Medicare publishes final rule on the Quality Payment Program

The Department of Health & Human Services (HHS) finalized a new payment system for Medicare clinicians that will continue to reform how the health care system pays for care. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program, which replaces the Sustainable Growth Rate (SGR), is designed to consolidate the SGR, Meaningful Use, and the Value Modifier into a single alternative payment system.  According to the HHS press release, the Administration is building a system that delivers better care, one in which clinicians work together and have a full understanding of patients’ needs, Medicare pays for what works and spends taxpayer money more wisely, and patients are in the center of their care, resulting in a healthier country.

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Obama administration issues most sweeping rules in a decade for Medicaid enrollees

The Obama administration tightened rules Monday for private insurance plans that administer most Medicaid benefits for the poor, limiting profits, easing enrollment and requiring minimum levels of participating doctors.

For consumers the most visible change may be quality ratings intended to reflect Medicaid plans’ health results and customer experiences. The administration agreed to move slowly on such a sensitive industry issue, saying it would develop the scores over several years.

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CMS announces new Primary Care delivery model

Public and private payers can apply through June 1 to participate in a new medical home model that will build on the Comprehensive Primary Care model to help practices support patients with serious or chronic diseases, the Centers for Medicare & Medicaid Services announced today. 

Under the CPC+ model, CMS will partner with insurers and Medicaid agencies in up to 20 regions and up to 5,000 practices to provide monthly care management fees based on beneficiary risk tiers.  The model can accommodate up to 5,000 practices, 20,000 doctors and the 25 million people they serve.

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CMS reports positive shared savings results for primary care value initiative

According to a blog by Patrick Conway, CMS Deputy Administrator for Innovation and Quality and Chief Medical Officer, CMS is showing promising results for the first shared savings performance year of the Comprehensive Primary Care (CPC) model.  The initiative was launched in October 2012 to advance primary care by paying clinicians to deliver accessible, comprehensive and coordinated care and is part of CMS's broader effort to promote better care, smarter spending, and healthier people.

In performance year 2014, CPC practices showed positive quality results, with hospital readmissions lower than national benchmarks and high performance on patient experience measures, particularly on provider communication with patients and timely access to care. CPC practices that demonstrated high quality care and reduced spending above a threshold shared in savings generated for Medicare.

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UPMC to post doctor ratings online

The University of Pittsburgh Medical Center has posted ratings of its doctors online related to a provider's ability to explain things in an understandable way, his or her listening skills and demonstration of respect for the patient, and whether the patient would recommend the provider to family and friends.

Increasingly, patients are researching online to find doctors and medical information, checking with "Dr. Google" before calling a physician. In an effort to share more and better information with these savvy and engaged consumers, UPMC is the first health care provider in Pennsylvania to publicly share patient satisfaction ratings and comments about its doctors and advanced practice providers.

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Now you can find information about your hospital on Yelp

ProPublica and Yelp recently agreed to a partnersship that will allow information from ProPublica's interactive health databases to begin appearing on Yelp's health provider pages. In addition to reading about consumers' experiences with hospitals, nursing homes and doctors, Yelp users will see objective data about how the providers' practice patterns compare to their peers.

According to NPR, Yelp is adding a ton of health-care data to its review pages for medical businesses to give consumers more access to government information on hospitals, nursing homes and dialysis clinics.

Consumers can now look up a hospital emergency room's average wait time, fines paid by a nursing home, or how often patients getting dialysis treatment are readmitted to a hospital because of treatment-related infections or other problems.

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IOM report establishes framework for standardized measures set

A recent Institute of Medicine (IOM) report, Vital Signs: Core Metrics for Health and Health Care Progress, identifies fundamental problems with the current state of health care quality measures as too many, unfocused, and unorganized and identifies a framework to streamline the measures.
The IOM report uses four domains—healthy people, care quality, lower cost, and engaged people—to propose the following 15 standardized measure sets that represent a more wholistic, organized and focused approach for required measures at the national, state, and local levels and recommends steps to implement the measures:
1. Life expectancy
2. Well-being
3. Overweight and obesity
4. Addictive behavior
5. Unintended pregnancy
6. Healthy communities
7. Preventive services
8. Care access
9. Patient safety
10. Evidence-based care
11. Care match with patient
12. Personal spending
13. Population spending
14. Individual engagement
15. Community engagement
The  report was published online April 28, 2015 in The Journal of the American Medical Association by the Commonwealth Fund's David Blumenthal, M.D. and the Institute of Medicine's J. Michael McGinnis, M.D. 

New Commonwealth Fund scorecard notes states made little progress before ACA

According to a recent Commonwealth Fund report on State Health System Performance, in the five years preceding implementation of the Affordable Care Act’s major coverage provisions, the majority of states declined or failed to improve on two-thirds of the measures that could be tracked over time.

Commonwealth Fund researchers ranked the health systems of every state and the District of Columbia on a variety of health care measures. Of the 34 measures that could be tracked between 2007 and 2011–12, all states saw meaningful improvement on at least seven. But more than half of states lost ground on at least nine measures. 

The Commonwealth Fund scorecard covers areas such as Access and Affordability, Prevention and Treatment, Potentially Avoidable Hospital Use and Cost, and Health Lives (public health measures). 

MAP has released list of quality and efficiency measures being considered for 2012

As part of the Patient Protection and Affordable Care Act, the Measure Applications Partnership has released the list of quality and efficiency measures the Centers for Medicare & Medicaid Services is considering adopting in 2012, according to AHA News Now.
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