News and Updates for Healthcare Professionals

AHRQ’s Primary Care Practice Facilitation Curriculum: An Expanded Resource for Workforce Development

The AHRQ Primary Care Practice Facilitation (PCPF) Curriculum is a new resource designed to help train practice facilitators, also called practice coaches, quality improvement coaches, or practice enhancement assistants on how to take an evidence-based approach to quality improvement in primary care practices. This is the latest addition to the portfolio of AHRQ products that support the growth of practice facilitation. The PCPF Curriculum is organized into five parts:

  • Use of Adult Education Methods in Teaching PCPF Core Competencies
  • Introduction to Practice Facilitation
  • Competencies for Practice Facilitators
  • In the Practice
  • Implementing the Care Model and Patient-Centered Medical Home

“AHRQ created this resource to support development of the workforce needed to provide quality improvement assistance to primary care practices,” said David Meyers, M.D., Chief Medical Officer, AHRQ. “There are a growing number of state and national quality improvement initiatives focusing on primary care, which will increase the demand for trained practice facilitators. A great example of the timeliness of this curriculum is its use by some of the grantees in EvidenceNOW – an AHRQ initiative working with over 1500 primary care practices to advance heart health.”

The PCPF curriculum supports the education and training of practice facilitators, and can be used by organizations that want to build a practice facilitation capacity, including payers, independent practice associations, accountable care organizations, and advocacy groups. Designed to be used as a resource when preparing new and experienced facilitators to work with primary care practices, the curriculum can also provide an introduction to principles and techniques of clinical quality improvement that can be used to educate other health care professionals.

Learn more about how to improve primary care by visiting AHRQ’s National Center for Excellence in Primary Care at: http://www.ahrq.gov/professionals/systems/primary-care/index.html.

Learn More about Clinical Decision Support Interventions

Clinical Decision Support (CDS) is a key functionality of health IT that contributes to improved quality of care and enhanced outcomes by avoiding errors and adverse events, improving efficiencies, reducing costs, and enhancing provider and patient satisfaction.

For the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs in 2016, eligible professionals and eligible hospitals must meet the CDS objective by:

  1. Implementing five CDS rules related to four or more clinical quality measures (CQMs) or related to a high-priority health condition for the EP, eligible hospital, or CAH's scope of practice or patient population.
  2. Enabling and implementing functionality for drug-drug and drug-allergy interaction checks.

CMS Guidance for CDS Interventions

The CDS objective gives providers flexibility in the types of CDS interventions they employ, as well as the timing of the CDS.

Providers can customize the implementation of the CDS to their own needs for their clinical practice and patient population. The CDS should be implemented at a “relevant point in patient care,” which refers to a relevant point in clinical workflows when the intervention can influence clinical decision-making before diagnostic or treatment action is taken in response to the intervention.

Additionally, providers are not limited to just “pop-up” alert CDS interventions. They can meet the objective by using other methods of CDS, including, but not limited to:

  • Computerized alerts and reminders for providers and patients
  • Information displays or links
  • Clinical guidelines
  • Condition-specific order sets
  • Focused patient data reports and summaries
  • Documentation templates
  • Diagnostic support
  • Contextually relevant reference information

Note: These functionalities may be deployed on a variety of platforms (e.g., mobile, cloud-based, installed).

To Learn More

For more information on CDS, review the specification sheets for eligible professionals and eligible hospitals.

Caregiver tip to keep people with Alzheimer’s active

People with Alzheimer’s disease need to stay active and do things they enjoy, but may have trouble deciding what to do each day. Try creating a schedule so the person does the same activities at a similar time each day and match the activities with their abilities. Doing physical activity like walking together can help both the person and the caregiver to manage stress and stay healthy.

Get more tips on how to plan activities for a person with Alzheimer’s.

Learn how to help a person with Alzheimer’s get exercise and stay physically active.

Putting Engaged and Empowered Individuals at the Center of our Health Care System

At HHS, we are working toward transforming our health care system into one that puts individuals at the center. By making prices and quality information more accessible, providing the right tools to help people navigate the system, and listening to patients, we can help engage and empower people to take control of their health, something that’s good for them and good for our communities. Personally, I have seen first-hand what a difference the right information at the right time can make to someone facing a health care decision, which is why I signed on to help expand this work at HHS.

