News and Updates for Healthcare Professionals

Quality Payment Program Qualified Clinical Data Registry (QCDR) and Qualified Registry Self- Nomination for the 2017 Performance Period is Open

To become a Qualified Clinical Data Registry (QCDR) or Qualified Registry for the Merit-based Incentive Payment System (MIPS) under the Quality Payment Program, you must self-nominate. The self-nomination period for vendors who wish to participate as a QCDR or a Qualified Registry in MIPS for the 2017 performance period opened November 15, 2016 and will close on January 15, 2017 at 5:00 p.m. Eastern Time (ET).

The Centers for Medicare & Medicaid Services (CMS) provides detailed instructions regarding how to obtain a JIRA account, and how to complete and submit a Quality Payment Program Self-Nomination Form.

Requirements to Self-Nominate

  1. Participants: You must have at least 25 participants by January 1, 2017. These participants don’t need to be using the QCDR/Qualified Registry to report MIPS data to us, but they need to be submitting data to the QCDR/Qualified Registry for quality improvement.
  2. Attestation Statement: You must provide a statement during the data submission period verifying that all data and results submitted to CMS are accurate and complete.
  3. Data Submission: You must submit data via a CMS-specified secure method for data submission, such as a QRDA or XML file.
  4. Data Validation Report: You must provide information on your process for data validation for both individual MIPS eligible clinicians and groups by submitting a data validation plan. Results of the executed data validation plan must be provided by May 31 of the year following the performance period.


For additional assistance to help support you in the self-nomination process, please see the QCDR/ Qualified Registry fact sheets that are available under the Education and Tools tab of the Quality Payment Program website.

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Congress Passes 21st Century Cures Act, Bringing Forth New Era for Biomedical Innovation

WASHINGTON, DC — FasterCures, a center of the Milken Institute, commends the U.S. Senate on today’s strong, bipartisan support of the 21st Century Cures Act (H.R. 34), which passed the Senate on a 94-5 vote, matching the U.S. House of Representatives’ vote of 392-26 on Nov. 30. The bill will now be sent to the White House. In last Saturday’s weekly address, President Barack Obama said that he would sign the bill into law as soon as it reaches his desk, enacting $4.8 billion of new funding for the National Institutes of Health (NIH) and $500 million for the Food and Drug Administration (FDA), as well as a comprehensive suite of policy provisions that will strengthen the entire biomedical innovation system.

“This landmark legislation will accelerate cures for many life-threatening diseases and help advance precision medicine,” said Michael Milken, chairman of the Milken Institute. “It assures patient-focused drug development, adds rigor to clinical trials, expands compassionate use of new drugs by dying patients, speeds the review of vaccines, addresses antibiotic resistance, responds to the opioid crisis and strengthens the nation’s research infrastructure.”

FasterCures has been honored to work with leaders in Congress, NIH and FDA throughout the bill’s journey. This is the culmination of more than two years of hard work and dedication by the bill’s bipartisan congressional champions and their staffs. House Energy and Commerce Committee Chairman Fred Upton and Representative Diana DeGette, with Ranking Member Frank Pallone, reached out to stakeholders throughout the medical research system to gather up the best ideas and translate them into legislation. Senate Health, Education, Labor and Pensions Chairman Lamar Alexander and Ranking Member Patty Murray also championed the effort and moved a set of bipartisan bills through their committee.

As the bill moved toward votes on the floors of both chambers, strong commitment from Speaker Paul Ryan, Majority Leader Kevin McCarthy and Democratic Leader Nancy Pelosi, in partnership with their Senate colleagues, Majority Leader Mitch McConnell and Democratic Leader Harry Reid, resulted in the overwhelmingly bipartisan votes we’ve seen in the past few days. Improving the biomedical innovation system is truly something that all can agree on.

“The time for medical research progress is now. We are so pleased that Congress seized this opportunity and united around this strong legislation,” said Margaret Anderson, executive director of FasterCures. “This act will invest in and strengthen the federal research system, which will support the United States’ long-standing tradition of scientific progress and hopefully spur advances for the many patients who are desperately waiting for effective treatments and cures.”

The 21st Century Cures legislation addresses the entire biomedical innovation system, and would support many of the recommendations from FasterCures’ Rx for Innovation project. Here are just a few examples from this comprehensive legislation:

  • Enhances patient centricity in biomedical product development and regulatory approval.
  • Bans efforts to block data sharing between health information systems, and provides the Department of Health and Human Services the authority to levy civil penalties against offenders.
  • Reforms FDA hiring authorities to fill the agency’s vacancies by enabling it to compete more effectively with industry to hire and retain the best and brightest experts to review medical product applications.
  • Expands the translational work done by the NIH’s National Center for Advancing Translational Sciences.
  • Catalyzes innovation in clinical trials and regulatory approval, without diminishing FDA’s authority to determine what constitutes a safe and effective medical product.

The new funding for NIH will provide $1.5 billion for the Precision Medicine Initiative, $1.8 billion for the Beau Biden Cancer Moonshot and $1.5 billion for the Brain Research through Advancing Innovative Neurotechnologies® (BRAIN) Initiative. All of these initiatives have the potential to significantly advance our understanding of disease and identify opportunities for new therapies.

FasterCures looks forward to working with Congress, the Obama administration and the incoming Trump administration to help implement the 21st Century Cures Act, realizing its promise to support scientific breakthroughs, translate those discoveries into medical products and deliver those treatments and cures to the patients who need them. There are approximately 10,000 diseases and 500 treatments; even with today’s vote, we still have work to do.

Blog—AHRQ Views

AHRQ’s Role in Improving Care for Patients With Multiple Chronic Conditions

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AHRQ Funding Opportunity: Developing Measures of Shared Decision Making (R01)

A new funding opportunity announcement from AHRQ solicits applications for research projects to develop, test and evaluate measures of shared decision making for research conducted in clinical settings. Shared decision making is a collaborative process in which patients and members of their clinical team make health care decisions that are informed by scientific evidence as well as patients’ values and preferences. Each project is expected to produce valid and reliable measures of shared decision making, along with instructions for implementing the measures, as well as documentation on the development, testing and evaluation of the measures. Maximum costs for each project are $500,000 per year and $1.5 million for entire project periods up to three years.

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Final Recommendation Statement: Statin Use for the Primary Prevention of Cardiovascular Disease in Adults

The U.S. Preventive Services Task Force released today a final recommendation statement on statin use for the primary prevention of cardiovascular disease in adults. The Task Force found that statin use is beneficial for some people ages 40 to 75 years who are at increased risk for cardiovascular disease, but did not find enough evidence to recommend for or against statin use for people older than age 75 years.
The final recommendation statement can also be found in the November 13, 2016 online issue of JAMA.

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Wyden Releases Report on Dangers of Underfunding Opioid Abuse

Earlier this year, Congress passed the Comprehensive Addiction and Recovery Act of 2016(CARA), but did not authorize funds for the policies it created. Shortly after that, the White House requested $920 million that would expand access to treatment in states as part of a larger effort to combat the opioid epidemic – Congress has not acted on that request.

