News and Updates for Healthcare Professionals

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

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 https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/index.html where you can also subscribe for important updates and announcements.

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 NQStrategy@ahrq.hhs.gov with details.

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.

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.

An estimated 73 percent of HealthCare.gov 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 HealthCare.gov 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.

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

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.”

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: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-08-25.html

For additional information on the Medicare Shared Savings Program, please visit: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/index.html

For additional information on the Pioneer Accountable Care Organization Model, please visit: https://innovation.cms.gov/initiatives/Pioneer-ACO-Model/

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

The following new items were posted on August 22, 2016:

Impact Case Studies:

• AHRQ Health Literacy Toolkit Supports Better Health Communication in Tasmania.
• Kimbrough Ambulatory Care Center Uses TeamSTEPPS® to Boost Patient Safety.
• Carilion Clinic Uses TeamSTEPPS® to Train Emergency Department Nurses in Virginia.
• Denver Hospital Uses AHRQ’s TeamSTEPPS® Training to Enhance Teamwork.

Blog—AHRQ Views:

• Create Positive Change—Lead From the Middle (Reposted).

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.

The Independence at Home Demonstration continues to provide high quality primary care services for chronically ill Medicare beneficiaries in the home setting while saving the Medicare program money, according to a new analysis released today by the Centers for Medicare & Medicaid Services (CMS).

“The Independence at Home Demonstration is a patient-centered model that supports providers in caring for chronically ill patients in their own homes,” said Dr. Patrick Conway, CMS acting deputy administrator and chief medical officer. “These results continue to support what most patients already want – the ability to have high quality care in the home setting”.

The CMS analysis found that, for the second performance year, Independence at Home participants saved Medicare more than $10 million – an average of $1,010 per beneficiary – while delivering higher quality patient care in the home. CMS will award incentive payments of $5.7 million to seven participating practices that succeeded in reducing spending while improving quality.

In the second performance year, 15 practices served more than 10,000 Medicare beneficiaries. According to the CMS analysis, all 15 practices improved quality from the first performance year in at least two of the six quality measures for the Demonstration. Four practices met the performance measures for all six quality measures.

These quality results mean improved care for Medicare beneficiaries who are participating in Independence at Home practices. On average, beneficiaries:

• Have follow-up contact from their provider within 48 hours of a hospital admission, hospital discharge, or emergency room visit;
• Have fewer hospital readmissions within 30 days;
• Have their medication identified by their provider within 48 hours of discharge from the hospital;
• Have their preferences documented by their provider;
• Use inpatient hospital and emergency room services less for conditions such as diabetes, high blood pressure, asthma, pneumonia, or urinary tract infection.

The Independence at Home Demonstration is part of the Administration’s broader strategy to improve the health care system by paying practitioners for what works, unlocking health care data, and finding new ways to coordinate and integrate care to improve quality. In March 2016, the Administration announced it reached its goal, nearly one year ahead of schedule, of tying 30 percent of Medicare payments to alternative payment models that reward the quality of care over the quantity of services provided to beneficiaries.

For more information on the Independence at Home Demonstration performance year two results, including individual practice results, please visit:https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-08-09.html.

The cost of health care became more affordable from 2011 to the first half of 2015 as fewer people overall reported having trouble paying their medical bills, according to AHRQ’s newly released Chartbook on Care Affordability.

The percentage of people who reported trouble paying their medical bills decreased from 21 percent to 17 percent. This applied to people under age 65 of all income levels and race/ethnicity. However, blacks and Hispanics were more likely to have problems paying medical bills in all years as compared with whites. Find more chartbook details here.

Access the National Quality Strategy “Priorities In Focus” brief that outlines current payment and delivery system reforms to make care more affordable.

Today, the Centers for Medicare & Medicaid Services (CMS) announced the participants in the Frontier Community Health Integration Project (FCHIP) Demonstration, an effort to increase access to care for Medicare beneficiaries in areas of the country where access to health services can be limited because of distance from providers. Ten critical access hospitals (CAHs) in Montana, Nevada, and North Dakota will participate in the Demonstration, which begins this August. The FCHIP Demonstration is another example of how the Administration is working to ensure that Americans receive better care, we spend our health care dollars more wisely, and we have healthier people.

