: Arizona, California, Florida, Georgia, Ohio, Pennsylvania and Texas. Click here for the report.

Senate Finance Committee Releases New Chronic Care Draft

The Senate Finance Committee, which oversees Medicare, released a draft bill last week that will expand use of home-based health services and telemedicine in caring for senior citizens with chronic diseases such as diabetes. It would also widen the supplemental benefits that Medicare Advantage plans can offer the chronically ill. Additionally, the draft bill would expand Medicare payment of telehealth services across Medicare Advantage, accountable care organizations and for stroke care. Click here for the draft bill and here for a summary from the Committee. The legislation will not likely pass this year, but is expected to be introduced in the next Congress.

New Funds Go to States to Fight Insurance Discrimination

The White House has announced new actions to crack down on insurance coverage discrimination of mental health and substance abuse treatment.  The White House’s Mental Health and Substance Use Disorder Parity Task Force, assembled last spring, awarded $9.3 million to help states enforce federal parity protections requiring equal coverage for mental health and behavioral health. Click here for the announcement.

Employees Continue to Feel Health Care Cost Pinch: Study

Why do employees feel so pinched by health-care costs? The growth in employees’ share of health-care premiums and deductibles has slowed over the past decade, but their incomes have lagged behind, according to a new study. Families that receive insurance through their employer spent, on average, 6.5 percent of their income on premiums and deductibles in 2006, according to the Commonwealth Fund. By 2015, those expenditures grew to 10.1 percent of income. Click here for the study.

OIG: Chiropractors Overpaid by Medicare

Medicare reimbursed chiropractors $438 million in 2013 for services to more than 17 million beneficiaries. About $359 million of that, approximately 82 percent, was wrongly paid, according to the Department of Health and Human Service’s Office of Inspector General. Although the report covers 2013, it provides no indication that CMS is doing a better job now. Click here for the news report.

FDA Says 12 Hospitals Failed to Report Issues with Medical Devices

FDA officials have found that 12 U.S. hospitals, including well-known medical centers in Los Angeles, Boston and New York, failed to promptly report patient deaths or injuries linked to medical devices.  The agency publicly disclosed the violations in inspection reports last week amid growing scrutiny of its ability to identify device-related dangers and protect patients from harm.  Under federal rules, hospitals have 10 days to report serious injuries potentially caused by devices to the manufacturer and notify both the manufacturer and the FDA about any deaths that may have resulted. To view the violations, click here.

Nurses Scrubs Transmit Superbugs in Hospitals: Study

A new study confirms that dangerous superbugs in patient rooms can end up on nurses’ scrub uniforms. The new study funded by CDC, involved 40 ICU nurses caring for 167 ICU patients over 120 shifts. Scrubs were cultured at the beginning and end of the shifts, and cultures were obtained from the patient and room environment. The study showed that the nurses’ midriffs were often the site of contamination (presumably from the leaning over the bedrails). Click here for more from Duke University.

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