News and Updates for Healthcare Professionals

CMS Takes Action to Modernize Medicare Home Health

CMS Action for Home Health Agencies Puts Value Over Volume and Advances MyHealthEData Initiative

WASHINGTON DC – Today, the Centers for Medicare & Medicaid Services (CMS) proposed significant changes to the Home Health Prospective Payment System to strengthen and modernize Medicare, drive value, and focus on individual patient needs rather than volume of care. Specifically, CMS is proposing changes to improve access to solutions via remote patient monitoring technology, and to update the payment model for home health care.

“Today’s proposals would give doctors more time to spend with their patients, allow home health agencies to leverage innovation and drive better results for patients,” said CMS Administrator Seema Verma. “The redesign of the home health payment system encourages value over volume and removes incentives to provide unnecessary care.”

CMS’s proposed changes promote innovation to modernize home health by allowing the cost of remote patient monitoring to be reported by home health agencies as allowable costs on the Medicare cost report form. This is expected to help foster the adoption of emerging technologies by home health agencies and result in more effective care planning, as data is shared among patients, their caregivers, and their providers. Supporting patients in sharing this data will advance the Administration’s MyHealthEData initiative.

As required by the Bipartisan Budget Act of 2018, this proposed rule would also implement a new Patient-Driven Groupings Model (PDGM) for home health payments.  The current system pays for 60-day episodes of care and relies on the number of therapy visits a patient receives to determine payment. The PDGM would eliminate the use of “therapy thresholds” in determining payment and changes the unit of payment to 30-day periods of care. The improved structure would move Medicare towards a more value-based payment system that puts the unique care needs of the patient first while also reducing the administrative burden associated with the HH PPS. The PDGM would be implemented in a budget-neutral manner on January 1, 2020.

The proposed rule also includes information on the implementation of home infusion therapy temporary transitional payments as required by the Bipartisan Budget Act of 2018. In addition, the proposed rule solicits comments on elements of the new home infusion therapy benefit category and proposes standards for home infusion therapy suppliers and accrediting organizations of these suppliers as required by the 21st Century Cures Act.

Physicians who order home health services for their patients would also see administrative burden reduced under this rule.  CMS is proposing to eliminate the requirement that the certifying physician estimate how much longer skilled services would be needed when recertifying the need for continuing home health care, as this information is already gathered on a patient’s plan of care.

The proposed rule helps advance the Trump Administration’s Meaningful Measures Initiative. CMS is proposing changes to the Home Health Quality Reporting Program (HH QRP). The cost impact related to updated data collection processes as a result of the proposed implementation of the PDGM and proposed changes to the HH QRP are estimated to result in a net $60 million in annualized cost savings to HHAs, or $5,150 in annualized cost savings per HHA, beginning in CY 2020.

In the proposed rule CMS is releasing a Request for Information to welcome continued feedback on the Medicare program and interoperability. CMS is gathering stakeholder feedback on revising the CMS patient health and safety standards that are required for providers and suppliers participating in the Medicare and Medicaid programs to further advance electronic exchange of information that supports safe, effective transitions of care between hospitals and community providers.

The proposed rule and the Request for Information can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection.

The proposed rule announced today is part of a broader effort to put patients over paperwork by improving access to and value of care, and reducing the administrative burden on physicians so that more effective care to patients may be provided. To date, CMS has taken the following notable actions in this year’s rulemaking for Medicare, among others, to advance the Patients Over Paperwork initiative for Medicare beneficiaries:

  • The modernizing proposals to advance CMS’ Meaningful Measures Initiative released in five separate fiscal year 2019 proposed rules are projected to save Medicare providers close to four million hours and more than $144 million as they take effect in 2019 and 2020.
  • CMS proposed a Patient-Driven Payment Model for the Skilled Nursing Facility Prospective Payment System  that ties payment to patients’ conditions and care needs rather than volume of services provided and simplifies complicated paperwork requirements that save facilities approximately $2.0 billion over 10 years.
  • CMS finalized a rule that would allow Medicare Advantage plans to offer more tailored plan benefit packages and new types of supplemental benefits.

For a fact sheet on today’s proposed rule, please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-07-02.html

For additional information about the Home Health Prospective Payment System, visit https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS/index.html and https://www.cms.gov/center/provider-Type/home-Health-Agency-HHA-Center.html.

For additional information about the Home Health Value-Based Purchasing Model, visit https://innovation.cms.gov/initiatives/home-health-value-based-purchasing-model.

For additional information about the Home Health Quality Reporting Program, visit https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Home-Health-Quality-Reporting-Requirements.html

Final Recommendation Statement: Screening for Osteoporosis to Prevent Fractures

The U.S. Preventive Services Task Force released today a final recommendation statement on screening for osteoporosis to prevent fractures. The Task Force found that screening for osteoporosis can prevent fractures in women 65 years and older and in women younger than 65 years who are at increased risk. More research is needed for men. To view the recommendation and the evidence on which it is based, please go here. The final recommendation statement can also be found in the June 26 online issue of JAMA.