The FCHIP Demonstration, a statutory mandate launched by the CMS Innovation Center in collaboration with the Federal Office of Rural Health Policy, located in the Health Resources and Services Administration, will test new models of integrated, coordinated health care in the most sparsely populated rural counties in the nation over three years. This demonstration program will encourage the ten CAHs to provide essential services that are often not financially viable in rural communities with the goals of improving quality of care, increasing patient satisfaction in rural communities, and spending health care dollars more wisely. The demonstration will provide financial incentives for care coordination activities for local CAHs to reduce unnecessary admissions and readmissions across their networks of care.

“Medicare beneficiaries who live in frontier areas of the country sometimes travel hundreds of miles to see a doctor. This increases the cost of care and can discourage beneficiaries from seeking treatment,” said Patrick Conway, M.D., principal deputy administrator and chief medical officer at CMS. “The effort that is beginning today will look at ways to shrink the distance between the Medicare beneficiary and the care they need.”

Applications were received from CAHs in Montana, Nevada, and North Dakota (although eligible, CAHs in Alaska or Wyoming did not apply).

Specifically, the demonstration aims to:

• support the CAH and local delivery system in keeping patients within the community who might otherwise be transferred to distant providers;
• test whether payments for certain services will enhance access to care for patients, increase the integration and coordination of care among providers, and reduce avoidable hospitalizations, admissions, and transfers; and
• test new CAH activities in three service categories: skilled nursing care, telehealth, and ambulance services.

HRSA’s Federal Office of Rural Health Policy will monitor the work of the technical assistance provider, Montana Health and Research Education Foundation, and collect information on key policy challenges facing frontier providers, while CMS will test alternative payment and administrative strategies.

Today, the Centers for Medicare & Medicaid Services (CMS) opened the application period for practices to participate in the new nation-wide primary care model, Comprehensive Primary Care Plus (CPC+). CPC+ is a five-year primary care medical home model beginning January 2017 that will enable primary care practices to care for their patients the way they think will deliver the best outcomes and to pay them for achieving results and improving care. CPC+ is an opportunity for practices of diverse sizes, structures, and ownership who are interested in qualifying for the incentive payment for Advanced Alternative Payment Models through the proposed Quality Payment Program. CMS estimates that up to 5,000 primary care practices serving an estimated 3.5 million beneficiaries could participate in the model.

CPC+ is a public-private partnership in 14 regions across the nation. CPC+ is a multi-payer model – Medicare, state Medicaid agencies, and private insurance companies partner together to support primary care practices – so CMS selected the regions based on payer interest and coverage. By aligning Medicare, Medicaid, and private insurance, CPC+ moves the health care system away from one-size-fits-all, fee-for-service to a model that supports clinicians delivering the care that best meets the needs of their patients and improves health outcomes.

The following regions were selected for CPC+. Eligible practices in these 14 regions may apply between August 1 and September 15, 2016 to participate in CPC+:

1. Arkansas: Statewide
2. Colorado: Statewide
3. Hawaii: Statewide
4. Kansas and Missouri: Greater Kansas City Region
5. Michigan: Statewide
6. Montana: Statewide
7. New Jersey: Statewide
8. New York: North Hudson-Capital Region
9. Ohio: Statewide and Northern Kentucky Region
10. Oklahoma: Statewide
11. Oregon: Statewide
12. Pennsylvania: Greater Philadelphia Region
13. Rhode Island: Statewide
14. Tennessee: Statewide

As a key part of CPC+, CMS and partner payers are committed to supporting primary care practices of all sizes, including small, independent, and rural practices, said Dr. Patrick Conway, CMS deputy administrator and chief medical officer. We see CPC+ as the future of primary care in the U.S. and are pleased to partner with payers across the country that are aligned in this mission to transform our health care system. This model allows primary care practices to focus on what they care about most – serving their patients’ needs when and how they choose.

