CMS announces new Medicare Advantage Value-Based Insurance demo

The Centers for Medicare & Medicaid Services last week announced the Medicare Advantage Valued-Based Insurance Design Model, which will test whether encouraging plan enrollees with certain conditions to consume high-value clinical services through reduced cost sharing and other approaches improves quality and reduces costs.

Read More

The US Department of Health and Human Services announces funding for learning networks

The Department of Health and Human Services (HHS) awarded $685 million to 29 “practice transformation networks,” including some hospitals and health systems, and 10 supporting organizations to help clinicians improve patient outcomes and lower costs for Medicare, Medicaid and Children’s Health Insurance Program enrollees through its Transforming Clinical Practice Initiative.

Read More

Kaiser Family Foundation poll finds overwhelming support for Medicare Paying for end-of-life talks

The public overwhelmingly supports Medicare’s plan to pay for end-of-life discussions between doctors and patients, despite GOP objections that such chats would lead to rationed care for the elderly and ill, a poll released Wednesday by the Kaiser Family Foundation finds.

Read More

CMS introduces New ACO Model

According to a blog post by Patrick Conway, MD, Deputy Administrator for Innovation and Quality and Chief Medical Office, Centers for Medicare and Medicaid Services (CMS), CMS is unveiling its next generation Accountable Care Organization model, which it hopes will provide an attractive alternate for providers not yet participating in the ACO program. 

How the new model works

The new model uses a combination of fee-for-service and capitation. It creates four payment systems and two risk tracks for its participants, including one with almost full risk.

According to Conway, the Next Generation ACO Model sets more predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality of care.  Key features of the new model include:

Read More

Medicare releases 2014 ACO results

According to a Centers for Medicare & Medicaid Services (CMS) press release, Medicare Accountable Care Organizations (ACO) continue to improve the quality of care for Medicare beneficiaries while generating financial savings.   

In Medicare's detailed results, the 20 ACOs in the Pioneer ACO Model and 333 Medicare Shared Shavings Program ACOs generated more than $411 million in total savings in 2014, which includes all ACOs’ savings and losses. At the same time, 97 ACOs qualified for shared savings payments of more than $422 million by meeting quality standards and their savings threshold. The results also show that ACOs with more experience in the program tend to perform better over time.

Read More

Use of virtual huddles support ACO care coordination; mobile devices helping improve quality and physician satisfaction

A recent article from Hospitals and Health Networks  highlights the growing use of virtual medical huddles to help coordinate care across the care team.

Communication is critical to successfully implementing new models of care to reduce costs and keep patients from making return trips to the hospital.  But communicating across care teams can be a big hurdle for accountable care organizations.

One such organization using virtual huddles is Meritage Medical Network based in Novato, Calif. The physician-led, Medicare Shared Savings ACO includes numerous physician practices and a hospital with disparate records systems, covering a 26,000 square-mile region.

Read More

Additional participants in CMS bundled payments pilot

The Centers for Medicare & Medicaid Service (CMS) announced that over 2,100 acute care hospitals, skilled nursing facilities, physician group practices, long-term care hospitals, inpatient rehabilitation facilities, and home health agencies transitioned to a risk-bearing implementation period in which they assumed financial risk for episodes of care.

Participants include 360 organizations that have entered into agreements with CMS to participate in the Bundled Payments for Care Improvement initiative and an additional 1,755 providers who have partnered with those organizations. CMS defines an episode of care as the set of services provided to treat a clinical condition or procedure, such as a heart bypass surgery or a hip replacement.

Read More

Rising drug costs influence national debate over military spending

In most budget years congressional debate over defense spending revolves around the future of Guantanamo Bay, closing of bases around the country, or huge weapons systems.

This year, a dispute over a bread-and-butter matter -- how to pay for the rising cost of prescription drugs -- may be most difficult of all for lawmakers who are trying to close a deal on the bill, H.R. 1735, that would authorize more than $620 billion in defense-related spending.

At issue are benefits for the estimated 9.6 million users of the Pentagon's Tricare health system and resulting profits for retail drugstores including those run by CVS Health Corp., Walgreens Boots Alliance Inc. and Rite Aid Corp.

Read More

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.

Read More

State and federal health reforms helping marginalized patients

According to Kaiser Health News, state and federal incentives and reforms have created new options for nonprofit organizations to support severely marginalized patients such as drug users and sex workers.

Such organizations or "harm reduction centers" are where such patients can get clean needles, syringes, free condoms and HIV prevention information.  They have existed for decades at the fringes of the health care system and supported by piecemeal and bootstrapped budgets of state and federal agencies.

Such organizations are increasingly trying to reposition themselves as a resource for hospitals and insurers because of their  experience coordinating care for high-risk and often marginalized patients.

Read More

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.

Read More

Half of nation's primary care physicians have negative view of quality metrics

A new survey from The Commonwealth Fund and The Kaiser Family Foundation asked primary care providers—physicians, nurse practitioners, and physician assistants—about their experiences with and reactions to recent changes in health care delivery and payment.

  • While doctors' views are generally positive regarding the impact of health information technology on quality of care, physicians are more divided on the use of medical homes and accountable care organizations.
  • Overall, providers are more negative about the increased reliance on quality metrics to assess their performance and about financial penalties.

  • Many physicians expressed frustration with the speed and administrative burden of Medicaid and Medicare payments.
Read More

Over half of nation's hospitals have Medicare readmission penalty

According to Kaiser Health News, the majority of the nation’s hospitals are being penalized by Medicare for having patients frequently return within a month of discharge — this time losing a combined $420 million, government records show.  The Kaiser story also includes links to data files.