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Sodium and Potassium Intake: Effects on Chronic Disease Outcomes and Risks

Key Messages
  • Decreasing dietary sodium intake most likely reduces blood pressure in normotensive adults and more so in those with hypertension
  • Higher sodium intake may be associated with greater risk for developing hypertension
  • Use of potassium-containing salt-substitutes in the diet to reduce sodium intake most likely reduces blood pressure in adults
  • Increasing potassium intake most likely decreases blood pressure in adults with hypertension
  • All-cause mortality may be associated with sodium intake
  • Reduced sodium intake may decrease the risk for combined CVD morbidity and mortality

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21st Century Cures Act: 2018 Mid-Year Update

The 21st Century Cures Act (P.L. 114-255) is landmark, bipartisan legislation that was signed into law on Dec. 13, 2016, and touches virtually all aspects of biomedical research, medical product development and the regulatory approval process. Read what FasterCures has said about 21st Century Cures over the years.

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EHC Program Update: Chronic Pain Final Report

Evidence Review Now Available

Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review
(Systematic Review, released on June 11, 2018)

Selected Key Messages:
- Interventions that improved function and/or pain for at least 1 month when used for—

  • Chronic low back pain: Exercise, psychological therapies (primarily cognitive behavioral therapy [CBT]), spinal manipulation, low-level laser therapy, massage, mindfulness-based stress reduction, yoga, acupuncture, multidisciplinary rehabilitation (MDR).
  • Chronic neck pain: Exercise, low-level laser, Alexander Technique, acupuncture.
  • Knee osteoarthritis: Exercise, ultrasound.
  • Hip osteoarthritis: Exercise, manual therapies.
  • Fibromyalgia: Exercise, CBT, myofascial release massage, tai chi, qigong, acupuncture, MDR.
  • Chronic tension headache: Spinal manipulation.

- Most effects were small. Long-term evidence was sparse.

- There was no evidence suggesting serious harms from any of the interventions studied; data on harms were limited.

For more, see: https://effectivehealthcare.ahrq.gov/topics/nonpharma-treatment-pain/research-2018

NIH launches HerbList, a mobile app on herbal products

App offers easy access to scientifically backed information on herbs and herbal products.

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EHC Program Update: Call for Nominations for Future EPC Reports by June 22nd

What health care decisions are you struggling with? Would a review of the scientific evidence help inform this decision? Share your ideas with the Agency for Healthcare Research and Quality’s (AHRQ) Evidence-based Practice Center (EPC) Program. AHRQ will use these ideas to determine the focus of its evidence reports for next fiscal year (i.e., AHRQ can provide an evidence report at no cost). Your input is important!

Propose your evidence report topics by June 22 at:
https://www.effectivehealthcare.ahrq.gov/index.cfm/submit-a-suggestion-for-research/.

The AHRQ EPC Program reviews and summarizes the available evidence on current health care issues, which can help:

  • Clinicians and policymakers understand the benefits and harms of different tests and treatments;
  • Health systems and policymakers understand the best options for implementing a new program or intervention; and
  • Patients make better decisions about their health care options;

Consistent with past years, we will review every proposed topic with our selection criteria (https://effectivehealthcare.ahrq.gov/about/epc/nomination/). Information about the importance and impact of a review will especially be helpful. In particular, the potential impact of a review on clinical practice and health outcomes --- going beyond a guideline or recommendation.

If you have any questions, please contact epc@ahrq.hhs.gov

NIH study explains why opioid therapy may not always work well for chronic pain

Findings show the impact of chronic pain on the brain and its relation to depression.

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Take Notice

The AHRQ National Guideline Clearinghouse (NGC, guideline.gov) Web site will not be available after July 16, 2018 because federal funding through AHRQ will no longer be available to support the NGC as of that date. AHRQ is receiving expressions of interest from stakeholders interested in carrying on NGC's work. It is not clear at this time, however, when or if NGC (or something like NGC) will be online again. In addition, AHRQ has not yet determined whether, or to what extent, the Agency would have an ongoing role if a stakeholder were to continue to operate the NGC. We will continue to post summaries of new and updated evidence-based clinical practice guidelines until July 2, 2018. For any questions, please contact Mary.Nix@ahrq.hhs.gov.

International study suggests combination therapy may prevent stroke in certain people

Results from an international clinical trial of more than 4880 participants, published in the New England Journal of Medicine, show that combining clopidogrel and aspirin following a small stroke or experiencing minor stroke symptoms decreases risk of a new stroke, heart attack or other ischemic event within 90 days.  The combination therapy was also associated with an increase in major bleeding, although many of those episodes were non-fatal and did not occur in the brain. The results were presented at the 4th European Stroke Organization Conference in Gothenburg, Sweden. The study was supported by the NIH’s National Institute of Neurological Disorders and Stroke (NINDS).

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