Building on the Comprehensive Primary Care initiative that launched in late 2012, CPC+ will benefit patients by helping primary care practices:

• Support patients with serious or chronic diseases achieve their health goals
• Give patients 24-hour access to care and health information
• Deliver preventive care
• Engage patients and their families in their own care
• Work together with hospitals and other clinicians, including specialists, to provide better-coordinated care

Practices may participate in one of two CPC+ tracks. In Track 1, CMS will pay practices a monthly fee in addition to regular Medicare fee-for-service payments. In Track 2, practices will receive the monthly fee, as well as a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments to allow greater flexibility in how practices deliver care. Practices in Track 2 will provide more comprehensive services for patients with complex medical and behavioral health needs, including, as appropriate, a systematic assessment of their psychosocial needs and an inventory of resources and supports to meet those needs. To promote high quality and high value care, practices in both tracks will also receive prospective performance-based incentive payments that they will either keep or have to pay back to CMS based on their performance on quality and utilization metrics. In addition, practices that participate in CPC+ may qualify for the additional incentive payments available for the Advanced Alternative Payment Models in the proposed Quality Payment Program beginning 2019.

The Affordable Care Act, through the creation of the Center for Medicare and Medicaid Innovation, allows for the testing of innovative payment and service delivery models, such as the CPC+ model, to move our health care system toward one that rewards clinicians based on the quality, not quantity of care they provide patients. 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. This new model supports 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).

On July 29, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final rule outlining fiscal year (FY) 2017 Medicare payment policies and rates for the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) and the IRF Quality Reporting Program (IRF QRP). The FY 2017 final policies are summarized below.

Updates to IRF payment rates

Updates to the payment rates under the IRF PPS. CMS is updating the IRF PPS payments for FY 2017 to reflect an estimated 1.65 percent increase factor (reflecting an IRF-specific market basket estimate of 2.7 percent, reduced by a 0.3 percentage point multi-factor productivity adjustment and a 0.75 percentage point reduction required by law). An additional approximate 0.3 percent increase to aggregate payments due to updating the outlier threshold results in an overall estimated update of approximately 1.9 percent (or $145 million), relative to payments in FY 2016.

No changes to the facility-level adjustments. For FY 2017, CMS will continue to maintain the facility-level adjustment factors at current levels as we continue to monitor the most current IRF claims data available to assess the effects of the FY 2014 changes.

Rural Adjustment Transition. Continue year two of the phase-out of the 14.9 percent rural adjustment for IRF providers in areas that were designated as rural and changed to urban under the new Office of Management and Budget (OMB) delineations. In accordance with the policy finalized in the FY 2016 IRF PPS final rule, these IRFs will receive one-third of the rural adjustment for FY 2017, and no rural adjustment for FY 2018 and subsequent years.

Changes to the IRF Quality Reporting Program (QRP)

The Improving Medicare Post-Acute Care Transformation Act of 2014 (the IMPACT Act) added Section 1899B to the Social Security Act (the Act) to require that IRFs report data on measures that satisfy measure domains specified in the Act. Section 1899B also requires that these measures be aligned with measures implemented for Long-Term Care Hospitals (LTCHs), IRFs, Skilled Nursing Facilities (SNFs), and Home Health Agencies (HHAs). This final rule adopts three measures to meet the resource use and other measure domains and one measure to satisfy the domain of medication reconciliation. IRFs that fail to submit the required quality data to CMS will be subject to a 2 percentage point reduction to their applicable FY annual increase factor.

Finalized Changes:
The quality measures finalized for the FY 2018 payment determination and subsequent years to meet the resource use and other measure domains are as follows:

• Medicare Spending Per Beneficiary – Post-Acute Care (PAC) IRF QRP
• Discharge to Community – PAC IRF QRP
• Potentially Preventable 30-Day Post-Discharge Readmission – IRF QRP.

