CMS PROPOSALS TO IMPROVE QUALITY OF CARE DURING HOSPITAL INPATIENT STAYSOn Apr. 26, 2013, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospitals Prospective Payment System (LTCH PPS) in Fiscal Year (FY) 2014. The proposed rule, which would apply to approximately 3,400 acute care hospitals and approximately 440 LTCHs, would affect discharges occurring on or after October 1, 2013. Continue reading...
Analysis Details Wasteful, Fraudulent Claims Paid by EmployersNew analysis of commercial insurance claims for 11.6 million individuals and dependents at 150 large employers finds six types of fraudulent or wasteful claims result in $122.6 million in annual overpayments. Continue reading...
Report to the Congress: Medicare and the Health Care Delivery Systemby Glenn M. Hackbarth, J.D., Michael E. Chernew, Ph.D., Mark E. Miller, Ph.D.The Commission’s June 2013 Report to the Congress examines a variety of Medicare payment system issues. The report discusses competitively determined plan contributions, reducing payment differences across ambulatory settings, bundling post-acute care services, Medicare’s hospital readmissions reduction program, the hospice payment system , and care needs for beneficiaries eligible for both Medicare and Medicaid benefits.  Continue reading...
Comment Period on Revised Forms for Prototype Consumer Patient Safety Reporting System Open Until July 8In an effort to realize the untapped potential of health care consumers to provide local providers with their important perspective regarding adverse events they have experienced, the Agency for Healthcare Research and Quality has funded the development of a prototype Consumer Reporting System for Patient Safety (CRSPS). The prototype is designed for hospitals, systems, group practices, and others to collect information from patients about adverse events that resulted or nearly resulted in harm or injury. The purpose of this project is to test this prototype for its ability to record data from consumers about patient safety events that are defined as an “incident” or “near miss” by the AHRQ Common Formats. AHRQ recognizes that the unique perspective of health care consumers could reveal important information that is not reported through current mechanisms. Patient reports could complement and enhance reports from providers and thus produce a more complete and accurate understanding of the prevalence and characteristics of medical adverse events. This proposed information collection was previously announced in the Federal Register on September 11, 2012, and allowed 60 days for public comment. AHRQ received 45 substantive comments and 64 personal stories from members of the public. To address these comments, substantial revisions were made to the data collection tools and supporting documentation. Details and information about how to comment on the revised data collection tools are now available for public comment until July 8.
To Expand or Not to Expand? States' Medicaid DilemmaAnalysis Finds States that Expand Medicaid will See Budget Gains and Greater Employment In 2014, many states will expand Medicaid to cover their poor and near-poor residents, but others will not. As the undecided states make up their minds, a new report shows that, in 10 diverse states, very different approaches were taken to analyze impacts. Those states that conducted comprehensive analyses found that Medicaid expansion will see: (a) net state budget gains and (b) increased employment and tax revenues. Learn what factors 10 states are using to make Medicaid expansion decisions.
New brief and data for end-of-life careA new Dartmouth Atlas brief released today demonstrates that improvements in care have occurred between 2007 and 2010 for chronically ill Medicare patients in their last six months of life. However, the pace of change varied across regions and hospitals, with some experiencing rapid change while other health systems showed little improvement. Read the brief...
Is the "Private Option" a Viable One for Expanding Medicaid?New Brief Examines Shifting Medicaid Recipients Into Private Health Plans States that oppose the ACA’s Medicaid expansion stand to lose millions in new federal funding and risk leaving a sizable portion of their low-income residents uninsured. Some of these states are now considering a plan to provide Medicaid recipients with a voucher to purchase private insurance on the state exchanges. A new policy brief from Health Affairs and RWJF examines whether such a “private option” can be cost-effective and still provide benefits equal to those provided by the traditional Medicaid program. Continue reading...
Declining Medicine Use and Costs: For Better or Worse?Murray Aitken, Executive Director of the IMS Institute for Healthcare Informatics, discusses key findings from the new IMS Institute report Declining Medicine Use and Costs: For Better or Worse? Continue reading...
Innovation director of CMS is moving onby Jennifer HaberkornThe innovation center charged by the health reform law with finding solutions to the toughest questions in health care — how to reduce costs and change the way health care is delivered — is losing its first leader.