Since passing CARA, Congressional Democrats have expressed concern surrounding the lack of funding to the policies the bill authorized. Senate Democrats, including Sen. Wyden, expressed frustration when only $7 million was provided in the legislation after efforts to produce an amendment that would deliver offsets to cover the full funding request.

On October 12, 2016, Senator Ron Wyden released a report that outlines the consequences of underfunding treatment for opioid addiction. According to Senator Wyden, “Congress’ approach to funding opioid addiction treatment is nothing short of legislative malpractice. There is bipartisan agreement that the opioid epidemic has to be confronted now. Yet, with dozens of Americans dying from an opioid overdose every day, Congress is breaking its promise to families around the country by not providing every resource available. The time for a ‘down payment’ has long passed.”

In his press release announcing the report, Senator Wyden referred to a study published by the Journal of American Medicine that showed nearly eighty percent of Americans suffering from opioid addiction are unable to access the treatment they need, especially in rural areas across the country.

Senator Wyden, who represents constituents in Oregon, stated,

“Sadly, Oregonians are no strangers to the human toll of drug use and addiction devastating families and communities. I’m extremely disheartened that Congress has closed up shop yet again without acting on its core promise to provide essential funding for proven opioid addiction treatment and prevention efforts. Until states receive real investments in these programs, Congress has failed its job. Families in Oregon and across the country deserve far better.”

Sen. Wyden’s report addresses two key challenges: (1) the lack of available treatment facilities and services across the country, and (2) the barriers patients face when treatment facilities or services are actually available. Additionally, the report details case studies in five states struggling with high rates of opioid addiction, including Wyden’s home state of Oregon, California, Ohio, Pennsylvania, and New Hampshire.

The report notes that “states are doing all they can to fight the epidemic, but as it stands now they do not have the money to build that capacity.” It then issues a call to action for Congress – “It is time for Congress to act. Every day Congress does not do so, another 78 people die waiting for someone to answer their call for help.”

According to Senator Wyden, if the requested funding were provided, it would help states like Oregon battle the opioid epidemic, by allowing them to establish additional treatment centers, to provide life-saving anti-overdose medication, and to train medical personnel to increase the number of those being treated.

The report includes appendices, which provide for a detailed breakdown of how much each state would receive under President Obama’s $920 million proposal; a justification of how the $920 million will be used, including eligible activities; and a summary of a Centers for Disease Control and Prevention (CDC) report, “Increases in Drug and Opioid Overdose Deaths – United States, 2000-2014”. At the end of the report is a lengthy list of footnotes, which provide additional reading for interested parties.

Pushing for additional federal money to go towards combating the opioid epidemic has been a top issue for Democrats in political office. When Congress comes back to work, and a new president elected, it is more likely than not this issue will rear its head once again.

Quality Measures Endorsed for Various Areas of Care

The National Quality Forum (NQF) has endorsed measures in the areas of cancer, palliative and end-of-life care, perinatal and reproductive health, and person- and family-centered care.


NQF has endorsed 15 measures related to cancer care. The measures focus on breast cancer screening, appropriate treatment of breast, colon and prostate cancer, hematology, and febrile neutropenia. In all, 18 measures were evaluated against NQF’s endorsement criteria. Thirteen of these measures received endorsement status and two received inactive endorsement with reserve status. Three of the 18 reviewed measures were newly submitted measures and 15 were maintenance measures. For a complete list of measures, see the Cancer 2015-2017 project page.

Palliative and End-of-Life Care

NQF has endorsed 23 measures related to palliative and end-of-life care. The measures focus on physical, spiritual, religious, existential, ethical, and legal aspects of care, as well as care of the patient at the end of life. In all, 24 measures were evaluated against NQF’s endorsement criteria and 23 received endorsement status. Eight of the 24 reviewed measures were newly submitted measures and 16 were maintenance measures. For a complete list of measures, see the Palliative and End-of-Life Care 2015-2016 project page.

Perinatal and Reproductive Health

NQF has endorsed 18 measures related to perinatal and reproductive health. The measures focus on treatment processes and outcomes for contraception, reproductive health, pregnancy and related complications, childbirth, and neonatal health. In all, 24 measures were evaluated against NQF’s endorsement criteria and 18 received endorsement status. Nine were newly submitted measures and 15 were maintenance measures. For a complete list of measures, see the Perinatal and Reproductive Health 2015-2016 project page.

Person- and Family-Centered Care

NQF has endorsed 13 measures related to person- and family-centered care. The measures focus on quality of life, functional status, experience of care, shared decision making, symptom/symptom burden, and communication. Twelve of the 13 measures that were evaluated against NQF’s endorsement criteria were newly submitted measures and one was a maintenance measure. For a complete list of measures, see the Person and Family Centered Care 2015-2017 project page.

Any party may appeal a decision to endorse a measure reviewed in these projects by submitting an appeal no later than November 25 at 6:00pm ET.

Appeals may be submitted through the NQF measure database. For an appeal to be considered, the notification must include information clearly demonstrating that the appellant has interests directly and materially affected by the NQF-endorsed recommendations and that the NQF decision has had (or will have) an adverse effect on those interests. All appeals are published on the relevant project pages on NQF’s website.

The recently announced changes to NQF’s measure endorsement procedures for decisions and appeals do not affect these projects.

Questions? Please contact project teams at,,,

Long-term oxygen treatment does not benefit some COPD patients

Study addresses long-standing question for those with moderately low blood oxygen levels.
Newly published data from the Long-Term Oxygen Treatment Trial (LOTT) show that oxygen use is not beneficial for most people with chronic obstructive pulmonary disease (COPD) and moderately low levels of blood oxygen. It neither boosted their survival nor reduced hospital admissions for study participants. Previous research showed that long-term oxygen treatment improves survival in those with COPD and severely low levels of blood oxygen. However, a long-standing question remained whether a different group of COPD patients — those with moderately low levels of blood oxygen—also benefit. The study was funded by the National Heart, Lung, and Blood Institute (NHLBI) — a part of the National Institutes of Health—and the Centers for Medicare & Medicaid Services.

The study, the largest of its kind to evaluate the effectiveness of home oxygen in this group of patients, is published in the current online issue of the New England Journal of Medicine. The 738 patients enrolled in this study had COPD and moderately low levels of blood oxygen (in contrast to severely low blood oxygen levels) at rest or during exercise.

In the current study, patients with moderately low levels of blood oxygen are defined as those with a blood oxygen saturation (SpO2) between 89 and 93 percent at rest (moderate resting hypoxemia), or a SpO2 below 90 percent during the 6-minute walk test. Patients with severely low blood oxygen levels are defined as those with a SpO2 equal to or less than 88 percent at rest. This latter group was excluded from the LOTT study because prior studies showed that they benefit from long-term oxygen treatment. Blood oxygen saturation or SpO2 refers to the percentage of oxygen-saturated hemoglobin relative to total hemoglobin in the blood and is measured through a pulse oximeter. A pulse oximeter is a special probe that indirectly measures oxygen levels in the blood, often by attachment to the finger.

