Report recommends federal policies to ensure sustainable U.S. blood system
Medical advances have reduced the demand for blood in the United States, creating financial pressure on the nation’s blood collection centers and threatening their future survival, according to a study prepared by RAND Corporation for the Department of Health and Human Services, released this week. To improve the sustainability of the U.S. blood system, the report recommends that federal officials collect comprehensive data about performance of the blood system; better define appropriate levels of surge capacity; build relationships with brokers and other entities to form a blood “safety net”; build and implement a value framework for new technology; and implement emergency use authorization and contingency planning for key supplies and inputs.
News Item - 11/23/2016
Abortion Surveillance — United States, 2013
by Tara C. Jatlaoui, MD; Alexander Ewing, MPH; Michele G. Mandel; Katharine B. Simmons, MD; Danielle B. Suchdev, MPH; Denise J. Jamieson, MD; Karen Pazol, PhD
Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2013, data were received from 49 reporting areas. For trend analysis, abortion data were evaluated from 47 areas that reported data every year during 2004–2013. Census and natality data, respectively, were used to calculate abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births).
The Centers for Medicare & Medicaid Services late today issued its final rule for the physician fee schedule for calendar year 2017. After application of the 0.5% payment increase required by the Medicare Access and CHIP Reauthorization Act of 2015 and mandated budget neutrality cuts, physician payment rates will increase 0.24% for 2017 compared to 2016. In addition, CMS finalized its proposals to pay for new telehealth services, including end-stage renal disease-related services for dialysis, advance care planning services and critical care consultations, and to expand the Center for Medicare & Medicaid Innovation Diabetes Prevention Program model. The agency also finalized a number of new codes to more accurately pay for primary care, care management and other cognitive specialties, including separate payments to primary care practices that use interprofessional care management resources to treat patients with behavioral health conditions. With respect to Medicare Advantage, CMS finalized its proposals to require health care providers and suppliers to be screened and enrolled in Medicare in order to contract with an MA organization for purposes of providing items and services to Medicare beneficiaries. This provision will begin two years after publication of the final rule and will be effective on the first day of the plan year. The agency also finalized routine releases of two new data sets: one which includes certain MA bid information that is at least five years old, and another with MA and drug plans’ medical-loss ratios. Other proposals finalized by CMS include changes to the quality measurement requirements of the Medicare Shared Savings Program, including revisions to the measure set and quality data validation process; a change to allow individual eligible professionals participating in MSSP to report quality data separately for the purposes of the Physician Quality Reporting System, and to have that data used in PQRS in the event the MSSP Accountable Care Organization fails to report quality data; and updates to the informal review process used in the physician value modifier program. AHA members will receive a Special Bulletin with further details at a later date.
News Item - 11/02/2016
CMS Finalizes Hospital Outpatient Prospective Payment System Changes to Better Support Hospitals and Physicians and Improve Patient Care
On Nov 1, the Centers for Medicare & Medicaid Services (CMS) finalized updated payment rates and policy changes in the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System for calendar year (CY) 2017. These finalized policy changes will improve the quality of care Medicare patients receive by better supporting their physicians and other health care providers and reflect a broader Administration-wide strategy to create a health care system that results in better care, smarter spending, and healthier people.
Are Nongroup Marketplace Premiums Really High? Not in Comparison with Employer Insurance
by Linda J. Blumberg, John Holahan, and Erik Wengle
In recent months, several news accounts have pointed to large increases in Marketplace premiums throughout much of the United States. Many have taken these reports to question the viability of the Marketplaces and the Affordable Care Act in general. In this brief we compare unsubsidized nongroup premiums with average premiums for employer sponsored insurance by metropolitan area and by state, after adjusting for differences in actuarial value (including effects on health care utilization) and age distribution.
Medicare’s investment in primary care shows progress
by Dr. Patrick Conway
Today, the Centers for Medicare & Medicaid Services (CMS) announced the Comprehensive Primary Care (CPC) initiative’s second round of shared savings results, with nearly all practices (95 percent) meeting quality of care requirements and four out of seven regions sharing in savings with CMS. These results reflect the work of 481 practices that served over 376,000 Medicare beneficiaries and more than 2.7 million patients overall in 2015.
