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GAO asks HHS for universally aligned quality measures

The Government Accountability Office (GAO) sent a report on October 13 to the Department of Health and Human Services (HHS) urging for better alignment of healthcare quality measures. The conclusion of the 42-page document is that payers haven’t agreed on what quality measures to track, which puts a burden on healthcare organizations.

“For example, a physician may participate in Medicare and a private health plan that each use different measures for assessing the care of diabetic patients,” the GAO wrote. “In another example, a physician may report similar measures to multiple payers that assess blood sugar levels among diabetic patients, but each measure may use a different threshold to determine which patients have their blood sugar levels under control.”

The GAO says there are three main drivers of these misalignments:

  • Dispersed decision-making:Each public and private payer decides which quality measures they want to use and which specifications apply. This is done without regard to the measures that other payers are using.
  • Variation in data collection and reporting systems:The electronic health record (EHR) systems, paper records, or clinical data registries that physicians use all differ in how they collect and report quality data. Without standard measures, there’s little incentive for EHR vendors to create systems to facilitate data collection and reporting.
  • Few meaningful measures:Of the hundreds of quality measures currently used, only a few are seen as leading to meaningful quality improvements.

“What we have right now is a labyrinth of confusing metrics, specifications and reporting rules that serve no one,” said Kathleen Ciccone, RN, introducing a Healthcare Association of New York State report calling for streamlined measures.

The GAO report recommends that HHS, CMS, and the Office of the National Coordinator for Health Information Technology develop a comprehensive plan, including timelines, for more meaningful quality measures and electronic quality measures. The GAO particularly wants to see the creation of standardized data elements to report on core electronic quality measures.

CMS: Hospitals must work with PSOs to keep their insurance plans

Hospitals will face new requirements for getting Health Insurance Marketplace (HIM) plans starting on January 1, 2017. The final rule, which was issued by CMS this year, says that hospitals with 50 beds or more can only receive HIM insurance if they:

  • Work with a Patient Safety Organization (PSO).
  • Are a member of a Quality Improvement Organization.
  • Are a member of a Hospital Engagement Network.
  • Are accredited by The Joint Commission. 
  • Implement an evidence-based initiative to improve healthcare quality through the collection, management, and analysis of patient safety events. The initiatives must meet reasonable exception criteria.

The Agency for Healthcare Research and Quality has a list of all the PSOs that apply for the rule. For more information on the new rule and it’s reasonable exception criteria, you can view CMS’ presentation and accompanying Q&A.

Pediatric quality measures receive $13.4 million from AHRQ and CMS for testing

Six Pediatric Quality Measures Program (PQMP) grantees have been given $13.4 million to test new pediatric quality measures over the next four years. The money is being provided by CMS and The Agency for Healthcare Research and Quality (AHRQ) with funds from the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).CMS Logo

“Medicaid and Children’s Health Insurance Programs (CHIP) give millions of children in the United States a healthy start,” said Vikki Wachino, director at the Center for Medicaid and CHIP Services, in a press release. “Through efforts such as this PQMP funding, we are able to advance states’ efforts to measure and report meaningful improvements in the quality of care for children.”

The pediatric measures were created by the PQMP Centers for Excellence with the goal of creating a portfolio of evidence-based, consensus pediatric quality measures available to public and private purchasers of children’s health care services. Grantees will be expected to test the feasibility and usability of the measures in in real-world settings at the state, health plan, and provider levels.

“The PQMP Centers of Excellence provided us with valid measures of children’s health care quality. This next step of research will help us test these measures in real-world settings,” said AHRQ director Andy Bindman, MD. “The ultimate goal is to improve children’s health throAHRQ-logough better health care, at lower costs, at both the federal and state level.”



CMS: Hospital readmission rate drop nationwide

Between 2010 and 2015, hospital readmission rates have dropped an average of 8% nationally, with 100,000 unnecessary patient readmissions avoided in 2015 alone. CMS reported the news on its blog, stating that 49 states and the District of Columbia have seen reductions in avoidable 30-day readmissions of Medicare patients over the past five years.

