Cooperating for better care.

CMS

Tag Archives

Mo. hospitals focus on patient poverty in CMS readmissions penalties

May 27, 2016by Robert Whitcomb in Uncategorized tagged , , , , , , , , ,

revolving door

 

By LISA GILLESPIE

For Kaiser Health News

Christian Hospital says its costly difference of opinion with Medicare hinges on how to count the large number of poor people that the St. Louis hospital treats.

Medicare penalizes hospitals that readmit too many patients within 30 days of discharge, and Christian expects to lose almost $600,000 in reimbursements this year, hospital officials said. Christian is one of 14 hospitals in the BJC HealthCare System.

Steven Lipstein, chief executive of BJC, which includes Barnes-Jewish Hospital in St. Louis, said Medicare doesn’t play fair because its formula for setting penalties does not factor in patients with socioeconomic disadvantages — low-income, poor health habits and chronic illnesses for instance — that contribute to repeated hospitalizations.

If Medicare did that, Christian’s penalty would have been $140,000, Lipstein said.

As every hospital executive knows, half a million dollars pays for “a whole lot of nurses.”

In total, hospitals around the country lost $420 million last year under Medicare’s Hospital Readmissions Reduction Program, an initiative of the federal health law that seeks to push hospitals to deliver better patient care.

Since the program began in 2012, “recent trends in readmissions suggest that (it) is having the desired impact,” Health Affairs reported in January.

Hospitals have lobbied Congress and Medicare to change the rules and gained some ground May 18 when Rep. Patrick Tiberi, R-Ohio, introduced a bill in the House to adjust Medicare’s program to account for socioeconomic status. The bill was co-sponsored by Rep. Jim McDermott,  D.-Wash.

Meanwhile, the Missouri Hospital Association is trying to pull public opinion behind it.

This year, the association overhauled its consumer Web site, Focus On Hospitals, to include not only the federal readmissions data, but also each member’s readmissions statistics, adjusted for patients’ Medicaid status and neighborhood poverty rates.

The federal government already adjusts its readmissions data for age, past medical history and other diseases or conditions, and that’s public on Medicare’s Hospital Compare Web site.

The association explains its adjustment methodology in an article on the site. “There is emerging national research that suggest poverty and other community factors increase the likelihood a patient will have an unplanned admission to the hospital within 30 days of discharge,” it states.

The hospital group’s alternative data — Lipstein’s source for how Christian could have reduced its 2015 penalty — comes from a study it commissioned. One finding: Missouri hospitals’ readmissions rates improved by 43 to 88 percent when patients’ poverty levels were considered.

“The question is, has [readjustment] been done in a just and fair way,” Lipstein said. The Missouri Hospital Association “has provided methodology that suggests what the Feds are doing is unfair.”

The controversy over penalties is likely to grow beyond the readmissions question. Federal health officials have announced that they want to shift from paying doctors and hospitals based on the services they provide and move toward a value-based system that encourages a better quality of care and better outcomes while controlling costs.

Medicare bases penalties on readmissions on the care of Medicare patients who were originally hospitalized for one of these five conditions — heart attacks, heart failure, pneumonia, chronic lung problems and elective hip or knee replacements.

This year, Medicare penalized almost half of all hospitals — 2,592 to be exact — for excessive readmissions. More than 500 were fined 1 percent of their Medicare payments, or more, for the fiscal year that will end Sept. 30.

Still, the system harms so-called safety-net hospitals most, said Herb Kuhn, the Missouri Hospital Association’s president.

“Hospitals in difficult neighborhoods are getting worse scores, and those in affluent [ones] are getting better. It’s time to adjust [rates] for the disease of poverty,” he said.

Kuhn’s experience makes him an influential voice on health-policy issues. He was deputy administrator of the Centers for Medicare & Medicaid Services from 2006 to 2009 and before that, director of the agency’s Center for Medicare Management. In April, Kuhn completed a three-year term on the Medicare Payment Advisory Commission, which advises Congress.

The commission proposed an alternative to Medicare’s readmission penalties last year. Others are also studying modifications.

The Centers for Medicare & Medicaid Services has taken a cautious stance, but last year CMS announced it is working with the National Quality Forum, a nonprofit group whose research influences CMS’s quality metrics, on a trial to test socioeconomic risk adjustment.

But Leah Binder, CEO of the Leapfrog Group, a nonprofit patient safety group, says Medicare’s readmission penalties have pushed hospitals to improve care and adjusting the data for patients’ poverty levels could deter them.

“Hospitals are paid a lot of money. I think they can find a way to handle their readmissions, the way they should have been handling them all along,” Binder said.