In the fourth year of federal readmission penalties, 2,592 hospitals will receive lower payments for every Medicare patient that stays in the hospital — readmitted or not — starting in October. The Hospital Readmissions Reduction Program, created by the Affordable Care Act, was designed to make hospitals pay closer attention to what happens to their patients after they get discharged.
Read More

CMS testing star ratings for hospitals until August 17

According to AHA News Now, hospitals have until Aug. 17 to review their results from the CMS dry run test of a proposed star rating system for overall hospital-level quality.

The test allows hospitals to ask questions and provide feedback, with a goal to contribute to refinements of the methodology before overall star ratings are posted on the Hospital Compare website next year. Each hospital will receive a Hospital-Specific Report, which includes its star rating results and the measures used to calculate them.

For more on the dry run, including links to a mock report and HSR User Guide, visit CMS will host an Aug. 13 call on the overall star ratings methodology, Hospital-Specific Reports and lessons learned from the dry run. To register for the CMS call, click here.

Consumer Reports ranks hospitals on infections

A new investigation from Consumer Reports looks into hospital infections to rate which hospitals do better or worse at protecting their patients from dangerous bugs.

Each year, about 648,000 people in the United States develop infections during a hospital stay, and about 75,000 die with them, according to the Centers for Disease Control and Prevention. Many of these cases can be traced back to inappropriate antibiotic use, the very drugs that are supposed to fight infections.

For the first time ever, Consumer Reports included data on MRSA and C. diff infections -- two of the most common and deadly "superbugs" in the U.S. -- in their hospital ratings.
Read More

Study finds Medical Home experiment failed to show savings

According to Kaiser Health News, A new RAND study found that a $57 million experiment to deliver better, more efficient care at federally funded health centers struggled to meet its goals and is unlikely to save money.

The test to coordinate treatment for high-risk Medicare patients in hundreds of communities was one of many demonstrations run by the Department of Health and Human Services’ innovation center.

The Affordable Care Act created the lab and gave it $10 billion over a decade to test new ways to improve care and save money.

As the trial wound down last fall, 69 percent of the clinics that hadn’t dropped out had obtained full accreditation as “medical homes” — primary care practices that coordinate care across the maze of specialists, hospitals and emergency rooms.  HHS had hoped for 90 percent.
Read More

Medicare deaths, length of stay and costs decrease over past 15 years

According to a new study in the Journal of the American Medical Association, over the last 15 years the number of deaths, hospital stays and healthcare costs decreased among older Americans on Medicare.

"Although our health care system has its failings, we are making remarkable progress," said Dr. Harlan Krumholz, the study's lead author from Yale University in New Haven, Connecticut.

"People are much better off today than they were 15 years ago," he told Reuters Health in an email. Researchers used data on over 68 million people on Medicare, the U.S. health insurance for the elderly and disabled.  In particular the study found:

  • Deaths from any cause fell among Medicare beneficiares from 5.3 to 4.45 percent between 1999 and 2013.  
  • The number of hospital stays per 100,000 people per year fell by 8,344 between 1999 and 2013.
  • The amount of money spent on care among those beneficiaries in hospitals fell by nearly $500 per beneficiary during that time.
Read More

ProPublica publishes scorecard on complication rates

ProPublica has published a scorecard of complication rates for almost 17,000 individual surgeons at more than 3,500 hospitals nationwide based on an analysis of Medicare data.  The scorecard allows users to search by location, by surgeon, or by hospital.

For its analysis, ProPublica analyzed Medicare data from 2009 to 2013 for eight common elective procedures, which accounted for 2.3 million total surgeries:

  • Knee replacements;
  • Hip replacements;
  • One type of spinal fusion on the neck;
  • Two types of spinal fusions in the lower back;
  • Gall bladder removals;
  • Prostate removals; and
  • Prostate resections.

National Patient Safety Foundation posts new report on Root Cause Analysis

THe National Patient Safety Foundation issued a new report entitled "RCA2: Improving Root Cause Analyses and Actions to Prevent Harm".

Root cause analysis (RCA) is a process widely used by health professionals to learn how and why errors occurred, but there have been inconsistencies in the success of these initiatives. With a grant from The Doctors Company Foundation, NPSF convened a panel of subject matter experts and stakeholders to examine best practices around RCAs and develop guidelines to help health professionals standardize the process and improve the way they investigate medical errors, adverse events, and near misses.

The goals of the report are to identify methodologies and techniques that will lead to more effective and efficient RCA2 and to provide tools to evaluate individual RCA2 reviews so that significant flaws can be identified and remediated to achieve the ultimate objective of improving patient safety.  


Few patients see or use price and cost data to make health decisions

According to Kaiser Health News, few individuals use quality and price data to make choices for their health care.

While there has been a recent push in the public and private sectors to increase health care transparency, the Kaiser Family Foundation poll found that:


  • Approximately two-thirds of respondents reported difficulties finding information on hospitals' and physicians' exact prices for treatments or procedures
  • Only about 20% of respondents reported seeing price or quality data about doctors, hospitals, or insurers.
  • Less than 9% of respondents said they used pricing data when making decisions on health plans;
  • About 6% of respondents said they used quality data when making a decision about a doctor, hospital or insurer; and
  • 3% of respondents reported using pricing information when making decisions about physicians