Readmissions reduction has been a major goal for CMS, with an estimated $17 billion in Medicare spending spent annually on avoidable hospital readmissions.  The agency also announced that it would be increasing its fines for high readmission rates in fiscal 2017. While hospitals may look to this new data as a sign of hope, a study in The New England Journal of Medicine  cautions that the continuing the drop may not be possible.

“Presumably, hospitals made substantial changes during the study period but could not sustain such a high rate of reductions in the long term,” the authors wrote. [more]

Surgeons rail against reporting every 10 minutes to CMS

A proposed CMS change to the 2017 Medicare Physician Fee Schedule will require surgeons document and report data every 10 minutes for new billing codes (G-codes). The penalty for not submitting this data is 5% of a facility’s Medicare reimbursement.

CMS’ plans to phase out 10-day and 90-day global surgery packages over the next two years. Instead, the fee schedule would have a zero-day package, with all preoperative and postoperative care bundled together on the day of the surgery. Surgeons would receive a lump sum for their work and bill CMS on a piecemeal basis for care provided before and after the day of surgery.

Surgeons and medical groups have loudly decried the move, calling it impractical, untested, and a huge waste of time and money. In one survey of 7,000 surgeons, 37% said the new codes will cost them between $25,000 and $100,000 per surgeon.  Fifteen percent said it would cost them over $100,000 in hiring scribes to keep up with documentation, updating electronic health records, and having less time for patients.

Respondents also claimed that if the standards go into effect:
•    85.9% will have to modify EHR and billing systems
•    88.8% of physicians and 75.7% of staff will lose time tracking and processing global surgery information into EHR and billing systems
•    82.8% will have to develop new tracking and collecting methods for global surgery data
•    46.4% will need to buy more technology (such as handheld devices or stopwatches) to document time spent providing global surgery services

So far, the American College of Surgeons (ACS), the American Association of Orthopaedic Surgeons, the American Association of Neurological Surgeons (AANS), the Congress of Neurological Surgeons (CNS), the American Medical Association, and several others have filed protests with CMS.

“The claims-based data collection mandate is so burdensome that most physicians will not be able to comply by January 1, 2017, which will result in CMS being unable to collect accurate and usable data, particularly in light of the unfinished final rule at the time of this writing,” the AANS and CNS wrote in a letter to CMS.
For more, read the full article at HealthLeaders Media.

CMS finalizes new emergency preparedness rule

CMS announced yesterday that it had finalized new emergency response requirements for healthcare providers participating in the Medicare or Medicaid system. The new rule comes as a response to a string of disasters, natural and mad-made, including the recent flooding in Louisiana. The rule requires that healthcare providers meet the following four standards:CMS Logo

  1. Emergency plan: Based on a risk assessment, develop an emergency plan using an all-hazards approach focusing on capacities and capabilities that are critical to preparedness for a full spectrum of emergencies or disasters specific to the location of a provider or supplier.
  2. Policies and procedures: Develop and implement policies and procedures based on the plan and risk assessment.
  3. Communication plan: Develop and maintain a communication plan that complies with both Federal and State law. Patient care must be well-coordinated within the facility, across health care providers, and with State and local public health departments and emergency systems.
  4. Training and testing program: Develop and maintain training and testing programs, including initial and annual trainings, and conduct drills and exercises or participate in an actual incident that tests the plan.

“As people with medical needs are cared for in increasingly diverse settings, disaster preparedness is not only a responsibility of hospitals, but of many other providers and suppliers of healthcare services. Whether it’s trauma care or long-term nursing care or a home health service, patients’ needs for health care don’t stop when disasters strike; in fact, their needs often increase in the immediate aftermath of a disaster,” said Dr. Nicole Lurie, Health and Human Services assistant secretary for preparedness and response, in a press release. “All parts of the healthcare system must be able to keep providing care through a disaster, both to save lives and to ensure that people can continue to function in their usual setting. Disasters tend to stress the entire health care system, and that’s not good for anyone.”