The quality measure finalized for the FY 2020 payment determination and subsequent years to meet the medication reconciliation domain is:

• Drug Regimen Review Conducted with Follow-Up for Identified Issues.

In addition to the measures listed above, we are adopting an additional measure “Potentially Preventable within Stay Readmission for IRFs” for FY 2018 payment determination and subsequent years.

Further, we will begin publically reporting IRF quality data in fall 2016. We finalized four measures for public display for calendar year 2017, pending final data analysis, and adopted procedures associated with public reporting, including the review and correction of data and provider confidential feedback reports.

Finally, we have adopted an extension of the time frame for submission of exception and extension requests for extraordinary circumstances from 30 days to 90 days from the date of the qualifying event.

For More Information

The final rule will be displayed on July 29, 2016, at the Federal Register’s Public Inspection Desk and will be available under “Special Filings,” at http://www.federalregister.gov/public-inspection.

It will publish in the August 5, 2016 Federal Register.

For further information, please see:

• IRF PPS: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/InpatientRehabFacPPS/index.html
• IRF QRP: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/IRF-Quality-Reporting/index.html

On July 29, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final rule outlining fiscal year (FY) 2017 Medicare payment rates and wage index and the Hospice Quality Reporting Program (QRP) for hospices serving Medicare beneficiaries.

This final rule updates the hospice wage index, payment rates, and cap amount for FY 2017. In addition, this rule finalizes changes to the hospice quality reporting program, including the addition of two new quality measures. The final rule also describes a potential future enhanced data collection instrument, as well as plans to publicly display quality measures and other hospice data beginning in calendar year (CY) 2017.

Updates to Hospice Payment Rates

As finalized, hospices would see a 2.1 percent ($350 million) increase in their payments for FY 2017 (reflecting an estimated 2.7 percent inpatient hospital market basket update, reduced by a 0.3 percentage point productivity adjustment and a 0.3 percentage point adjustment required by law).

As discussed in the FY 2016 Hospice Wage Index and Payment Rate Update final rule (80 FR 47183), CMS implemented changes required by the Improving Medicare Post-Acute Care Transformation Act of 2014 (Pub. L. 113-185) (IMPACT Act). Specifically, for accounting years that end after September 30, 2016 and before October 1, 2025, the hospice cap is updated by the hospice payment update percentage rather than using the consumer price index for urban consumers (CPI–U). As required by section 1814(i)(2)(B)(ii) of the Act, the hospice cap amount for the 2017 cap year will be $28,404.99, which is equal to the 2016 cap amount ($27,820.75) updated by the FY 2017 hospice payment update percentage of 2.1 percent.

As a reminder, in the FY 2016 Hospice Wage Index and Payment Rate Update final rule (80 FR 47142), CMS finalized the alignment of the cap accounting year with the federal fiscal year beginning in 2017. Therefore, the 2017 cap year will start on October 1, 2016 and end on September 30, 2017. Table 26 in the FY 2016 Hospice Wage Index and Payment Rate Update final rule (80 FR 47185) outlines the timeframes for counting beneficiaries and payments during the 2017 transition year.

Changes to the Hospice Quality Reporting Program (QRP)

Hospice CAHPS® Experience of Care Survey

The Hospice CAHPS® Survey is a component of the Hospice QRP. This final rule provides a description of the Hospice CAHPS® Survey, including the model of survey implementation, the survey respondents, eligibility criteria for the sample, and the languages in which the survey is offered, among other details. The final rule also outlines participation requirements for the FY 2019 and FY 2020 annual payment updates (APU). For the FY 2019 APU, hospices must collect survey data on an ongoing basis from January through December of CY 2017. For the FY 2020 APU, hospices must collect survey data on an ongoing basis from January through December of CY 2018. The final rule also includes survey data submission deadlines for the FY 2018, FY 2019, and FY 2020 APU periods. Public display of the survey results will not occur until CMS has collected at least four quarters of data. CMS anticipates that public display of the data will occur during CY 2017.