Senators urge flexibility in Medicare payment cuts at off-campus hospital units

May 23, 2016by Robert Whitcomb in Uncategorized tagged , ,

 

A bipartisan group of 51 senators has asked CMS to allow flexibility in implementing  Medicare payment reductions for services  in new off-campus hospital outpatient departments (HOPDs).

The senators said   that off-campus HOPDs that relocate, rebuild or change ownership or types of services shouldn’t  be subject to site-neutral rates.

They also urged CMS to use the rule of “reasonable proximity” when determining on-campus status. Current regulations define “on-campus” as buildings within 250 yards of the main buildings of the hospital or other buildings that the CMS regional office determines to be part of the hospital campus. The senators argued that a strict interpretation of the 250-yard criterion would  unfairly treat hospitals  next to such barriers  as rivers and wetlands that prevent on-campus expansion.

CMS pays bonuses to subpar-quality hospitals

May 6, 2016by Robert Whitcomb in Uncategorized tagged , , ,

By JONATHAN RAU

For Kaiser Health News

The federal government paid bonuses to 231 hospitals with subpar quality because their patients tend to be less expensive for Medicare, new research shows.

The bonuses are small, generally a fraction of a percent of their Medicare payments. Nonetheless, rewarding hospitals of mediocre quality was hardly the stated goal when the Affordable Care Act created financial incentives to encourage better medical care from hospitals, doctors and other healthcare providers.

A study published Monday in  HealthAffairs looked at the more than $1 billion in payments made last year in the Hospital Value-Based Purchasing program, which raises or lowers Medicare payments to hospitals based on the government’s assessment of their quality. Medicare primarily uses death and infection rates and patient surveys to judge hospitals, but it also evaluates how much each hospitals’ patients cost, both in treatment and recovery.

The 231 hospitals the study identified had below average scores on quality measures but were awarded the bonuses because caring for their patients during their stays and in the 30 days following their discharge cost Medicare less than what it cost at half of hospitals evaluated in the program.

The Centers for Medicare & Medicaid Services, or CMS, began measuring cost in October 2014 to encourage hospitals to provide care in the most efficient way possible. In the period examined in the study — the federal fiscal year that ended in September 2015 — spending counted for 20 percent of a hospital’s score in determining whether a hospital would get a bonus, penalty or regular payment.

Under this formula, hospitals with Medicare spending below the median hospital were able to qualify for bonuses even though their quality measures were below the median, the study found. Patients at those 231 hospitals cost Medicare on average nearly $16,000, about $2,300 less than the average spending for the patients at other hospitals that received bonuses, according to the study’s lead author, Anup Das, a  health-policy student at the University of Michigan.

The average bonus for those lower quality hospitals was an 0.18 percent increase in Medicare payments for each patient stay during that fiscal year. Most of the 1,700 hospitals that received a bonus that year had higher than average quality ratings, and their patients in some cases were more costly to Medicare.

“High-quality low-spending hospitals received the greatest financial benefit from the program,” the study said. “In this respect, CMS achieved its goal with the new spending measure. However, some low-quality hospitals received bonuses because of their low spending.”

In a statement, CMS said it would consider revising the program for future years so that hospitals scoring below the national median for quality would not receive a bonus. The statement also noted that this year, three-fourths of hospitals’ scores were based on quality measures. “We believe that there needs to be a balanced consideration between quality and cost, which is reflected in our scoring methodology,” the statement said.

The study found the lower-quality hospitals that received bonuses in the last fiscal year had higher death rates for heart attacks, heart failure and pneumonia than half of the nation’s other hospitals evaluated in the program. These hospitals were also less likely to follow recommended procedures for care, like choosing the right antibiotic for patients or performing an angioplasty on a heart attack patient within 90 minutes of their arrival at the hospital.

The 231 lower-quality hospitals with bonuses also received less enthusiastic ratings from patients about how well doctors and nurses communicated, responded to issues and managed pain, the study found. The study did not name the 231 hospitals.

“It’s a small decrease in quality, but the differences are significant,” Das said in an interview.

Other new federal quality payment programs created by the health law, such as Accountable Care Organizations, deny bonuses to doctors or hospitals with substandard quality of care, no matter how efficiently they operate. The study suggested the government add a similar limitation to the Value-Based Purchasing program.

The study did not look at the current federal fiscal year, which runs through this September. This year, Medicare gave bonuses to 1,705 hospitals, averaging 0.51 percent, and reduced payments to 1,375 hospitals by an average of 0.34 percent, according to a Kaiser Health News analysis. Along with spending, Medicare’s other criteria are: death and infection rates; how faithfully a hospital followed basic clinical guidelines; and how patients rated their experiences in surveys.

Spending counts for a fourth of each hospitals’ scores, more than last year, and is scheduled to continue to do so for the next two years. The study’s lead author, Das, said in the interview that a preliminary analysis found some lower-quality hospitals again received bonuses.

