News and Updates for Healthcare Professionals

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...

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.

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.

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.

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.

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 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)

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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December 16, 2015

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

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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 Cure — discusses 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