The U.S. Senate unanimously passed bipartisan legislation introduced by Senator Mark R. Warner (D-VA), a member of the Senate Finance Committee, to improve health outcomes for Medicare beneficiaries living with chronic conditions. [ FULL ARTICLE ]
In The News
Warner’s CHRONIC Care Act Unanimously Passes Senate
Federal agencies partner for military and veteran pain management research
Joint HHS-DoD-VA initiative will award multiple grants totaling $81 million. [ FULL ARTICLE ]
Managing hypertension in diabetes: a position statement from the ADA
The American Diabetes Association (ADA) has released a position statement to update the assessment and treatment of hypertension among patients with diabetes.
The position statement, published in Diabetes Care, includes advances in care since the ADA last published a statement on this topic in 2003. The ADA notes that antihypertensive therapy is shown to reduce atherosclerotic cardiovascular disease (ASCVD) events, heart failure, and microvascular complications in patients with diabetes. There have also been reductions in ASCVD morbidity and mortality in patients with diabetes since 1990, which are likely due to improvements in blood pressure control.
“Treatment should be individualized to the specific patient based on their comorbidities; their anticipated benefit for reduction in ASCVD, heart failure, progressive diabetic kidney disease, and retinopathy events; and their risk of adverse events,” according to the ADA. “This conversation should be part of a shared decision-making process between the clinician and the individual patient.”
The ADA has made the following recommendations:
Screening and diagnosis
- Clinicians should measure blood pressure at every routine clinical care visit. Patients with elevated blood pressure ?140/90 mmHg should have blood pressure confirmed with multiple readings to diagnose hypertension (Grade B recommendation).
- Hypertensive patients with diabetes should have home blood pressure monitoring to identify white-coat hypertension (Grade B recommendation).
- Orthostatic measurement of blood pressure should be performed during initial evaluation of hypertension and periodically at follow-up, or when symptoms of orthostatic hypotension are present, and regularly if orthostatic hypotension has been diagnosed (Grade E recommendation).
Blood pressure targets
- The systolic blood pressure goal should be <140 mmHg, and the diastolic blood pressure goal should be <90 mmHg for most individuals with diabetes and hypertension (Grade A recommendation).
- Lower systolic and diastolic blood pressure targets may be appropriate for those with high risk of cardiovascular disease if they can be achieved without excessive treatment burden (Grade B recommendation).
- Lifestyle intervention for those with systolic blood pressure >120 mmHg or diastolic blood pressure >80 mmHg consists of weight loss if overweight or obese; a Dietary Approaches to Stop Hypertension (DASH)-style dietary pattern; increased fruit and vegetable consumption; moderation of alcohol intake; and increased physical activity (Grade B recommendation).
Pharmacologic antihypertensive treatment
- Patients with confirmed blood pressure ?140/90 mmHg should have timely titration of pharmacologic therapy to achieve blood pressure goals, in addition to lifestyle therapy (Grade A recommendation).
- Patients with confirmed blood pressure ?160/100 mmHg should have prompt initiation and timely titration of 2 drugs or a single-pill combination of drugs demonstrated to reduce cardiovascular events in patients with diabetes, in addition to lifestyle therapy (Grade A recommendation).
- Treatment should include drug classes demonstrated to reduce cardiovascular events in patients with diabetes. These include ACE inhibitors, angiotensin receptor blockers (ARBs), thiazide-like diuretics, or dihydropyridine calcium channel blockers. Multiple-drug therapy is generally required to achieve blood pressure targets (Grade A recommendation).
- An ACE inhibitor or ARB is the recommended first-line treatment for hypertension in patients with diabetes and urine albumin-to creatinine ratio ? 300 mg/g creatinine (Grade A recommendation) or 30–299 mg/g creatinine (Grade B recommendation). If one class is not tolerated, the other should be substituted. (Grade B recommendation).
- Serum creatinine/estimated glomerular filtration rate and serum potassium levels should be monitored in patients treated with an ACE inhibitor, ARB, or diuretic (Grade B recommendation).