“These results provide insight into a long-standing question about oxygen use in patients with COPD and moderately low levels of blood oxygen. For the most part, this treatment did not improve or prolong life in study participants,” said James P. Kiley, Ph.D., director of NHLBI’s Division of Lung Diseases. “The findings also underscore the need for new treatments for COPD.”

Researchers say patients with any form of COPD should check with their doctors before making changes in their treatment plans. “We want to make it clear that LOTT was not designed to assess individual responses to oxygen treatment and that individual responses can vary. Each COPD patient should discuss their own personal situation with their healthcare provider,” said William C. Bailey, M.D., Professor Emeritus at the University of Alabama at Birmingham School of Medicine, and study Chair.

COPD, the third leading cause of death in the United States, is a progressive lung disease triggered primarily by cigarette smoking, although up to 20 percent of patients with COPD never smoked. Symptoms include shortness of breath, chronic coughing, and wheezing. The disease also causes low oxygen levels in the blood. About 15 million people have been diagnosed with COPD in the United States and another 10 million may be undiagnosed.

For decades, oxygen has been one of the main treatment tools for patients with COPD and low oxygen levels. It involves the use of metal tank cylinders containing oxygen or concentrators that extract oxygen from air; both systems deliver the gas through a nasal tube or mask.

The LOTT study is a randomized clinical trial to determine whether oxygen use could help COPD patients with moderately low levels of blood oxygen. The seven-year study, which included patients from 42 medical centers throughout the United States, began in 2009 and was completed in 2015.

In the study, half of the patients received long-term oxygen and the other half did not. The researchers found no significant differences between the two groups based on how long patients survived, and the amount of time leading to their first hospitalization. They also found no differences in other important benchmarks, such as the rates at which the patients were hospitalized or experienced worsening of COPD symptoms. Nor did researchers find statistically significant differences between the groups in quality of life, levels of depression or anxiety, lung function, or ability to walk for short periods.

Although no cure for COPD exists, there are a number of treatment options, including the use of bronchodilators and steroids, as well as pulmonary rehabilitation, surgery, and lung transplantation. Researchers worldwide are also studying new medications and exploring other approaches such as gene therapy. They continue to emphasize the importance of not smoking tobacco in preventing or slowing the progression of COPD.

About the National Heart, Lung, and Blood Institute (NHLBI): NHLBI, a part of the National Institutes of Health (NIH), plans, conducts, and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders. The Institute also administers national health education campaigns on women and heart disease, healthy weight for children, and other topics. NHLBI press releases and other materials are available online at

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit

Structure of primary cannabinoid receptor is revealed

Findings give insight into designing safe and effective cannabinoid medications.
New research is providing a more detailed view into the structure of the human cannabinoid (CB1) receptor. These findings provide key insights into how natural and synthetic cannabinoids including tetrahydrocannabinol (THC)—a primary chemical in marijuana—bind at the CB1 receptor to produce their effects. The research was funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.

There is considerable interest in the possible therapeutic uses of marijuana and its constituent cannabinoid compounds. Molecules that target CB1 receptors may have promise in treating a variety of conditions such as pain, inflammation, obesity, nerve cell diseases, and substance use disorders. However, some synthetic cannabinoids such as K2 or Spice can produce severe and even deadly reactions, whereas other cannabinoids produce less serious side effects.

“Cannabinoids can produce very different outcomes, depending on how they bind to the CB1 receptor,” said NIDA Director Nora D. Volkow, M.D. “Understanding how these chemicals bind to the CB1 receptor will help guide the design of new medications and provide insight into the therapeutic promise of the body’s cannabinoid system.”

Researchers used a specific chemical, AM6538, to inactivate and crystallize the CB1 receptor. They then computed the three-dimensional structure of the CB1-AM6538 complex through crystallography, which determines molecular shape by measuring the angles and intensities of x-rays that are bounced off a crystal structure. Based upon prior evidence showing how specific cannabinoids attach to different chemical configurations, researchers were able to predict how these cannabinoids would fit into the three-dimensional CB1 model. The model was also used to calculate how long each cannabinoid bound to the CB1 receptor, thereby providing clues into mechanisms whereby some chemicals produce longer-lasting effects.

“We found that the CB1 receptor consists of multiple sub-pockets and channels,” said Alexandros Makriyannis, Ph.D., director of the Center for Drug Discovery, Northeastern University in Boston, and a co-author on the paper. “This complex structure will allow chemists to design diverse compounds that specifically target portions of the receptor to produce desired effects.”

The paper by Hua, et al., can be found at

To learn more about NIH-supported research on marijuana and cannabinoids, go to:

This study was funded in part by NIDA under grants DA009158 and DA023142.

About the National Institute on Drug Abuse (NIDA): The National Institute on Drug Abuse (NIDA) is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug use and addiction. The Institute carries out a large variety of programs to inform policy, improve practice, and advance addiction science. Fact sheets on the health effects of drugs and information on NIDA research and other activities can be found at, which is now compatible with your smartphone, iPad or tablet. To order publications in English or Spanish, call NIDA’s DrugPubs research dissemination center at 1-877-NIDA-NIH or 240-6450228 (TDD) or email requests to NIDA’s media guide can be found at You can follow NIDA on Twitter and Facebook.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit

CMS BLOG: Medicare’s investment in primary care shows progress

By Dr. Patrick Conway, CMS Principal Deputy Administrator and Chief Medical Officer

Medicare’s investment in primary care shows progress

Today, the Centers for Medicare & Medicaid Services (CMS) announced the Comprehensive Primary Care (CPC) initiative’s second round of shared savings results, with nearly all practices (95 percent) meeting quality of care requirements and four out of seven regions sharing in savings with CMS. These results reflect the work of 481 practices that served over 376,000 Medicare beneficiaries and more than 2.7 million patients overall in 2015.

As the largest test of advanced primary care in U.S. history, CPC demonstrates the potential of primary care clinicians redesigning their practices to deliver better care to their patients, and provides clinicians support to innovate and deliver care in ways that better meet their patients’ needs and preferences.

During 2015, its second shared savings performance year, CPC generated a total of $57.7 million gross savings in Part A and Part B expenditures. These savings are essentially equivalent to the $58 million paid in care management fees to the practices. Four of the seven regions participating in CPC – the states of Arkansas, Colorado, and Oregon, and the Greater Tulsa region in Oklahoma – realized net savings (after accounting for the care management fees paid) and will share in those savings with CMS. Although three of the CPC regions had net losses, the savings generated in the other four regions covered those losses, such that care management fees across CPC were offset by reduced spending on Medicare Part A and Part B services. Further, more than half of participating CPC practices will receive a share of over $13 million in earned shared savings.

In addition to the gross Medicare savings, CPC practices showed positive quality, with lower than expected hospital admission and readmission rates, and favorable performance on patient experience measures. CPC practices’ performance on electronic Clinical Quality Measures (eCQMs) also exceeded national benchmarks, particularly on preventive health measures.

This is the first year CMS has included eCQM performance in Medicare shared savings determinations for CPC. eCQM reporting covering the entire practice population at the practice site level is critical to using health information technology as a tool to support care delivery transformation. eCQM data are recorded in the electronic health record in the routine course of clinical care, allowing practices to engage in real time quality improvement efforts that drive population health. As we move to a health care system that rewards value over volume, CPC practices are at the forefront of using eCQMs for quality improvement, measurement, and reporting.