New Hospice Quality Measures

This rule also finalizes new quality measures and provides an update on the Hospice QRP. In accordance with section 1814(i)(5)(A) of the Act, starting in FY 2014, hospices that fail to meet quality reporting requirements receive a 2.0 percentage point reduction to their payments. The Hospice QRP is finalizing two new quality measures for FY 2017. The first, Hospice Visits When Death is Imminent, is a measure that will assess hospice staff visits to patients and caregivers in the last three and seven days of life. The second, Hospice and Palliative Care Composite Process Measure, will assess the percentage of hospice patients who received care processes consistent with guidelines. This measure will be based on the seven that are currently being submitted under the Hospice QRP (Pain Screening, Pain Assessment, Dyspnea Screening, Dyspnea Treatment, Patients Treated with an Opioid who are given a Bowel Regimen, Treatment Preferences, and Beliefs/Values Addressed (if desired by patient).

Public Reporting

CMS expects to begin public reporting hospice quality measures via a Compare site in CY 2017. CMS began posting hospice demographic data on a public use file at https://data.medicare.gov on June 14, 2016.

Enhanced Data Collection

CMS is considering enhancing the current Hospice Item Set (HIS) data collection instrument to be more in line with other post-acute care settings. This revised data collection instrument would be a comprehensive patient assessment instrument, rather than the current chart abstraction tool. By integrating a core standard data set into a comprehensive assessment system, hospices can use such a data set as the foundation for valid and reliable information for patient assessment, care planning, and service delivery. This will enable greater accuracy in quality reporting; decrease provider burden; help surveyors ensure hospices are meeting Conditions of Participation (CoP) and providing high quality patient care; and, in the future, enable payment determinations.

For More Information

For more information, see http://www.cms.gov/Center/Provider-Type/Hospice-Center.html.

The final rule will publish in the Federal Register on August 5, 2016, and the rule becomes effective on October 1, 2016.

On July 29, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final rule outlining fiscal year (FY) 2017 Medicare payment policies and rates for the Skilled Nursing Facility Prospective Payment System (SNF PPS), the SNF Quality Reporting Program (SNF QRP), and the SNF Value-Based Purchasing (SNF VBP) Program. The FY 2017 final policies are summarized below.

The policies in the final rule continue to shift Medicare payments from volume to value. The Administration has set measurable goals and a timeline to move the Medicare program, and the health care system at large, toward paying providers based on the quality, rather than the quantity of care they provide to their patients. This final rule includes policies that advance that vision and support building a health care system that delivers better care, spends health care dollars more wisely, and results in healthier people.

Updates to Payment Rates under the SNF Prospective Payment System (PPS)

CMS projects that aggregate payments to SNFs will increase in FY 2017 by $920 million, or 2.4 percent, from payments in FY 2016. This estimated increase is attributable to a 2.7 percent market basket increase reduced by 0.3 percentage points, in accordance with the multifactor productivity adjustment required by law.

Changes to the SNF Quality Reporting Program (QRP)

The Improving Medicare Post-Acute Care Transformation Act of 2014 (the IMPACT Act) added Section 1899B to the Social Security Act that requires SNFs to report data on measures that satisfy measure domains specified in the Act. Section 1899B also requires that these measures be aligned with measures implemented for Long-Term Care Hospitals (LTCHs), Inpatient Rehabilitation Facilities, SNFs, and Home Health Agencies (HHAs). This final rule adopts three measures to meet the resource use and other measure domains and one measure to satisfy the domain of medication reconciliation. SNFs that fail to submit the required quality data to CMS will be subject to a 2 percentage point reduction to the annual market basket percentage update factor for fiscal years beginning with FY 2018.

Finalized Changes:

The quality measures finalized for the FY 2018 payment determination and subsequent years to meet the resource use and other measure domain are as follows:

• Medicare Spending Per Beneficiary – Post-Acute Care (PAC) SNF QRP
• Discharge to Community – PAC SNF QRP
• Potentially Preventable 30-Day Post-Discharge Readmission – SNF QRP.