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What's New at AHRQ
The following new item has been posted:
- AHRQ Views—Blog Post: Providing a State-by-State Picture of the Nation's Opioids Crisis
What's New at AHRQ
The following new item has been posted:
Cognitive Impairment Detection and Earlier Diagnosis
CMS Releases Hospice Compare Website to Improve Consumer Experiences, Empower Patients
Today, as part of our continuing commitment to greater data transparency, Centers for Medicare & Medicaid Services (CMS) unveiled the Hospice Compare website. The site displays information in a ready-to-use format and provides a snapshot of the quality of care each hospice facility offers to its patients. CMS is working diligently to make healthcare quality information more transparent and understandable for consumers to empower them to take ownership of their health. By ensuring patients have the information they need to understand their options, CMS is helping individuals make informed healthcare decisions for themselves and their families based on objective measures of quality.
“The Hospice Compare website is an important tool for the American people and will help empower them in a time of vulnerability as they look for information necessary to make important decisions about hospice care for loved ones,” said CMS Administrator Seema Verma. “The CMS Hospice Compare website is a reliable resource for family members and care givers who are looking for facilities that will provide quality care.”
Hospice facilities offer specialized care and support to individuals with a terminal illness and a prognosis of six months or less if the illness runs its normal course. Once a patient elects hospice care, the focus shifts from curative treatment to palliative care for relief of pain and symptom management, and care is generally provided where the patient lives. Additionally, caregivers can get support through the hospice benefit, such as grief and loss counseling. Hospice Compare helps patients and caregivers find hospice providers in their area and compare them on quality of care metrics.
Section 1814(i)(5) of the Social Security Act authorizes a quality reporting program for hospices. The Act requires hospice providers to report data to CMS on a number of quality measures selected through notice and comment rulemaking. The Hospice Quality Reporting Program (HQRP) includes both quality data from the Hospice Item Set (HIS) and Hospice Consumer Assessment of Healthcare Providers and Systems (Hospice CAHPS®).
The Hospice Compare site allows patients, family members, caregivers, and healthcare providers to compare hospice providers based on important quality metrics, such as the percentage of patients that were screened for pain or difficult or uncomfortable breathing, or whether patients’ preferences are being met. Currently, the data on Hospice Compare is based on information submitted by approximately 3,876 hospices.
The Hospice Compare website will reflect current industry best practices for consumer-facing websites and will be optimized for mobile use. For more information, please visit https://www.medicare.gov/hospicecompare/ to view the new Compare site.
For more information, visit the Hospice Quality Public Reporting webpage.
Effective Health Care Program - Helping You Make Better Treatment Choices
The Effective Health Care Program is pleased to announce the launch of its newly redesigned Web site today, Friday, August 11, 2017. The Web site's address remains the same: https://effectivehealthcare.ahrq.gov. All of your bookmarks will continue to work.
The new design offers streamlined menus, clear navigation, improved search capabilities, and a responsive layout that works on all your devices.
The Web site offers these new navigation features –
- “Health Topics” – organizes EHC Program products by categories such as demographic groups and condition.
- “Consumers” – lists all of the consumer summaries and patient decision aids on one page.
- “Products & Tools” – offers quick access to EHC Program reports, shared decisionmaking tools, and professional education resources.
- “Research Methods” – provides guidance, methods, and tools to support systematic reviews as well as research using registries.
- “Get Involved” – presents ways to participate in EHC Program research by suggesting topics, commenting on research in development, and submitting scientific data.
- "Product Search" – helps to more easily find reports using faceted searching.
We hope you enjoy the new Web site! For any questions, suggestions, feedback, or comments, please email us.
Effective Health Care Program
Accredited Online Course Available; Correction: Explanation of Special Status; Attend CMS Office Hours; Reminder: Hardship Exception Application Now Open
Now Available: Accredited Online Course – Quality Payment Program 2017 Merit-based Incentive Payment System: Quality Performance Category
A new, online and self-paced overview course on the Quality Payment Program is now available through the MLN Learning Management System. Participants will receive information on:
- The Quality Performance Category requirements, and how this category fits into the larger Quality Payment Program
- The data submission methods for the Quality Performance Category
- The scoring and benchmark methodology for the Quality Performance Category
This course is the fourth course in an evolving curriculum on the Quality Payment Program, where participants will gain knowledge and insight on the program all while earning valuable continuing education credit. Keep checking back with us for updates on new courses. First time participants will need to register for the MLN Learning Management System. Once registered, you will be able to access additional courses without having to register. For information on how to login or find training, please visit our MLN Learning Management System FAQ sheet.