Quality highlights from the 2015 shared savings performance year include:

  • 97 percent of CPC practices successfully reported 9 eCQMs. For ten out of the eleven eCQMs in the CPC measure set, the majority of CPC practices who reported surpassed the median national performance.
  • Nearly all (99 percent) practices reported higher levels of colorectal cancer screening and influenza immunization compared to national benchmarks. Additionally, 100 percent of practices who reported on screening for clinical depression surpassed national benchmarks.
  • Compared to 2014, most regions maintained or improved their scores on hospital readmissions and admissions for chronic obstructive pulmonary disorder and congestive heart failure.
  • Patients rated the care they receive from their CPC practitioners highly, particularly on how well practitioners supported them in taking care of their own health and the attention they paid to care from other providers.

The positive performance is a testament to the efforts CPC practices have made to provide truly “comprehensive primary care.”

CPC is a multi-payer partnership launched by the Center for Medicare and Medicaid Innovation (Innovation Center) in October 2012 to advance primary care by paying clinicians to deliver accessible, comprehensive, and coordinated care in seven regions across the country. CPC supports advanced primary care as the foundation of our health system. In addition to attending to patients’ acute, chronic, and preventive health care needs, primary care practices act as the quarterback of each patient’s health care team. CPC practices help patients navigate their care, communicate with specialists and hospitals, and ensure that patients with complex social and medical needs do not “fall through the cracks” of the health care system.

These results build on the first shared savings performance year in 2014. Gross savings nearly doubled from the first performance year to the second and practices in four regions were eligible to receive shared savings, compared to one region in 2014. Primary care transformation takes time, and it is especially encouraging that CPC practices maintained such positive quality of care results while also seeing gross Medicare savings in the 2015 performance year.

The experience in CPC has contributed to our continued efforts to support primary care going forward in the Innovation Center’s Comprehensive Primary Care Plus (CPC+), which will begin on January 1, 2017 and for which we recently announced the 14 selected regions and are currently reviewing practice applications. CMS anticipates that CPC+ could meet the criteria to qualify as an Advanced Alternative Payment Model (Advanced APM) under the recently finalized Quality Payment Program rule, which implements the Medicare Access and CHIP Reauthorization Act of 2015. A robust primary care system is essential to achieve better care, smarter spending, and healthier people. For this reason, CMS is committed to supporting primary care clinicians to deliver the best, most comprehensive primary care possible for their patients.

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HHS finalizes streamlined Medicare payment system that rewards clinicians for quality patient care

MACRA rule will accelerate health care system’s shift toward value

Today, the Department of Health & Human Services (HHS) finalized a landmark new payment system for Medicare clinicians that will continue the Administration’s progress in reforming how the health care system pays for care. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program, which replaces the flawed Sustainable Growth Rate (SGR), will equip clinicians with the tools and flexibility to provide high-quality, patient-centered care. With clinicians as partners, the Administration is building a system that delivers better care, one in which clinicians work together and have a full understanding of patients’ needs, Medicare pays for what works and spends taxpayer money more wisely, and patients are in the center of their care, resulting in a healthier country.

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CMS NEWS: MACRA Quality Payment Program Final Rule (CMS-5517-F)

HHS finalizes streamlined Medicare payment system that rewards clinicians for quality patient care MACRA rule will accelerate health care system’s shift toward value

Today, the Department of Health & Human Services (HHS) finalized a landmark new payment system for Medicare clinicians that will continue the Administration’s progress in reforming how the health care system pays for care. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program, which replaces the flawed Sustainable Growth Rate (SGR), will equip clinicians with the tools and flexibility to provide high-quality, patient-centered care. With clinicians as partners, the Administration is building a system that delivers better care, one in which clinicians work together and have a full understanding of patients’ needs, Medicare pays for what works and spends taxpayer money more wisely, and patients are in the center of their care, resulting in a healthier country.

“Today, we’re proud to put into action Congress’s bipartisan vision of a Medicare program that rewards clinicians for delivering quality care to their patients,” said HHS Secretary Sylvia M. Burwell. “Designed with input from thousands of clinicians and patients across the country, the new Quality Payment Program will strengthen our health care system for patients, clinicians and the American taxpayer.”

With the Affordable Care Act, America has made important strides in helping more Americans than ever afford quality health insurance and access patient-centered care. The Affordable Care Act created important tools to put individuals at the center of their own care and unlock access to health care data for patients and their clinicians. Today’s announcement builds on this progress and make our health care system work better for everyone. With MACRA, Congress gave HHS the tools to keep improving how we pay for care, so clinicians can focus on the quality of care they give, not the quantity of services they provide; and to keep improving the way care is delivered, by encouraging better coordination and prioritizing wellness and prevention.

“It’s time to modernize the Medicare physician payment system to be more streamlined and effective at supporting high-quality patient care. To be successful, we must put patients and clinicians at the center of the Quality Payment Program,” said Andy Slavitt, Acting Administrator of the Centers for Medicare & Medicaid Services (CMS). “A critical feature of the program will be implementing these changes at a pace and with options that clinicians choose. Today’s policies are designed to get all eligible clinicians to participate in the program, so they are set up for successful care delivery as the program matures.”

Today’s rule is informed by a months-long listening tour with nearly 100,000 attendees and nearly 4,000 public comments. A common theme in the input HHS received was the need for flexibility, simplicity, and support for small practices. And that’s what this final policy aims to provide. First, the new payment system creates two pathways. These paths let clinicians pick the right pace for them to participate in the transition from a fee-for-service health care system to one that uses alternative payment models that reward quality of care over quantity of services. Clinicians will choose between two options:

  • The first path gives clinicians the opportunity to be paid more for better care and investments that support patients. It reduces existing requirements, while still emphasizing and rewarding quality care. In the first year, it also provides a flexible performance period, so that those who are ready can dive in immediately, but those who need more time can prepare for participation later in the year.
  • The second path helps clinicians go further by participating in organizations that get paid primarily for keeping people healthy. For example, they could be part of an Accountable Care Organization where clinicians come together to coordinate high-quality care for the patients they serve. When they get better health results and reduce costs for the care of their patients, the clinicians receive a portion of the savings.

Evolving along with payment reform

CMS is building the Quality Payment Program to evolve along with the health care system. That’s why it facilitates participation in new payment models. The Affordable Care Act created the Center for Medicare and Medicaid Innovation (Innovation Center) to implement and scale the best ideas from the medical community to improve the quality of care for Medicare beneficiaries while lowering costs. Thanks to the Innovation Center’s work so far, Medicare has a plan for eligible beneficiaries to receive free diabetes prevention services, the quality of hip and knee replacements are being improved while lowering costs, and primary care clinicians are using flexibility to deliver the best outcomes with a payment system that rewards results. CMS intends to broaden opportunities for clinicians, including small practices and specialties, to participate in these kinds of initiatives. For example, a major opportunity being considered for 2018 will be the new Accountable Care Organization Track 1+ model that provides more flexibility for clinicians. CMS is also reviewing reopening some existing Advanced Alternative Payment Models for application to allow more clinicians to join these types of initiatives. In 2018, CMS expects about 25 percent of eligible clinicians will be a part of the second path of Advanced Alternative Payment Models.