The quality measure finalized for the FY 2020 payment determination and subsequent years to meet the medication reconciliation domain is:

• Drug Regimen Review Conducted with Follow-Up for Identified Issues.Policies and procedures associated with public reporting are also being finalized, including the reporting timelines, preview period, review and correction of assessment-based and claims-based quality measure data, and the provision of confidential feedback reports to SNFs. SNF Value-Based Purchasing (VBP) Program Section 215 of the Protecting Access to Medicare Act of 2014 (PAMA) authorizes the establishment of a SNF VBP Program beginning with FY 2019 under which value-based incentive payments are made to SNFs based on performance. Measures: In this final rule, CMS has also finalized additional policies related to the SNF VBP Program including:
• Other Policies
• This final rule specifies the SNF 30-Day Potentially Preventable Readmission Measure, (SNFPPR), as the all-cause, all-condition risk-adjusted potentially preventable hospital readmission measure as required by law. The SNFPPR assesses the facility-level risk-standardized rate of unplanned, potentially preventable hospital readmissions for SNF patients within 30 days of discharge from a prior admission to a hospital paid under the Inpatient Prospective Payment System, a critical access hospital, or a psychiatric hospital.
• Establishing performance standards;
• Establishing baseline and performance periods;
• Adopting a performance scoring methodology; and
• Providing confidential feedback reports to SNFs.

For More Information

The final rule displayed on July 29, 2016, at the Federal Register’s Public Inspection Desk and will be available under “Special Filings,” at http://www.federalregister.gov/inspection.aspx.

It will publish in the August 5, 2016 Federal Register and become effective on October 1, 2016.

For further information, please see:

• SNF PPS: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/index.html
• SNF QRP: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Post-Acute-Care-Quality-Initiatives/IMPACT-Act-of-2014/IMPACT-Act-Downloads-and-Videos.html

The National Institute on Minority Health and Health Disparities (NIMHD), part of the National Institutes of Health, has committed approximately $31 million over five years, pending available funding, to launch a new program for Transdisciplinary Collaborative Centers (TCCs) for health disparities research exploring the potential for precision medicine to promote health equity and advance the science of minority health and health disparities.

MediCaring Communities: How to Get What We Want and Need in Frail Old Age at an Affordable Cost, recently released by the Center for Elder Care and Advanced Illness, is a blueprint for serious eldercare reform. The book is available on Amazon, and is currently #28 on the best-seller list for Public Affairs & Administration!

The MediCaring Communities model relies upon six interlocking elements:

1. Recognize the frail phase of life
2. Develop comprehensive care plans that reflect elder and family priorities
3. Make medical care responsive to the medical needs of elders
4. Enhance the supportive services in the community
5. Monitor the community needs and implement high-priority improvements
6. Use savings from more appropriate medical care to meet those community needs

The book describes several potential paths to realizing the promise of community-based reforms: through an expansion of the Program of All-Inclusive Care for the Elderly (PACE), or an adapted Accountable Care Organization or managed care organization.

After reading the book, there are additional steps you can take to get America moving in the right direction—you can urge your Congressional representatives to take a look at how MediCaring Communities can be set up in their states and districts, and encourage local organizations to get involved in pushing a community coalition effort forward. Please spread the word about MediCaring Communities—once you read it, take a couple of minutes to type in a review on Amazon! We also welcome your thoughts and feedback. Write us at info@MediCaring.org with suggestions for improvement.

To get details about how MediCaring Communities can be implemented, read our blog: http://medicaring.org/2016/07/26/implementation

To send along interest, ideas, organizational commitments, email us at info@MediCaring.org.

Let’s build the future together!

CMS will be releasing two reports in early fall that will require Enterprise Identity Management (EIDM) accounts to access. The reports scheduled for release are:

• PQRS feedback reports depicting your program year 2015 PQRS reporting results, including payment adjustment assessment for 2017.
• 2015 Annual Quality and Resource Use Reports (QRURs) that will show how groups and solo practitioners performed in 2015 on the quality and cost measures used to calculate the 2017 Value Modifier.