Rick Gilfillan, who has led the Department of Health and Human Services’ Center for Medicare & Medicaid Innovation since it was established in 2010, plans to leave at the end of June, according to an internal memo obtained by POLITICO.
“During this time, CMMI has grown from a startup center to an organization of over 230 people, and we believe that these new care models will make a difference in patients’ lives and improve the efficiency of our health system,” Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services, wrote on Friday.
Tavenner has asked CMS Chief Medical Officer Patrick Conway to serve as acting director of CMMI. He’ll maintain his other post as well as his role as director of the Center for Clinical Standards and Quality.
CMMI was created by the health reform law to come up with short- and long-term fixes to the biggest problem facing health care: how to reduce costs.
Under Gilfillan’s watch, CMMI has started the development of accountable care organizations — new models of care that are supposed to improve quality and reduce costs by coordinating care for Medicare patients across providers. CMMI is also responsible for restructuring how Medicare payments are made and overseeing hundreds of demonstration projects to test new ideas in health care.
Gilfillan, who has experience as a family doctor, will pursue “new opportunities,” Tavenner wrote in the memo. Before joining the Obama administration, he was president and CEO of Geisinger Health Plan, where he helped design a bundled payment system.
Geisinger is known as one of the most innovative health systems in the country — part of the reason Gilfillan was tasked with the CMMI job.
Report (OEI 07-09-00440): Improvements Are Needed To Ensure Provider Enumeration and Medicare Enrollment Data Are Accurate, Complete, and ConsistentHealth care provider information, including providers' unique National Provider Identifiers (NPIs), is maintained in the National Plan and Provider Enumeration System (NPPES). To enroll in Medicare, providers must supply their NPIs and other information to CMS to be entered into the Provider Enrollment, Chain and Ownership System (PECOS). Accurate, complete, and consistent provider data in NPPES and PECOS help to ensure the integrity of all health care programs. Previous OIG work has revealed ongoing problems with CMS's oversight of provider data, sometimes resulting in improper Medicare payments to fraudulently enrolled providers. Read the report...
Spotting preventable readmissionsScorecard detects one-in-four high-risk patients before discharge With hospitals nationwide feeling the burden of Medicare penalties for avoidable 30-day readmissions, C-suite managers have been frantically searching for ways to pinpoint these high-risk patients early on. A recent analysis suggests a low-cost and simple scorecard that detects one out of four of these patients. With the help of an algorithm that was based on administrative data (SQLape), investigators from Harvard Medical School, looked at potentially avoidable 30-day readmissions at three hospitals in Boston’s Partners Healthcare network. They used the data to formulate a scoring system that included 10 risk factors that hospitals may want to use to spot high-risk (and expensive) patients. Jacques Donze, MD, from Harvard Medical School and Partners Healthcare, and his associates initially looked at more than 10,000 eligible discharged patients, nearly 2,400 of which were readmitted within 30 days. Among those 2,400 patients, they identified 879 readmissions that were potentially avoidable. They found seven markers that helped predict readmission: - Low hemoglobin at discharge
- Discharge from a cancer unit
- Low sodium at discharge
- The occurrence of any ICD-9 coded procedure during the hospital stay
- Non-elective admission
- One or more hospital stays during the previous year
- A length of stay of five or more days
“This easy-to-use model enables physicians to prospectively identify approximately 27 percent of the patients as high risk of having a potentially avoidable readmission and would allow targeting intensive transitional care interventions …,” according the JAMA Internal Medicine report on the analysis. Donze pointed out during a recent interview with Healthcare Finance News that his team wanted to create a scoring system that was not only simple but that could be used before patients were discharged. Existing scorecards have used “billing data and ICD-9 that are only available a few weeks after the patient is discharged …,” Donze said. To make a score useful for readmission assessment, it has to be available before the discharge of the patient, Donze emphasized. There are a number of methods that may be used to reduce the risk of readmission in these high-risk patients, noted Jeffrey L. Schnipper, MD, senior author of the JAMA paper, but they’re expensive and resource intensive. “You probably only want to do them when you know you’re going to get the biggest bang for your buck,” he said. And that’s the value of a scoring system, he said – it gives hospitals the information needed so that they are resorting to use these expensive methods only on the highest-risk patients. [See also: Hospitals' readmission penalties revised by Medicare]
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