Providing comprehensive support to clinicians

To further support small practices, MACRA provides $20 million each year for five years to train and educate Medicare clinicians in small practices of 15 clinicians or fewer and those working in underserved areas. Beginning December 2016, local, experienced organizations will offer free, on-the-ground, specialized help to small practices using this funding. In addition, Jean Moody-Williams, Registered Nurse and Deputy Director of the CMS Center for Clinical Standards and Quality (CCSQ), is leading an outreach effort to individual clinicians nationwide to help them prepare for the Quality Payment Program. In addition, CMS has launched a long-term initiative, led by Dr. Shantanu Agarwal, to improve the clinician experience with Medicare.

Today, we’re also launching a new Quality Payment Program website, which will explain the new program and help clinicians easily identify the measures most meaningful to their practice or specialty. There will also be a service center available by email and phone that will answer questions about the Quality Payment Program.

Continuing to listen

Today’s rule incorporates input received to date, but it is only the next step in an iterative process for implementing the new law. We are launching a new interactive website to help clinicians understand the program and successfully participate. We will continue to host listening and learning sessions throughout the country, and welcome additional feedback from patients, caregivers, clinicians, health care professionals, Congress and others on how to better achieve these goals. HHS looks forward to feedback on the final rule with comment period and will accept comments until 60 days after the final rule’s release date.

For more information about today’s rule, including a fact sheet, please visit:

Comments may be submitted electronically through our e-Regulation website at

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CMS News: CMS announces new initiative to increase clinician engagement

First step of the initiative is to reduce medical review for certain Advanced Alternative Payment Models.

Today, the Centers for Medicare & Medicaid Services (CMS) announced a new initiative to improve the clinician experience with the Medicare program. As we implement delivery system reforms from the Affordable Care Act and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), this new long-term effort aims to reshape the physician experience by reviewing regulations and policies to minimize administrative tasks and seek other input to improve clinician satisfaction. The initiative will be led by senior physicians within CMS who will report to the Office of the Administrator.

“Physicians and their care teams are the most vital resource a patient has. As we implement the Quality Payment Program under MACRA, we cannot do it without making a sustained, long-term commitment to take a holistic view on the demands on the physician and clinician workforce,” said Andy Slavitt, CMS Acting Administrator. “The new initiative will launch a nationwide effort to work with the clinician community to improve Medicare regulations, policies, and interaction points to address issues and to help get physicians back to the most important thing they do – taking care of patients.”

Acting Administrator Andy Slavitt is appointing Dr. Shantanu Agrawal to lead the development of this function and implementation, which will cover documentation requirements and existing physician interactions with CMS, among other aspects of provider experiences. To ensure CMS is hearing from physicians on the ground, each of the ten CMS regional offices will oversee local meetings to take input from physician practices within the next six months and regular meetings thereafter. These local meetings will result in a report with targeted recommendations to the CMS Administrator in 2017. Three of CMS’s regional Chief Medical Officers – Dr. Barbara Connors in Philadelphia, Dr. Ashby Wolfe in San Francisco, and Dr. Richard Wild in Atlanta – have agreed to serve as regional champions of this initiative.

“CMS is turning a new page in assessing not only how to reward for quality, but also to reduce administrative hurdles,” said Dr. Agrawal. “I look forward to hearing about what steps we can take to make the practice of medicine in Medicare more efficient and rewarding.”

Launch of First Initiative: Medical Review Reduction

The first action is the launch of an 18-month pilot program to reduce medical review for certain physicians while continuing to protect program integrity. Under the program, providers practicing within specified Advanced Alternative Payment Models (APMs) will be relieved of some scrutiny under certain medical review programs. Advanced APMs were identified as a potential opportunity for this pilot because participating clinicians share financial risk with the Medicare program. Two-sided risk models provide powerful motivation to deliver care in the most efficient manner possible, greatly reducing the risk of improper billing of services. After the results of the pilot are analyzed, CMS will consider expansion along various dimensions including additional Advanced APMs, specialties, and provider types.

“Like all successful changes, we will begin with the basic steps and build over time,” said Dr. Ashby Wolfe, Region IX Chief Medical Officer. “Most importantly, we are excited to build on the listening and engagement process we began this year by creating more opportunities for physicians to interact with CMS, especially through our regional offices.”

The dedicated team of clinicians participating in Medicare serve over 55 million of the country’s seniors and individuals with disabilities. Through this new initiative, CMS is focused on supporting and empowering those clinicians through a flexible, modern Medicare program informed by clinician expertise and experience.

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NIH funds additional medical centers to expand national precision medicine research program

NIH today announced awards to add four regional medical center groups to the national network of health care provider organizations that will implement the PMI Cohort Program.

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NIH task force formed to develop first nutrition strategic plan

Strategic plan will complement and enhance ongoing research efforts across NIH on diseases and conditions affected by nutrition.

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CMS NEWS: Medicare Advantage Value-Based Insurance Design Model

The Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation is announcing refinements to the design of the second year of the Medicare Advantage Value-Based Insurance Design (MA-VBID) model. The MA-VBID model is an opportunity for Medicare Advantage plans (MA plans), including Medicare Advantage plans offering Part D benefits (MA-PD plans), to offer clinically nuanced benefit packages aimed at improving quality of care while also reducing costs.

In the second year of the model, beginning January 1, 2018, CMS will: open the model test to new applicants; conduct the model test in three new states – Alabama, Michigan, and Texas; add rheumatoid arthritis and dementia to the clinical categories for which participants may offer benefits; make adjustments to existing clinical categories; and change the minimum enrollment size for some MA and MA-PD plan participants.

Value-Based Insurance Design (VBID) generally refers to health insurers’ efforts to structure enrollee cost sharing and other health plan design elements to encourage enrollees to use high-value clinical services – those that have the greatest potential to positively impact enrollee health. VBID approaches are increasingly used in the commercial market, and evidence suggests that the inclusion of clinically-nuanced VBID elements in health insurance benefit design may be an effective tool to improve the quality of care while reducing its cost for Medicare Advantage enrollees with chronic diseases. As part of the “better care, smarter spending, healthier people” approach to improving health care delivery, CMS will test VBID in Medicare Advantage and measure whether structuring patient cost sharing and other health plan design elements encourages enrollees to use health care services in a way that improved their health and reduces costs.

The MA-VBID model will begin January 1, 2017 and run for five years. CMS expects to release a Request for Applications for the second year of the model test in the fall of 2016, and will accept proposals from MA and MA-PD plans to offer VBID benefits in 2018.

