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.Read More
Although pay-for-performance programs have gained “rapid and widespread” appeal as ways to increase care quality, a new study in the Journal of General Internal Medicine finds that how practices utilize incentive payments may determine their impact on quality and that putting payments toward physician productivity and efficiency may negatively affect the patient experience.
More than 85,000 physicians and other eligible professionals who successfully reported quality-related data to Medicare under the 2008 Physician Quality Reporting Initiative (PQRI) received incentive payments totaling more than $92 million, the Centers for Medicare & Medicaid Services (CMS) announced today, well above the $36 million paid in 2007.
Although the United States spends more than $2 trillion annually on health care, patient outcomes lag other developed countries that spend far less per capita. Physicians wield significant influence—directly and indirectly—over the quality and cost of health care, and efforts to measure and improve physician performance have gained momentum. Much of the impetus has come from purchasers seeking to engage consumers to be more active participants in their health and health care decisions.
Five years of physician performance data places Massachusetts in the forefront of quality reporting
Massachusetts Health Quality Partners (MHQP) today released the organization's fifth annual Quality Insights: Clinical Quality in Primary Care report, comparing the performance of 150 medical groups across the state. The results are available at www.mhqp.org, where consumers can compare how well medical groups perform in meeting national standards for providing preventive care, helping patients manage chronic conditions such as diabetes, and avoiding the overuse of certain medications and tests.
According to the Government Accounting Office (GAO), the Department of Health and Human Services should develop and implement a written plan to use the data collection instrument and methodology to conduct recurring periodic surveys of randomly selected Ambulatory Surgery Centers (ASC) in order to obtain information on the extent to which ASCs implement specific infection control practices that reduce the risk of transmitting HAIs to their patients.
The Centers for Medicare & Medicaid Services selected five hospitals to participate in a three-year bundled payment demonstration, which the agency plans to launch early this year. The hospitals are Baptist Health System in San Antonio; Oklahoma Heart Hospital in Oklahoma City; Exempla Saint Joseph Hospital in Denver; Hillcrest Medical Center in Tulsa, OK; and Lovelace Health System in Albuquerque, NM.
CMS yesterday released its final rule for the outpatient prospective payment system (OPPS) in calendar year (CY) 2009, under which the agency will give providers a 3.6% annual inflation update and pay an estimated $30.1 billion in 2009 for outpatient services, up from an estimated $28.5 billion for CY 2008 (see related story in the July 7 Daily Briefing). Hospitals that do not meet quality reporting requirements, however, will receive a 1.6% inflation update.
The Center for Medicaid and Medicare Services (CMS) has added an e-prescribing incentive program on the Physician Quality Reporting Initiative (PQRI) web site. The page includes a fact sheet that describes the MIPPA provisions for the e-prescribing incentive program. Additional information on the program and how to quality for the e-prescribing incentive for the 2009 reporting year will be posted in early November.
In a new advisory opinion, the Department of Health and Human Services' Office of Inspector General said it would not impose sanctions on a hospital for sharing with a physician group the bonus compensation it receives in a pay-for-performance agreement with a private insurer.
The eHealth Initiative and other groups today issued a guide to help office-based physicians transition from paper to electronic prescribing systems. The guide provides an overview of e-prescribing and the steps involved in planning, selecting and implementing an e-prescribing system. The guide is designed physician practices new to e-prescribing and who want an overview of what it is and for physician practices that are ready to move forward with implementing e-prescribing, and already have a good grasp of the fundamentals.
More than 100 Million Americans Covered By Health Plans that Report Performance; Two-Thirds of the System Remains a Mystery
According to a recent report by the National Committee for Quality Assurance (NCQA), health care quality for millions of Americans improved in 2007 but significant variations in performance continue to leave many people receiving substandard care. While quality improved for most people in private health insurance plans, there was little improvement in the care delivered to those enrolled in Medicare and Medicaid, the nation’s two largest public health care programs. Eliminating variations in the delivery of evidence-based care across the health care system could save up to 88,000 lives each year, the report concludes.
The Centers for Medicare & Medicaid Services yesterday updated its Health Care Consumer Initiatives web site to include calendar year 2007 data on average Medicare payments made for common and elective procedures and services provided by physicians. Ambulatory surgical center payment information was updated on Aug. 22, and CMS expects to update the hospital outpatient department payment information later this fall.
Standards emphasize measurement gaps and harmonization
Washington, DC - To fill gaps in assessing clinician performance that can promote higher quality health care, the National Quality Forum (NQF) has endorsed 67 clinician-level consensus standards relating to cancer care, infectious diseases, perioperative care, and care provided by thousands of medical professionals who are not MDs, but provide critical services. NQF also endorsed four facility-level measures in surgery and anesthesia, 17 measures addressing prevention and management of stroke across the continuum of care, and three measures for influenza and pneumococcal immunizations, a total of 91 consensus standards.