ACOs improve patient care and save $1.29 billion since 2012

CMS reports that between 2012 and 2015, accountable care organizations (ACO) have generated more than $1.29 billion in total Medicare savings. In 2015 alone, all 392 Medicare Shared Savings Program (MSSP) participants and 12 Pioneer ACO Model participants saved a combined $466 million while improving care quality.

“The coordinated, physician-led care provided by Accountable Care Organizations resulted in better care for over 7.7 million Medicare beneficiaries while also reducing costs,” said CMS Acting Administrator Andy Slavitt in the press release. “I congratulate these leaders and look forward to significant growth in the program in the coming year.”

Since 2012, MSSPs’ quality scores have increased 21%, with nine out of 12 MSSPs achieving quality scores over 90%. ACOs showed improvement on 84% of quality measures in both 2014 and 2015. ACOs also improved performance on key preventive measures such as including screening for falls risks, depression, blood pressure, and providing pneumonia vaccinations by 15%.

“Accountable Care Organization initiatives in Medicare continue to grow and achieve positive results in providing better care and health outcomes while spending taxpayer dollars more wisely,” said Dr. Patrick Conway, CMS Principal Deputy Administrator and Chief Medical Officer. “CMS continues to work and partner with providers across the country to improve the way health care is delivered in the United States.”

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CMS to save millions by increasing hospital readmission fines

CMS LogoWith spending on inpatient hospital services expected to increase by $746 million next year, CMS is in need of new ways to save and raise revenue. On August 2, the agency announced a change that will help ease some of its money woes.

At the beginning of the 2017 fiscal year in October, CMS will add new criteria to the Hospital Readmissions Reduction Program that’s expected to save CMS $538 million; $108 million over the previous fiscal year. The new criteria will increase the number of hospitals that are penalized for high readmission rates, as well as the amount for which they are penalized.

CMS has added coronary artery bypass grafts as a surgery for which hospitals can receive a readmission penalty, as well as alter how it calculates readmissions for pneumonia. Other readmission penalty procedures include heart failure, heart attacks, chronic obstructive pulmonary disease, and hip and knee replacements. It’s estimated that 2,588 hospitals will be fined next year due to the update, losing 0.73% of their Medicare payments on average. Only 49 hospitals are expected to receive the maximum penalty of 3% according toKaiser Health News.

Readmissions have been a major point of contention between hospital groups and CMS. Many argue that since CMS’ program doesn’t take socioeconomic factors into account, hospitals that serve poorer or sicker patients are disproportionately fined for high readmissions.

“We are disappointed CMS missed another opportunity to adjust for the social and economic challenges of vulnerable patients in its quality improvement and reporting programs,” said Beth Feldpush, senior vice president at America’s Essential Hospitals, in a statement. “The evidence is clear that these programs disproportionately penalize hospitals that serve disadvantaged patients and communities.”

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HFAP releases prepublication standards manual

HFAP this week released its prepublication manual for acute care hospitals. The manual has been changed to include requirements of the 2012 Life Safety Code® (LSC), which was recently adopted by CMS.  The CMS adoption of the 2012 LSC went into effect in July, and the new requirements will go into effect for HFAP facilities on November 1, 2016.

The changes to the accreditation requirements are in Chapters 9, 11, and 13 of the manual and can be read here.

Hospital star ratings now online despite Congressional and hospital group efforts

Yesterday, CMS publicly released its hospital star ratings system on its Hospital Compare website. The rankings are meant to provide patients with more transparency on hospital quality.CMS Logo

The release comes one day after Congress announced a bill that, if passed, would have delayed the release for a full year. The bill would have also have required third-party verification of CMS’ data and methodology, which has been a major point of contention for opponents.

Get more details on the CMS decision at HealthLeaders Media.