In its first year, CMS will test the model in seven states: Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, and Tennessee. Beginning January 1, 2018, CMS will also test the model in Alabama, Michigan, and Texas. These states have been selected in order to be generally representative of the national Medicare Advantage market, including urban and rural areas, areas with both high and low average Medicare expenditures, areas with high and low prevalence of Low-Income Subsidies, and areas with varying levels of penetration of and competition within Medicare Advantage. Test states have also been selected based on the availability of appropriate paired comparison areas for the purposes of evaluation. Eligible MA plans in these states, upon CMS approval, may offer varied plan benefit designs for enrollees who fall into certain clinical categories identified and defined by CMS. Benefit design changes made through this model may reduce cost sharing and/or offer additional services to targeted enrollees; however, targeted enrollees can never receive fewer benefits or be charged higher cost sharing than other MA enrollees in their plan as a result of the model.


The existing Medicare Advantage “uniformity” requirement generally requires that an MA plan’s benefits and cost sharing be the same for all plan enrollees. Because of this, clinically-nuanced VBID approaches have generally not been incorporated into MA or MA-PD plans.

The model will test the hypothesis that giving MA plans flexibility to offer supplemental benefits or reduced cost sharing to targeted groups of enrollees with CMS-specified chronic conditions in order to encourage the use of services that are of highest value to them, will lead to higher-quality and more cost-efficient care. The increase in high-quality, cost-efficient care is expected to improve beneficiary health, reduce utilization of avoidable high-cost care, and reduce overall costs for plans, beneficiaries, and the Medicare program. The model is also intended to improve outcomes and reduce costs by encouraging targeted enrollees to obtain care from high-value providers and by providing new supplemental benefits specifically tailored to targeted enrollees’ clinical needs.

The MA-VBID model is authorized under Section 1115A of the Social Security Act (added by section 3021 of the Affordable Care Act) (42 U.S.C. § 1315a), which authorizes the Center for Medicare and Medicaid Innovation to test innovative health care payment and service delivery models that have the potential to reduce Medicare, Medicaid, and Children’s Health Insurance Program expenditures while preserving or enhancing the quality of beneficiaries’ care. CMS will test this model in the Medicare program through a limited waiver of the Medicare Advantage and Part D uniformity requirements.


The MA-VBID model supports improved health outcomes and health care cost savings or cost neutrality through the use of structured patient cost sharing and other health plan design elements that encourage enrollees to use high-value clinical services. The MA-VBID model will provide flexibility for MA and MA-PD plans accepted into the model to develop clinically-nuanced benefit designs for enrollee populations that fall within certain clinical categories.

The conditions are:

  • Diabetes
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Congestive Heart Failure (CHF)
  • Patient with Past Stroke
  • Hypertension
  • Coronary Artery Disease
  • Mood disorders
  • Rheumatoid Arthritis (starting in 2018)
  • Dementia (starting in 2018)

In addition to developing interventions targeted at all enrollees in one or more of the above categories, participating MA plans will have the flexibility to identify specific combinations of the listed chronic conditions for one or more “multiple co-morbidities” groups and establish tailored VBID interventions for each group. Participating MA plans are required to provide VBID benefits to all VBID-eligible enrollees in the selected group. Participating MA plans selecting the Mood Disorders group will also have additional flexibility to focus on specific conditions within that group.

For each of the selected enrollee groups, participating plans may select one or more plan design modifications from a menu of four general approaches. Within each approach, plans have flexibility on how (and to what extent) to implement that approach. Plans may vary their proposed interventions from one target population to another, and from one participating plan to another. CMS will also consider proposals for related variants of these interventions offered to targeted groups of enrollees, such as supplemental benefits conditional on participation in a disease management program.

The four approaches are:

1. Reduced Cost Sharing for High-Value Services

Plans can choose to reduce or eliminate cost sharing for items or services, including covered Part D drugs, that they have identified as high-value for a given target population. Participating plans have flexibility to choose which items or services are eligible for cost-sharing reductions; however, these services must be clearly identified and defined in advance, and cost-sharing reductions must be available to all enrollees within the target population.

Examples of interventions within this category include eliminating co-pays for eye exams for diabetics and eliminating co-pays for angiotensin converting enzyme inhibitors for enrollees who have previously experienced an acute myocardial infarction.

2. Reduced Cost Sharing for High-Value Providers

Plans can choose to reduce or eliminate cost sharing when providers that the plan has identified as high-value treat targeted enrollees. Plans may identify high-value providers based on their quality and not solely based on cost, across all Medicare provider types, including physicians/practices, hospitals, skilled-nursing facilities, home health agencies, ambulatory surgical centers, etc.

Examples of interventions within this category include reducing cost sharing for diabetics who see a physician who has historically achieved strong results in controlling patients’ HbA1c levels and eliminating cost sharing for heart disease patients who elect to receive non-emergency surgeries at high-performing cardiac centers.

3. Reduced Cost Sharing for Enrollees Participating in Disease Management or Related Programs

Participating plans can reduce cost sharing for an item or service, including covered Part D drugs, for enrollees who choose to participate in a plan-sponsored disease management or similar program. This could include an enhanced disease management program, offered by the plan as a supplemental benefit, or it could refer to specific activities that are offered or recommended as part of a plan’s basic care coordination activities. Plans using this approach can condition enrollee eligibility for cost-sharing reductions on meeting certain participation milestones. For instance, a plan may require that enrollees meet with a case manager at regular intervals in order to qualify. However, plans cannot make cost-sharing reductions conditional on achieving any specific clinical goals (e.g., a plan cannot condition cost-sharing reductions on enrollees achieving certain thresholds in HbA1c levels or body-mass index).

Examples of interventions within this category include elimination of primary care co-pays for diabetes patients who meet regularly with a case manager and reduction of drug co-pays for patients with heart disease who regularly monitor and report their blood pressure.

4. Coverage of Additional Supplemental Benefits

Under this approach, participating plans can make coverage for specific supplemental benefits available only to targeted populations. Such benefits may include any service currently permitted under existing Medicare Advantage rules for supplemental benefits.

Examples of interventions within this category include physician consultations via real-time interactive audio and video technologies for diabetics, or supplemental tobacco cessation assistance for enrollees with COPD.

Eligible Applicants and Application Process for 2018

The MA-VBID model test is open to all qualifying MA and MA-PD plans in the test states that submit acceptable programmatic proposals to CMS. Only certain MA and MA-PD plan types are eligible and certain restrictions apply to multi-state plans.

CMS will generally restrict the model test to plans with a minimum enrollment in the test states of 2,000 enrollees. However, beginning in 2018, a MA organization participating in the model test with at least one plan with enrollment over 2,000 enrollees may have additional Plan Benefit Packages (PBPs) participate with a minimum enrollee requirement of 500 enrollees; an additional plan benefit package using this lower enrollment requirement may be from that MA organization or other organizations with the same parent organization. CMS may also grant an exception upon request.

Additionally, plans must meet minimum quality thresholds, including: being rated by CMS at three stars or higher, not consistently low-performing, not an outlier in the CMS past performance analysis, not under sanction, and able to pass a program integrity screening.

The plan must have been offered in at least three annual coordinated election (open enrollment) periods prior to the open enrollment period for the year for which the plan is applying to participate. There is no cap on the total number of participating plans.

CMS will accept applications for the second year of the MA-VBID model via a Request for Applications (RFA), to be released shortly. Once released, application materials will be available at:

More information

More information about the MA-VBID model test can be found in the model’s announcements and other documents, available at The announcement includes instructions for providing CMS with feedback on this model test’s design.