Prepare now by either signing up for an Enterprise Identity Management (EIDM) account or ensuring that your existing account is active. EIDM accounts are required for participants to obtain 2015 PQRS feedback reports and 2015 Annual QRURs. The same EIDM account can be used to access both reports. To register for an EIDM account, visit the CMS Enterprise Portal and click “New User Registration” under “Login to CMS Secure Portal.”

The EIDM system provides a way for business partners to apply for, obtain approval of, and receive a single user ID for accessing multiple CMS applications, including PQRS feedback reports.

CMS has packaged several resources for EIDM system users into the EIDM System Toolkit, including the “EIDM User Guide” and “EIDM Quick Reference Guides”. These resources provide instructions for PQRS participants obtaining a new EIDM account, managing and updating information for an existing EIDM account, and adding account role(s) in the Physician Value-Physician Quality Reporting System (PV-PQRS) Domain. The PV-PQRS Domain provides access for PQRS program information for various tasks, including viewing feedback reports.

Information about the 2015 Annual QRURs is available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/2015-QRUR.html.

Stay tuned for more information and resources in the coming weeks and months! In the meantime, please ensure that your EIDM account is active, current, and you’re able to log in, or begin the process to create an account.

For additional assistance regarding EIDM, contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715- 6222) from 7:00 a.m. to 7:00 p.m. Central Time, Monday through Friday, or via email at qnetsupport@hcqis.org. To avoid security violations, please do not include personal identifying information such as Social Security Number or Tax Identification Number in email inquiries to the QualityNet Help Desk.

Five years of work with many clinicians and researchers across the U.S. gave rise today to the release of our reform agenda for frail elders. MediCaring Communities: How to Get What We Want and Need in Frail Old Age at an Affordable Cost is a blueprint for serious reform.

The book is also available on Amazon, and more information can be found at MediCaring.org.

The MediCaring Communities model relies upon six interlocking elements:

1. Recognize the frail phase of life
2. Develop comprehensive care plans that reflect elder and family priorities
3. Make medical care responsive to the medical needs of elders
4. Enhance the supportive services in the community
5. Monitor the community needs and implement high-priority improvements
6. Use savings from more appropriate medical care to meet those community needs

The revenue estimates from Medicare were published last week in Milbank Quarterly on-line early and open access. In 2013, four communities were projected to show substantial savings within a year, making it possible to buttress supportive services and to monitor the service availability and quality for the community.

Please read this comprehensive presentation. We are always eager to hear your ideas in response. Please post reviews on Amazon! That really helps in getting the book into the algorithm that links the book with other searches on Amazon. The book is available for under $10. But if you’d like us to send you a copy, send us a note with your address (and a promise to review!) to info@MediCaring.org.

vidence in Action: AHRQ Reports Adding to the Momentum for Evidence-Based Care.

The U.S. Preventive Services Task Force posted today a final research plan on screening for cardiovascular disease risk and atrial fibrillation with electrocardiography. The draft research plan for this topic was posted for public comment from May 5 to June 1, 2016. The Task Force reviewed all of the comments that were submitted and took them into consideration as it finalized the research plan.

A comprehensive investigation has unveiled genetic differences that heighten a person’s risk for developing type 2 diabetes.

Evidence-Based Report: Telehealth: Mapping the Evidence for Patient Outcomes From Systematic Reviews.

National Healthcare Quality and Disparities Reports: Chartbook on Care Coordination

One in three American adults has high blood pressure, putting them at risk for heart disease and stroke, conditions that are among the leading U.S. killers. High blood pressure (also called hypertension) can also impact brain health in significant ways. Observational studies show that having high blood pressure in midlife—the 40s to early 60s—increases the risk of cognitive decline later in life.

Can controlling hypertension help delay or prevent cognitive impairment? It’s an intriguing question, particularly since hypertension is easily treatable with lifestyle changes and medication.