CMS Finalizes the New Medicare Quality Payment Program
Today, the Department of Health and Human Services (HHS) finalized its policy implementing the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM) incentive payment provisions in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), collectively referred to as the Quality Payment Program. The new Quality Payment Program will gradually transform Medicare payments for more than 600,000 clinicians across the country, and is a major step in improving care across the entire health care system.
The final rule with comment period offers a fresh start for Medicare by centering payments around the care that is best for the patients, providing more options to clinicians for innovative care and payment approaches, and reducing administrative burden to give clinicians more time to spend with their patients, instead of on paperwork.
Accompanying today’s announcement is a new Quality Payment Program website http://qpp.cms.gov, which will explain the new program and help clinicians easily identify the measures most meaningful to their practice or specialty.
How Tiny Are Benefits From Many Tests And Pills? Researchers Paint A Picture
by Jay Hancock
Mammograms are said to cut the risk of dying from breast cancer by as much as 20 percent, which sounds like an invincible argument for regular screening.
Two Maryland researchers want people to question that kind of thinking. They want patients to reexamine the usefulness of cancer exams, cholesterol tests, osteoporosis pills, MRI scans and many other routinely prescribed procedures and medicines.
Falls and Fall Injuries Among Adults Aged ≥65 Years - United States, 2014
by Gwen Bergen, PhD; Mark R. Stevens, MA, MSPH; Elizabeth R. Burns, MPH
Falls are the leading cause of fatal and nonfatal injuries among adults aged ≥65 years (older adults). During 2014, approximately 27,000 older adults died because of falls; 2.8 million were treated in emergency departments for fall-related injuries, and approximately 800,000 of these patients were subsequently hospitalized.* To estimate the numbers, percentages, and rates of falls and fall injuries among older adults by selected characteristics and state, CDC analyzed data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) survey. In 2014, 28.7% of older adults reported falling; the estimated 29.0 million falls resulted in 7.0 million injuries. Known effective strategies for reducing the number of older adult falls include a multifactorial clinical approach (e.g., gait and balance assessment, strength and balance exercises, and medication review). Health care providers can play an important role in fall prevention by screening older adults for fall risk, reviewing and managing medications linked to falls, and recommending vitamin D supplements to improve bone, muscle, and nerve health and reduce the risk for falls.
U.S. Health-Care System Ranks as One of the Least-Efficient
by Lisa Du, Wei Lu
America is number 50 out of 55 countries that were assessed.
America was 50th out of 55 countries in 2014, according to a Bloomberg index that assesses life expectancy, health-care spending per capita and relative spending as a share of gross domestic product. Expenditures averaged $9,403 per person, about 17.1 percent of GDP, that year — the most recent for which data are available — and life expectancy was 78.9. Only Jordan, Colombia, Azerbaijan, Brazil and Russia ranked lower.
The U.S. has lagged near the bottom of the Bloomberg Health-Care Efficiency Index since it was created in 2012. Hong Kong and Singapore — consistently at the top — are smaller countries with less diverse populations. Their governments also play a stronger role in regulating and providing care, with spending per capita averaging $2,386 and longevity averaging about 83 years.
Now that ICD-10 is in full swing, we are seeing a lot of activity with providers, payers, consultants and regulators who need to understand how Acute Inpatient and Long Term Care Hospital claims "behave" when the claim is coded in ICD-10. This includes both prospective and retrospective review of claims scenarios to understand MS-DRG grouping. This article offers a basic primer on MS-DRG grouping logic, and research techniques for using related MediRegs Coding Suite tools. If you'd like a personalized training on these tools, or a demonstration of them in action to see if they are a good fit for your research scenarios, please let us know!
OVERVIEW OF THE FY 2016 IPPS FINAL RULE: SUMMARY OF CALCULATION ELEMENTS
New Health Analytics, a national healthcare software developer and data analytics firm, is pleased to announce that it has released a special report with an concise review of the FY 2016 Hospital Inpatient Prospective Payment System (IPPS) Final Rule recently posted by the Centers for Medicare & Medicaid Services.