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Government as a Platform for Progress: HHS’s Open Government Plan

By: Mary K. Wakefield, Ph.D., RN, HHS Acting Deputy Secretary

One of the first actions President Obama took after taking office was to direct federal agencies to find new ways to increase transparency, collaboration and public engagement. Since then, one of our top priorities at HHS has been to make our Department more open and accountable to the people we serve.

With the publication of our fourth HHS Open Government Plan, we’re building on our past performance in making government more transparent to the public and engaging in new ways of collaborating and partnering with our stakeholders.

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Targeting cardiovascular disease risk factors may be important across a lifetime

NIH-funded study suggests efforts to prevent risk factors should extend to those older than 65.

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CMS Blog: The Medicare Current Beneficiary Survey: Celebrating Our 25th Anniversary and a Bright Future Ahead

By Niall Brennan, Chief Data Officer, CMS

This year marks the 25th anniversary and the one millionth beneficiary interview for the Medicare Current Beneficiary Survey (MCBS), a survey that the Centers for Medicare & Medicaid Services (CMS) first fielded in 1991. This in-person survey of 15,000 Medicare beneficiaries collects valuable information about aspects of the Medicare program that cannot be analyzed based on CMS administrative data alone. In particular, the MCBS gathers information on self-reported health status, satisfaction with care, and functional limitations. The MCBS also collects information on beneficiaries that is key to understanding patient-centered care. Beneficiary’s out-of-pocket spending and source of payment for medical services received outside the Medicare program provides a window into the “invisible” and missed costs of health care. One unique aspect of the MCBS is that it includes beneficiaries who reside in institutional settings, such as a nursing home, as well as those in the community.

The MCBS is used across CMS to provide important insights that support internal program analyses. For example, over the past several years, the MCBS has become a key resource for evaluating the impact of CMS Innovation Center demonstration models as well as for approving Medicare Advantage and Prescription Drug Plan benefits.

The MCBS also serves as the foundation for thousands of health policy analyses across a diverse external user community. To date, we know of more than 1,000 peer-reviewed papers based on MCBS data in leading publications such as the New England Journal of Medicine, the Journal of the American Medical Association, Journal of Health Economics, and the Journal of the American Geriatrics Society.

Today, I want to acknowledge a number of important efforts CMS has undertaken to ensure the MCBS remains a valuable resource for the agency and external stakeholders. We have made the data more accessible, releasing the first ever MCBS public use file in May of this year. While MCBS data files have always been available for a relatively nominal fee, we heard that this fee was a barrier to entry for certain users such as students. We believe that increased access through this freely available public resource will expand the MCBS user community, and thus help cement its importance as a critical tool in the evaluation of systemic changes in the US health care delivery system.

We are also implementing changes to the MCBS questionnaire and survey design. Revising and improving the survey questions is underway. We have added new relevant content including an updated dental utilization module, a module on care coordination, and new questions on food security. Enhancing the sampling methodology to include newly enrolled beneficiaries in the first year of their Medicare enrollment, conducting an oversample of Hispanic beneficiaries, and, beginning in 2017, conducting an oversample of low-income beneficiaries increase our ability to conduct disparities research and improve our survey estimates.

We are also committed to a more rapid data release schedule, with improved user documentation and file structure. The 2015 MCBS files will be the first to have many of the improvements discussed above. We anticipate releasing the 2015 data file in the 2nd quarter of 2017, more than one year earlier than the previous file release schedule. The release of the 2015 data will also include improved chart books to accompany data releases and more intuitive naming conventions and file layouts with modern file formats for SAS, Stata, and R use. However, to accommodate these long overdue innovations, we had to make the difficult decision not to release 2014 data files.

As we celebrate our 25th anniversary of the MCBS, we are renewing our commitment to providing the most useful and relevant information about the Medicare program and, more importantly, the health and satisfaction of its beneficiaries.

We hope that you’ll visit us on our MCBS webpage at where you can also subscribe for important updates and announcements.

New National Quality Strategy Priorities in Action

Two new Priorities in Action are featured on the National Quality Strategy’s (NQS) Web site. The Priorities in Action series features some of our Nation’s most promising and transformative quality improvement programs, and describes their alignment to the Strategy’s six priorities.

  • Researchers at Indiana University designed the Geriatric Resources for Assessment and Care of Elders (GRACE) Team model as a solution to the health and health care challenges faced by low-income seniors with multiple chronic conditions. Their efforts promote effective communication and care coordination, one of the NQS six priorities, through the NQS levers of Innovation and Diffusion and Learning & Technical Assistance.
  • Better Health Partnership addresses the prevalence of heart disease in Ohio by developing and partnering with programs across the State that align with core principles of ongoing national health care delivery system reform efforts. The Partnership’s efforts promote the prevention and treatment of the leading causes of morbidity and mortality, one of the six NQS priorities, through the NQS levers of Public Reporting and Innovation & Diffusion.

If your program aligns with the priorities, email with details.

Making Progress on Combating Antibiotic Resistance

By: Sylvia Mathews Burwell, HHS Secretary
This week, Secretary Burwell is traveling to New York City to address the United Nations General Assembly at a High-Level Meeting focused on antibiotic resistance. It’s a chance to share the progress we’ve made in combatting resistance, the direction we’re headed, and how important global cooperation is to global health – all points that the Secretary highlights in her blog post below.

– Kevin Griffis, Assistant Secretary for Public Affairs


Most of modern medicine is possible because antibiotics gave us the power to fight common infections. Unfortunately, we’ve seen this tool’s power gradually diminish over time. Every year, at least 2 million people become infected with antibiotic-resistant bacteria, and 23,000 die as a result.

To find a solution to this public health challenge, President Obama tasked HHS to work with our federal partners on a comprehensive, five-year National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB).

To put this plan into action, the CARB Task Force, which includes the Departments of Defense and Agriculture, has been working to implement the National Action Plan for over a year now. So I wanted to take this opportunity to share some of our progress.

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AHRQ Data Identify States That Rank Highest in Health Care Quality

Maine, Massachusetts, Wisconsin, New Hampshire and Minnesota were the nation’s top-performing states for health care quality, according to AHRQ’s updated State Snapshots. The snapshots are an interactive online resource that provides state-level data showing how all 50 states and the District of Columbia performed on more than 250 measures related to health care quality and access. Drawn from AHRQ’s 2015 National Healthcare Quality and Disparities Report, the State Snapshots show how each state fared according to National Quality Strategy priorities, prevalence of diseases and conditions, health status of priority populations, insurance status, access to care, type of care and setting of care. While the 2015 report shows progress nationwide in access and care affordability, the State Snapshots reveal substantial variations across states and sizable disparities related to race, ethnicity, income and other factors. Learn more about AHRQ’s State Snapshots, which offer easy-to-read charts on the strengths, weaknesses and opportunities for improvement in each state.


AHRQ’s Unique Role in Developing Surveys to Measure Patients’ Experience With Their Health Care.

