In The News

Accountable Care Organization initiatives announced to improve health system care delivery

Today, the Centers for Medicare & Medicaid Services (CMS) announced 121 new participants in Medicare Accountable Care Organization (ACO) initiatives designed to improve the care patients receive in the health care system and lower costs. With this announcement, ACOs now represent 49 states and the District of Columbia.

ACOs are delivering better care, and they continue to show promising results on cost savings. In 2014, they had a combined total net program savings of $411 million for 333 Medicare Shared Savings Program (Shared Savings Program) ACOs and 20 Pioneer ACOs. Based on 2014 quality and financial performance results for Shared Savings Program ACOs who started the program in 2012, 2013, and 2014, those that reported in both 2013 and 2014 improved on 27 of the 33 quality measures, including patients’ ratings of clinicians’ communication, beneficiaries’ rating of their doctors, screening for tobacco use and cessation, screening for high blood pressure, and Electronic Health Record use. Shared Savings Program ACOs also outperformed group practices reporting quality on 18 out of 22 measures.

CMS also announced today that providers and hospitals have signed up to join new types of ACOs, which in addition to being paid for positive patient outcomes will also receive penalties for negative ones. With new participants in the Shared Savings Program (SSP), the Next Generation ACO Model, Pioneer ACO Model, and the Comprehensive ESRD Care Model, there will now be:

  • Nearly 8.9 million beneficiaries served
  • A total of 477 ACOs across SSP, Pioneer ACO Model, Next Generation ACO Model, and Comprehensive ESRD Care Model
  • 64 ACOs are in a risk-bearing track including SSP, Pioneer ACO Model, Next Generation ACO Model , and Comprehensive ESRD Care Model

More information can be found by visiting the Next Generation ACO, Pioneer ACO, Comprehensive ESRD Care Models web pages.

New Guidance for EPs Reporting the Diabetes: Hemoglobin A1c (CMS122v3) Measure for Program Year 2015

Due to an error found in the logic, the Centers for Medicare & Medicaid Services (CMS) is providing guidance on measure CMS122 (Diabetes: Hemoglobin A1c Poor Control), which is included in the 2014 measure set for the Electronic Health Record (EHR) Incentive Program for eligible professionals (EPs). Version CMS122v3 of the measure was posted on the CMS website in May 2014. A subsequent posting of this measure in 2015 (CMS122v4) resolved this issue for the 2016 program year.

Background
CMS122 measures the percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement year. A patient meets the numerator condition if any of the following are true:

  1. The most recent HbA1c reading is > 9.0%;
  2. The most recent HbA1c result is missing; or
  3. If there are no HbA1c tests performed and results documented during the measurement period.

CMS122 is an inverse measure, meaning that lower scores indicate better performance. In 2014, this measure was updated as CMS122v3 to include logic and specifications for numerator condition (2), where there is evidence of a laboratory test’s having been performed, but the result of the test was not recorded. This logic introduced an error, which results in patients with HbA1c laboratory results of less than 9.0% as being numerator compliant, artificially inflating the (inverse) performance score.

What should you do if you report this measure?
Version CMS122v3 affects the 2015 program year and 2017 payment year for several programs including the Physician Quality Reporting System (PQRS), the Medicare EHR Incentive Program, the Value-Based Payment Modifier (VM) and the Comprehensive Primary Care (CPC) initiative. Guidance for each program is provided below.

  • PQRS
    Reporting CMS122v3 will count as one of the nine measures required to satisfactorily report for the PQRS program. For PQRS questions regarding CMS122v3, please contact the QualityNet Help Desk at Qnetsupport@hcqis.org or 1-866-288-8912, TTY: 1-877-715-6222.
  • EHR Incentive Programs
    Reporting CMS122v3 will count as one of the nine measures required to satisfactorily report for the EHR Incentive Programs. For questions regarding CMS122v3, please contact the EHR Incentive Programs Information Center at 1-888-734-6433 or TTY 1-888-734-6563.
  • Value Modifier (VM) Program
    Based on this logic error, CMS will not include CMS122v3 in the calculation of the Quality Composite for the CY 2017 Value Modifier. For VM questions regarding CMS122v3, please contact the Physician Value Help Desk at pvhelpdesk@cms.hhs.gov or 1-888-734-6433 (press option 3).
  • Comprehensive Primary Care Initiative (CPC)
    All practices are required to report 9 measures from the 13 CPC eCQM measures. If a practice is unable to report on a different CPC eCQM, then they should report this measure to meet the 9 measure reporting requirement for the CPC program. For 2015 CPC Medicare shared savings, CMS will not include this measure in performance calculations for quality scoring purposes. Practices that report on CMS122v3 will still be eligible to receive any Medicare shared savings based on their other reported eCQMs. For CPC questions regarding CMS122v3, please contact the CPC Support at: cpcisupport@telligen.org or 1-800-381-4724.

For more information on eCQMs, visit the eCQM Library.