Earlier this month, Secretary Burwell hosted leaders who represent consumers, providers, health insurers, technology companies, and other industry perspectives to share their experiences with putting individuals at the center of the health care system and to help HHS leaders recognize ways we can walk the same path. Read more...

Final Recommendation Statement: Screening for Depression in Adults

The U.S. Preventive Services Task Force released today a final recommendation statement on Screening for Depression in Adults. The Task Force recommends that clinicians screen all adults for depression. The Task Force found evidence that screening in the primary care setting is beneficial. To view the recommendation and the evidence on which it is based, please go to Final Recommendation Statement: Depression in Adults: Screening. A fact sheet that explains the final recommendation in plain language is also available. The final recommendation statement can also be found in the January 26, 2016 online issue of the Journal of the American Medical Association.

MACRA Physician Focused Payment Model Technical Advisory Committee Announcement

The U.S. Department of Health and Human Services announces the first meeting of the new Physician-Focused Payment Model Technical Advisory Committee on February 1, 2016. The Committee is required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), and its members were appointed by the Comptroller General. On January 5, 2016, Secretary Burwell signed the Charter of the Committee. The Committee will review proposals for physician-focused payment models submitted by stakeholders based on criteria that the law requires the Secretary to establish through notice and comment rulemaking by November 1, 2016.

The Committee includes 11 members who are nationally recognized for their expertise in physician-focused payment models and related delivery of care. With authority delegated by the Secretary, the Assistant Secretary for Planning and Evaluation, Richard G. Frank, PhD has appointed Jeffrey Bailet, MD, as the Chairperson of the Committee and Elizabeth Mitchell as the Vice Chairperson of the Committee.

Dr. Bailet is an otolaryngologist and President of Aurora Health Care Medical Group in Wisconsin. Ms. Mitchell is President and Chief Executive Officer of the Network for Regional Healthcare Improvement in Maine.

Meeting information can be found by visiting the Federal Register Notice of Public Meeting.

More information on the Committee can be found at https://aspe.hhs.gov/medicare-access-and-chip-reauthorization-act-2015

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

Finalization of the Affordable Care Act Federal Upper Limit

This notification is to update states and stakeholders on the finalization of the Affordable Care Act Federal upper limits (FUL) for multiple source drugs. The Centers for Medicare & Medicaid Services (CMS) plans to publish draft Affordable Care Act FULs calculated in accordance with the Medicaid Covered Outpatient Drug final rule with comment (CMS-2345-FC) for two months beginning in January 2016 before finalizing the FULs. The final Affordable Care Act FULs will be published in late March 2016 and will be effective on April 1, 2016 to coincide with the effective date of the final rule with comment. States will have up to 30 days from the April 1, 2016 effective date to implement the FULs. Thereafter, the FULs will be updated monthly on the Medicaid.gov website, and will be effective on the first date of the month following the publication of the update. States will, likewise, have up to 30 days after the effective date to implement the FULs. CMS also plans to publish an updated Methodology and Data Elements Guide used to calculate these draft FULs.

CMS will issue a monthly Listserv notification when the updated draft FULs are available on the Medicaid.gov website, and when the FULs are finalized. Further, CMS will continue to issue these monthly Listserv notifications to stakeholders when the updated monthly FULs are available on the Medicaid.gov website for the first six months after the finalization of the FULs.

Although CMS will no longer be publishing the draft Affordable Care Act FULs based on the methodology proposed in the Notice of Proposed Rulemaking (CMS-2345-P) (77 FR 5345) published in February 2012, those draft files and the draft Methodology and Data Elements Guides used to calculate those FULs will be available on the Medicaid.gov website at the address provided below.

Once we publish the final Affordable Care Act FULs, the prior FULs calculated using the methodology at 42 CFR 447.332 (FUL Changes Made To Transmittal No.37 and Transmittal No.37 – FUL November 20, 2001), as in effect on December 31, 2006, under the authority of the Medicare Improvements for Patients and Providers Act of 2008 will no longer be in effect.

We look forward to continuing to work with you as you apply the provisions of the Affordable Care Act.

For more information on the Affordable Care Act FULs, please visit http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Prescription-Drugs/Federal-Upper-Limits.html.

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.