Consumer-testing quality ratings

May 3, 2016by Robert Whitcomb in Uncategorized tagged , , ,

Here’s an ACA implementation update from the always authoritative Tmothy Jost.

He writes:

“Under earlier technical guidance, qualified health plan (QHP) insurers are required to submit quality rating system (QRS) clinical measures and QHP enrollee survey information during 2016 to support the display of quality ratings on HealthCare.gov for the 2017 open enrollment period. CMS beta tested its QRS for 2015, but has decided to delay a full-scale QRS launch until the 2018 open enrollment period.

“HealthCare.gov will continue to consumer test the display of QRS star ratings before implementing them on the federally facilitated marketplace (FFM) nationwide. For 2017, star ratings will only be available in the FFM in five states: Michigan, Ohio, Pennsylvania, Virginia, and Wisconsin. These states were chosen because they had ample participation by QHP insurers and relative variation in star ratings in the beta test. CMS hopes that the further pilot testing will give it additional time to better ascertain how consumers will use quality reporting, to develop technical assistance and educational tools to facilitate the use of quality ratings, and to allow insurers to measure and improve the quality of their QHP offerings.”

CMS chief’s tour d’horizon

April 28, 2016by Robert Whitcomb in Uncategorized tagged , ,

 

Acting CMS Administrator Andy Slavitt discussed a wide range of issues at a forum in Boston this week, including new CMS payment systems, soaring drug prices and physicians overwhelmed by new regulations. As The Boston Globe noted in its coverage of Mr. Slavitt’s talk:

“The federal government has imposed numerous new healthcare regulations in recent years, prompting doctors to describe them regulations as time-consuming burdens that hamper patient care. Earlier this year, Slavitt acknowledged regulators have lost the ‘hearts and minds’ of physicians. ‘I do think it can be won back,’ he said Tuesday.

7 things to know about CMS’s new primary-care initiative

April 26, 2016by Robert Whitcomb in Uncategorized tagged , , , , , ,

 

Here are seven things to know from Becker’s Hospital Review about CMS’s  new primary-care initiative that seeks to help practices transition to  value-based primary care.  It’s called the  Comprehensive Primary Care Plus model (CPC+). “Participating practices will be in one of two tracks. In both tracks, practices receive upfront incentive payments that they will either keep or repay based on performance and quality metrics,” Becker’s says.

2. “Practices in both tracks are required to use certified health IT to allow remote access to the EHR, allow 24/7 access to the EHR for the care team members with real-time access, report on electronic clinical quality measures and generate quality reports.

3. “However, there is a heavier emphasis in Track 2 on leveraging health IT to achieve healthcare delivery changes. ‘The care delivery CMS expects in Track 2 is reliant upon the use of advanced health IT capabilities that practices will need to attain through EHR enhancements or by adding or securing additional health IT services/tools,’ according to CMS. ‘Thus practices will engage their vendors to support the attainment and optimization of health IT to meet the goals and objectives of practice transformation.’

4. “‘The IT requirements pertaining specifically to Track 2 include adopting IT certified to ‘Care Plan’ and ‘Social, Behavioral and Psychological Data’ criteria as identified in the certified EHR technology definitions in the Medicare EHR Incentive program.

5. “Track 2 participants will be expected to leverage health IT capabilities that are not always available in current platforms or are not required for ONC certification. Some of these capabilities include risk-stratifying patient populations and identifying patients with complex needs; producing and displaying eCQM results at the practice level; assessing patient’s psychosocial needs; establishing a patient-focused care plan to guide care management; and documenting and tracking patient-reported outcomes.

“As such, practices in this track will work with vendors to develop and optimize functions to support clinical objectives. ‘CMS will not prescribe how the health IT enhancement is accomplished, rather only that the health IT solution meets the CPC objective for use of the health IT by the CPC practice site team,’ according to CMS.

6. “Furthermore, vendors of Track 2 participants will provide a ‘Letter of Support’ to the CPC+ practice indicating they are willing to support the practice in the initiative if the practice is selected for participation. If the practice is selected for participation, the vendor will enter a memorandum of understanding with CMS outlining their commitment to support the practices in reaching the goals of the initiative. CMS will not pay vendors for their involvement in CPC+.

7. “All health IT enhancements are expected to be completed within 24 months of the January 2017 program launch.”

CMS offers 2-year extension for bundled-payment program

April 19, 2016by Robert Whitcomb in Uncategorized tagged , , , ,

 

CMS is  offering participants in the Bundled Payments for Care Improvement initiative the option to extend participation an additional two years, says a blog post from Patrick Conway, M.D., CMS’s acting principal deputy administrator and chief medical officer.