The Centers for Medicare & Medicaid Services designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Credit for this course expires August 1, 2020. AMA PRA Category 1 Credit™ is a trademark of the American Medical Association.
Explanation of Special Status Calculation – Correction
On July 24, the Centers for Medicare & Medicaid Services (CMS) distributed an email update with an explanation for its special status calculation for the Quality Payment Program. The message incorrectly stated that clinicians considered to have “special status” would be exempt from the Quality Payment Program.
Special status affects the number of total measures, activities, or entire categories that an individual clinician or group must report. Individual clinicians or groups with special status are not exempt from the Quality Payment Program because of their special status determination.
To determine if a clinician’s participation should be considered special status under the Quality Payment Program, CMS retrieves and analyzes Medicare Part B claims data. Calculations are run to indicate a circumstance of the clinician's practice forwhich special rules would apply. These circumstances are applicable for clinicians in: Health Professional Shortage Area (HPSA), rural, non-patient facing, hospital-based, and small practices.
For more information, please visit the Quality Payment Program website.
Attend CMS Office Hours to Ask Questions about the Quality Payment Program NPRM
Join CMS for an office hours session on Wednesday, August 16 on the draft provisions included in the Quality Payment Program Year 2 Notice of Proposed Rulemaking (NPRM). CMS will provide a brief overview of the Quality Payment Program and address questions from attendees on the Year 2 NPRM.
Title: Quality Payment Program Year 2 NPRM Office Hours Session
Date: August 16
Time: 12 - 1 pm ET
Registration Link: https://engage.vevent.com/rt/cms/index.jsp?seid=845
Space for this webinar is limited. Register now to secure your spot. After you register, you will receive a follow-up e-mail with step-by-step instructions about how to log-in to the webinar.
For More Information
Reminder: Quality Payment Program Hardship Exception Application for the 2017 Transition Year Is Now Open
Clinicians Can Now Submit Quality Payment Program Hardship Exception Applications
The Quality Payment Program Hardship Exception Application for the 2017 transition year is now available on the Quality Payment Program website.
MIPS eligible clinicians and groups may qualify for a reweighting of their Advancing Care Information performance category score to 0% of the final score, and can submit a hardship exception application, for one of the following specified reasons:
- Insufficient internet connectivity
- Extreme and uncontrollable circumstances
- Lack of control over the availability of Certified EHR Technology (CEHRT)
There are some MIPS eligible clinicians who are considered Special Status, who will be automatically reweighted (or, exempted in the case of MIPS eligible clinicians participating in a MIPS APM) and do not need to submit a Quality Payment Program Hardship Exception Application.
About the Hardship Exception Application Process
In addition to submitting an application via the Quality Payment Program website, clinicians may also contact the Quality Payment Program Service Center and work with a representative to verbally submit an application.
To submit an application, you’ll need:
- Your Taxpayer Identification Number (TIN) for group applications or National Provider Identifier (NPI) for individual applications;
- Contact information for the person working on behalf of the individual clinician or group, including first and last name, e-mail address, and telephone number; and
- Selection of hardship exception category (listed above) and supplemental information.
If you’re applying for a hardship exception based on the Extreme and Uncontrollable Circumstance category, you must select one of the following and provide a start and end date of when the circumstance occurred:
- Disaster (e.g., a natural disaster in which the CEHRT was damaged or destroyed)
- Practice or hospital closure
- Severe financial distress (bankruptcy or debt restructuring)
- EHR certification/vendor issues (CEHRT issues)
Please note: Once an application is submitted, you will receive a confirmation email that your application was submitted and is pending, approved, or dismissed. Applications will be processed on a rolling basis.