AHRQ-Sponsored Continuing Education Activities

AHRQ offers continuing education (CE) and continuing medical education (CME) videos and articles on a range of health care topics including patient safety and patient-centered outcomes research findings. The CE/CME activities summarize reviews of evidence on the effectiveness and safety of treatments and strategies for improving patient care. These resources provide health care providers with skills and information to support individual decision making and patient management. The activities are available at no cost for CE/CME credit here: AHRQ-Sponsored Continuing Education Activities (12/15)

Management of Insomnia Disorder

January 1, 2016

The term insomnia is variously defined to describe a symptom and/or a disorder. It involves dissatisfaction with sleep quantity or quality and is associated with one or more of the following subjective reports: difficulty initiating sleep, difficulty maintaining sleep, or early morning waking with inability to return to sleep.

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NIH unveils FY2016–2020 Strategic Plan

December 16, 2015

Detailed plan sets course for advancing scientific discoveries and human health.

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2014-2015 NIH Alzheimer’s disease progress report available online

A new online report provides an easy-to-read overview of recent National Institutes of Health-funded research advances and initiatives in Alzheimer’s disease and related dementias. Issued by the National Institute on Aging (NIA) at NIH, the annual report — 2014-2015 Alzheimer’s Disease Progress Report: Advancing Research Toward a Curediscusses research momentum under the National Plan to Address Alzheimer’s Disease, describes research opportunities, and summarizes scientific advances in several areas:

  • Understanding the biology of Alzheimer’s, related dementias, and the aging brain
  • Identifying genetic influences on risk for late-onset Alzheimer’s, the most common form
  • Detecting the earliest Alzheimer’s-related brain changes, including further development of biomarkers to track the onset and progression of Alzheimer’s
  • Understanding gender and racial differences in the impact of Alzheimer’s
  • Stepping up translational research enabling the design and testing of new drugs
  • Testing in clinical trials potential new therapies to prevent, delay or treat Alzheimer’s
  • Finding better ways to support caregivers

The report includes searchable tables of NIA-funded clinical trials that are testing promising interventions for Alzheimer’s disease, mild cognitive impairment, age-related cognitive decline, delirium and dementia-related psychiatric conditions and symptoms—agitation, apathy and depression.

Read the report online: 2014-2015 Alzheimer’s Disease Progress Report: Advancing Research Toward a Cure

CDC issues guidelines on opioid prescribing for chronic pain

The CDC has released draft guidelines on prescribing opioids for chronic pain days after the National Center for Health Statistics reported a 16.3% jump in opioid overdose-related deaths in 2014. The guidelines, which don't apply to pain associated with serious diseases or end-of-life care, call for primary care providers to be more conservative when prescribing pain drugs, such as prioritizing physical therapy and other non-opioid treatments. When opioids are needed, prescribers should use the minimum effective dose and short-acting versions of the drugs. The Washington Post (tiered subscription model) (12/14)

Rates of Drug Overdose Deaths Continue to Rise, More Action Needed to Reverse Troubling Trends

December 10, 2015
By: Richard Frank, Assistant Secretary for Planning and Evaluation at HHS

New CDC data shows the overall number and rate of drug overdose deaths increased notably between 2013-2014, driven in large part by continued increases in heroin deaths and an emerging increase in deaths involving illicit synthetic opioids. These new data reaffirm that we have not seen the peak of the opioid abuse and overdose epidemic and highlights the need for continued action to prevent opioid misuse and dependence to save lives.

Drug overdose death rates have never been higher. Data shows 18,893 overdose deaths involving opioid pain relievers in 2014, which is an increase of 16%, or 2,658 deaths, compared to 2013 data. Prescription opioid-related overdose deaths are increasing in part because deaths involving synthetic opioids, such as fentanyl and tramadol, increased by 79% from 2013-2014, totaling 5,544 deaths in 2014. Heroin-related deaths have more than tripled since 2010. Heroin-related death rates increased 28% from 2013-2014, totaling 10,574 deaths in 2014. Heroin is often cut with fentanyl – with or without the user’s knowledge – in order to increase its effect.

The opioid epidemic touches all of us. HHS Secretary Sylvia Burwell’s home state of West Virginia, for example, has the highest drug overdose death rate of any state in the country. These statistics reflect what we’re seeing across America, in communities large and small and among people from all walks of life - a rising tide of opioid abuse and overdose.

READ MORE: Rates of Drug Overdose Deaths Continue to Rise, More Action Needed to Reverse Troubling Trends

Management and Outcomes of Binge-Eating Disorder

Research Review - Final – Dec. 9, 2015

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Nonpharmacological Versus Pharmacological Treatments for Adult Patients With Major Depressive Disorder

Research Review - Final – Dec. 8, 2015

Formats
View PDF (PDF) 5.8 MB

This report is available in PDF (5.8 MB) only. People using assistive technology may not be able to fully access information in this file. For additional assistance, please contact us.