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New analysis shows consumers will still have affordable health coverage options next year

An estimated 73 percent of consumers could still purchase a plan for less than $75 per month, even if all final rates were to increase by double digits

Since the Affordable Care Act became law, health care prices have risen at the lowest rate in 50 years, and premiums for the 150 million Americans with employer-sponsored insurance have grown at some of the slowest rates on record. Today, a new HHS analysis finds that consumers would continue to have affordable coverage options, even if all Marketplace final health insurance premium rates were to increase by double digits next year. In a hypothetical scenario where all rates increase by 25 percent, the vast majority of consumers (73%) would be able to purchase coverage for less than $75 per month, according to today’s report. All Marketplace premiums will be finalized and public in October.

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NIH review finds nondrug approaches effective for treatment of common pain conditions

U.S. study reviews trial results on complementary health approaches for pain relief; aims to assist with pain management.

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Medicaid expansion lowers Marketplace premiums by 7 percent

New analysis finds Medicaid expansion brings down Marketplace rates – another benefit on top of gains for low-income individuals and state economies

Today, the U.S. Department of Health and Human Services released a report showing that expanding Medicaid lowers Marketplace premiums by about 7 percent in those states.

“Today’s report identifies yet another group that would gain if all states chose to expand Medicaid: Marketplace consumers, who would see lower premiums,” said Secretary Sylvia M. Burwell. “These gains are on top of the direct benefits of expansion for millions of Americans who would gain coverage and on top of the economic benefits for states. The Administration remains committed to working with all states to expand coverage and improve the health and financial wellbeing of their citizens.”

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Physicians and health care providers continue to improve quality of care, lower costs

Affordable Care Act Accountable Care Organization initiatives put patients at the center of their care while generating more than $1.29 billion in total Medicare savings since 2012

The Centers for Medicare & Medicaid Services (CMS) today announced the 2015 performance year results for the Medicare Shared Savings Program and the Pioneer Accountable Care Organization Model that show physicians, hospitals, and health care providers participating in Accountable Care Organizations continue to make significant improvements in the quality of care for Medicare beneficiaries, while achieving cost savings. Collectively, Medicare Accountable Care Organizations have generated more than $1.29 billion in total Medicare savings since 2012.

“The coordinated, physician-led care provided by Accountable Care Organizations resulted in better care for over 7.7 million Medicare beneficiaries while also reducing costs,” said CMS Acting Administrator Andy Slavitt. “I congratulate these leaders and look forward to significant growth in the program in the coming year.”

In 2015, Medicare Accountable Care Organizations had combined total program savings of $466 million, which includes all Accountable Care Organizations’ experiences, for 392 Medicare Shared Savings Program participants and 12 Pioneer Accountable Care Organization Model participants. The results show that more Accountable Care Organizations shared savings in 2015 compared to 2014 and those with more experience tend to perform better over time.

Today’s results from the Medicare Shared Savings Program and the Pioneer Accountable Care Organization Model show significant improvements in the quality of care providers are offering to an increasing number of Medicare beneficiaries. Accountable Care Organizations are judged on their performance, as well as their improvement, on an array of meaningful metrics that assess the care they deliver. Those metrics include how highly patients rated their doctor, how well clinicians communicated, whether patients are screened for high blood pressure, and their use of Electronic Health Records.

All 12 participants in the Pioneer Accountable Care Organization Model improved their quality scores from 2012 to 2015 by more than 21 percentage points. Overall quality scores for nine out of 12 Pioneer participants were more than 90 percent in 2015.

Accountable Care Organizations in the Medicare Shared Savings Program also continued to show improvement, with Accountable Care Organizations that reported in both 2014 and 2015 improving on 84 percent of the quality measures that were reported in both years. Additionally, comparing 2014 and 2015 results, average quality performance improved by more than 15 percent on key preventive care measures including screening for risk of future falls, depression screening and follow-up, blood pressure screening and follow-up, and providing pneumonia vaccinations.

By meeting quality performance standards and their savings threshold, 125 Accountable Care Organizations qualified for shared savings payments. Since the passage of the Affordable Care Act, more than 470 Medicare Accountable Care Organizations – serving nearly 8.9 million Medicare beneficiaries – have been established through the Medicare Shared Savings Program, the Pioneer Accountable Care Organization Model, the Next Generation Accountable Care Organization Model, and the Comprehensive End-Stage Renal Disease Care Model.

“Accountable Care Organization initiatives in Medicare continue to grow and achieve positive results in providing better care and health outcomes while spending taxpayer dollars more wisely,” said Dr. Patrick Conway, CMS Principal Deputy Administrator and Chief Medical Officer. “CMS continues to work and partner with providers across the country to improve the way health care is delivered in the United States.”

Accountable Care Organizations were created to change the incentives for how medical care is delivered and paid for in the United States, moving away from a system that rewards the quantity of services to one that rewards the quality of health outcomes. They are groups of doctors, hospitals, and other health care providers who voluntarily come together to develop and execute a plan for a patient’s care and share information, putting the patient at the center of the health care delivery system. In addition, under the proposed Quality Payment Program, health care providers that sufficiently participate in advanced tracks of Medicare Accountable Care Organizations may qualify for exemption from payment adjustments under the Merit-based Incentive Payment System, as well as the additional incentive payments available beginning in 2019 for participation in Advanced Alternative Payment Models.

The Affordable Care Act provides tools, such as Medicare Accountable Care Organizations, to move our health care system toward one that provides patients with high-quality, cost-effective care. Today’s announcement is part of the Administration’s broader strategy to improve the health care system by paying providers for what works, unlocking health care data, and finding new ways to coordinate and integrate care to improve quality. These efforts support the Administration’s goal to have 50 percent of traditional Medicare payments flowing through alternative payment models by 2018 (already, 30 percent of Medicare payments go through alternative models).

For more detailed information on the quality and financial results, please visit:

For additional information on the Medicare Shared Savings Program, please visit:

For additional information on the Pioneer Accountable Care Organization Model, please visit:

NIH establishes new research program to address health disparities of chronic diseases

Two centers will focus on development of community-based interventions to combat chronic diseases.

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New Care Coordination Survey from AHRQ

AHRQ has developed and pilot tested a new care coordination survey that is designed for use in research and evaluation in primary care settings. The Care Coordination Quality Measure for Primary Care (CCQM-PC) is a reliable and valid survey that builds on AHRQ’s previous work to define care coordination (Care Coordination Measures Atlas) and on new research. It addresses key care coordination activities, such as information sharing and creating and using care plans, from the patient perspective. The survey fills a critical measurement gap.

The CCQM-PC is intended for use in health services research and primary care improvement activities. It is not a CAHPS™ survey and is not designed to be used for reporting or accountability purposes.

The CCQM-PC is in the public domain. The full survey and guidance for its use in research are available here. AHRQ strongly encourages primary care researchers to use the CCQM-PC in studies of primary care transformation and would welcome additional research to further refine the survey for use in primary care quality improvement activities.

For more about AHRQ’s funding commitment to primary care research and to improving the patient care experience, including research on care coordination, see our Special Emphasis Notices on Innovative Research in Primary Care and Optimizing Care for People Living with Chronic Conditions.

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