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.
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.
WalletHub Lists States With the Best and Worst Health Care
WalletHub, a personal finance website, has listed the best and worst health care states based on 29 metrics including average premiums, coverage rates and physicians per capita. The top five are: Minnesota, Maryland, South Dakota, Iowa and Utah, respectively. The bottom five: Arkansas, Nevada, Mississippi, Louisiana and Alaska.
Cesarean birth trends: Where you live significantly impacts how you give birth
by Blue Cross Blue Shield: Blue Health Intelligence
The likelihood that an expectant mother will have a cesarean delivery1 is determined in large part by where she lives. An analysis of Blue Cross and Blue Shield (BCBS) companies’ data taken from 3 million deliveries by BCBS commercially-insured members shows that the rate of cesarean deliveries is more than twice as high in some parts of the country than in other parts and that even rates by U.S. Census Division vary by as much as 35 percent.
While geographic variation in cesarean deliveries is stark, the trend nationally may be shifting back toward vaginal deliveries. During a five-year period between July 2010 and June 2015, the cesarean rate decreased slightly each year within the BCBS population, to 33.7 percent from 35.2 percent.
Many Well-Known Hospitals Fail To Score 5 Stars In Medicare’s New Ratings
by Jordan Rau
The federal government released its first overall hospital quality rating on Wednesday, slapping average or below average scores on many of the nation’s best-known hospitals while awarding top scores to dozens of unheralded ones.
The Centers for Medicare & Medicaid Services rated 3,617 hospitals on a one- to five-star scale, angering the hospital industry, which has been pressing the Obama administration and Congress to block the ratings. Hospitals argue the ratings will make places that treat the toughest cases look bad, but Medicare has held firm, saying that consumers need a simple way to objectively gauge quality.
Data Brief: Evaluation of National Distributions of Overall Hospital Quality Star Ratings
Hospital Compare is a consumer-oriented website that provides information on how well hospitals provide care to their patients. This information can help consumers make informed decisions about their health care. The Centers for Medicare & Medicaid Services (CMS) has been posting quarterly hospital quality star ratings based on patients’ experience of care on the Hospital Compare website since April 16, 2015.
To continue our efforts to make quality of care information more readily available, we developed an Overall Hospital Quality Star Rating (Star Rating) that reflects comprehensive quality information about the care provided at our nation’s hospitals. We have previously stated our intention to begin posting this overall star rating on Hospital Compare in 2016, which we expect to begin shortly.
New Health System Scorecard Finds Improvement in Most U.S. Communities Since ACA Took Effect
by The Commonwealth Fund
Many U.S. communities saw gains in their health and health care between 2011 and 2014, but wide variation in progress indicates there is room for improvement across the country, The Commonwealth Fund’s newly updated Scorecard on Local Health System Performance finds.
Those areas of the U.S. that improved did so largely because more people had insurance coverage and could afford to get the care they needed, and because health care providers performed better on quality and efficiency measures—such as limiting hospital readmissions. The Affordable Care Act (ACA) has contributed to many of these improvements, the researchers say.
Medicare Will Use Private Payor Prices to Set Payment Rates for Clinical Diagnostic Laboratory Tests Starting in 2018
On June 17, the Centers for Medicare and Medicaid Services (CMS) released a final rule implementing Section 216(a) of the Protecting Access to Medicare Act of 2014 (PAMA), requiring laboratories performing clinical diagnostic laboratory tests to report the amounts paid by private insurers for laboratory tests. Medicare will use these private insurer rates to calculate Medicare payment rates for laboratory tests paid under the Clinical Laboratory Fee Schedule (CLFS) beginning Jan. 1, 2018. The final rule includes provisions to ease administrative burdens for physician office laboratories and smaller independent laboratories.
CMS to initiate Medicare home health pre-claim review in five states
by AHA News Now
The Centers for Medicare & Medicaid Services yesterday announced a pre-claim review demonstration for all Medicare fee-for-service home health services in Illinois, Florida, Texas, Michigan and Massachusetts. Start dates will be determined in the coming months, but will be no earlier than Aug. 1 in Illinois, Oct. 1 in Florida, Dec. 1 in Texas, and Jan. 1 in Michigan and Massachusetts, the agency said. Under the three-year demonstration, the home health provider, billing entity or beneficiary will be encouraged to submit to the relevant Medicare Administrative Contractor a request for pre-claim review, along with relevant documentation, within 30 days of the beneficiary’s first treatment and before submitting the final claim.
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.