Rather than ending the program this fall, participating providers can extend participation through Sept. 30, 2018.

Becker’s Hospital Review says that the agency hopes that “the extension will help it better determine the effectiveness of the program, which aims to incentivize providers to improve care coordination by paying for services patients receive across an episode of care, such as a heart bypass surgery or hip replacement.”

Dr. Conway wrote: “By extending their participation, CMS will be able to provide a more robust and rigorous evaluation of the initiative and determine whether the efforts of bundling payments are successful in providing better care while spending healthcare dollars more wisely”.

The initiative tests four payment models, which vary based on the services in the episode of care and whether payments are made prospectively or retrospectively. BPCI has 1,522 participants, nearly all of which are in Models 2, 3 and 4.

The extension will be available to providers in Models 2, 3 and 4 that began the BPCI initiative in October 2013 or in 2014.

The most alluring ACO model

April 18, 2016by Robert Whitcomb in Uncategorized tagged , , , ,

In this HealthAffairs post, the authors argue that today’s most attractive national Accountable Care Organization model is offered by CMS.

They write:

“Fortunately, CMS heard the complaints about early MSSP  {Medicare Shared Savings Program} models and addressed the majority of them through the progressive structure of the Next Gen {of ACOs} model. In fact, the core difference between MSSP Track 1 and the current Next Gen model is that the latter is based upon extensive feedback from health systems regarding their concerns about MSSP Track 1.

“Next Gen is therefore a program that health systems have directly asked for. The model still has room for further improvement — for example, Next Gen ACOs should have access to the full toolkit of benefit- and network-design strategies found in Medicare Advantage and other provider-led offerings. But the CMMI {Center for Medicare & Medicaid Innovation} leadership has pledged to pursue additional features that could take effect in the later years of the Next Gen model, and will continue the virtuous cycle of improvements.”

AMA president says physicians need more payment-system consistency

April 15, 2016by Robert Whitcomb in Uncategorized tagged , , , ,

 

Steven J. Stack, M.D., says that physicians need  more consistency and predictability in new alternative-payment models.

He made his remarks in a Physicians Practice interview after CMS’s new multi-payer initiative  aimed at improving primary care was announced earlier this week.

The program will give practices an upfront care-management fee that they can  keep if they meet performance-based quality and use-performance thresholds.

Dr. Stack said, among other things:  “There needs to be predictability and stability. We need to not be changing the rules every 12 months to 18 months. You can’t run a business when the payment method is changing year over year. Predictability and stability are important. The other thing is there needs to be candor and transparency.”

“Some of the methodologies for the current programs — the Value-Based Modifier or Meaningful Use — have set physicians up for failure. They are not good methodologies to do some of the things that are required. The likelihood of failure is high. Meaningful Use is an all or none, pass/fail paradigm. You get 100 percent you pass, you get 99.9 percent, you fail. Those kinds of things I think most Americans would feel are unreasonable and not fair.

“CMS has to (design) programs that are reflective of the variation in healthcare that’s appropriate and (accommodate for the fact) there are multiple ways to achieve different outcomes. If CMS can design programs that reflect the variation in physician care and patient needs, and hold physicians accountable for more reasonable deliverables … if that’s able to be done over a period of years, physicians can come to learn to be accepting of CMS and less frustrated by it.”

Why physicians should join clinically integrated networks

March 10, 2016by Robert Whitcomb in Uncategorized tagged , , ,

 

Susanne Madden writes in Physicians Practice on why physicians need to join clinically integrated networks. She concludes:

“Many smaller practices and organizations are floundering as the healthcare market changes around them. Requirements for data reporting, care coordination, patient follow up, and so on, in order to meet new market and contracting demands is becoming too costly and cumbersome to support. Many smaller groups have little leverage in the market to secure good contract terms with both payers and hospitals that are building ACOs and limiting employee benefits to narrow networks —so coming together under these structures is a good way to share the load.

“Being part of a larger network of high performing (that is, ability to meet market quality metrics) providers improves leverage, minimizes participation costs, and allows for data to be managed centrally; which can help with CMS reporting, commercial payer pay-for-performance compliance, and patient tracking and management, for example. It is expensive to manage to metric-driven contracts, so utilizing CIN data mining across EHRs from multiple vendors helps to reduce that burden substantially. And if you can’t manage to the data, you can’t take advantage of performance initiatives and may be facing payment penalties in the months to come.

So if you are an independent physician, you may want to see what options are available to you to partner up with larger physician groups, hospitals, or health systems that can help you thrive in the big data market. Now is the time.

Page 7 of 10First...678...Last

Contact Info

info@cmg625.com

(617) 230-4965

Wellesley, Mass