News and Updates for Healthcare Professionals

At the 5-year anniversary of the National Quality Strategy, progress is being made towards the three aims of the National Quality Strategy, to provide better, more affordable care for individuals and the community, according to the new
2015 National Healthcare Quality and Disparities Report and 5th Anniversary Update on the National Quality Strategy. For the first time, this year’s Agency for Healthcare Research and Quality (AHRQ) National Healthcare Quality and Disparities Report and the National Quality Strategy Annual Progress Report are integrated, providing a comprehensive update on the Nation’s progress in improving health care access, quality, and disparities.

Key findings from the new report include:

• More people have health care coverage, have a usual place to go for medical care, and can more easily afford medical bills after the Affordable Care Act’s provisions have taken effect.
• More people had a usual place to go for medical care. The percentage of people with a usual place to go for medical care increased overall for Blacks and Hispanics. Hispanics showed the biggest gains in this measure, climbing from 77 percent in 2010 to 83 percent in the first half of 2015.
• The cost of health care coverage also became more affordable as fewer people overall reported having trouble paying medical bills within the past year. Low-income people saw the greatest benefit, and all racial and ethnic groups showed a decline in payment problems during this period.
• Quality of care is improving, particularly in hospitals and for measures that are being publicly reported by the Centers for Medicare & Medicaid Services. However, quality is still far from optimal overall, and disparities based on race/ethnicity and income continues to impact the care people receive.

Are you a health professional working with older adults? Your patients may be concerned about changes in their memory and thinking skills, and may worry about dementia disorders like Alzheimer’s disease. You can help.

Talking With Your Older Patient: A Clinician’s Handbook has information on cognitive problems to help you:

• Determine when to screen for cognitive impairment
• Convey findings about memory problems
• Communicate with a confused patient

A new AHRQ white paper, “Creating Patient-Centered, Team-Based Primary Care,” offers a conceptual framework, as well as strategies, that health care providers have used to ensure team-based care offered in primary care settings is patient-centered. The paper discusses the potential well-implemented team-based care has to improve the overall quality and comprehensiveness of primary care. It also stresses that team-based approaches have the ability to disrupt or change specific aspects of care, such as ongoing relationships, important to patients and providers. Strategies and resources provided in the white paper are intended to help create the culture, structure, and processes that support the development and maintenance of these relationships.

The paper is designed for physicians in primary care practices, practice facilitators, decision makers, and others committed to helping practices successfully transition to patient-centered team-based care. This paper and additional AHRQ resources related to the patient-centered medical home and primary care improvement are available on AHRQ’s PCMH Resource Center web site.

Dear Colleague,

Thank you for submitting comments on the U.S. Preventive Services Task Force (USPSTF, Task Force) draft recommendation statement and draft evidence reviews for aspirin use for the primary prevention of cardiovascular disease and colorectal cancer during the public comment period. We appreciate your input and carefully considered all comments as we finalized the recommendation and evidence summary.

I am writing to let you and your members know that the Task Force has published the final recommendation statement. In addition, the evidence summaries for this topic have been published. The evidence summaries outline the studies the Task Force reviewed to reach its recommendation. The final recommendation statement and evidence summaries were published in the online edition of Annals of Internal Medicine and are available on the Task Force Web site. A fact sheet that explains the final recommendation in plain language is also available on the Task Force Web site.

Please consider sharing this recommendation statement and evidence summary with your members.

If you are interested in learning about Task Force recommendations like aspirin use for the primary prevention of cardiovascular disease and colorectal cancer, public comment opportunities, and other Task Force activities, then we encourage you to sign up for the USPSTF email list. Please note that this will bring you to a sign-up page on the Agency for Healthcare Research and Quality (AHRQ) Web site. AHRQ manages the administration of the Task Force email list as part of the support it provides to the Task Force.

Also, if you know of any other organizations, subject matter experts, or individuals who may be interested in being informed of Task Force recommendations, please encourage them to sign up.

If you have any questions, please contact the USPSTF Coordinator at coordinator@uspstf.net.

Together, we can improve the health of all Americans.

Sincerely,

Albert L. Siu, M.D., M.S.P.H.
Chair, U.S. Preventive Services Task Force

The U.S. Preventive Services Task Force is an independent, volunteer panel of national experts in prevention and evidence-based medicine that works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications. The Task Force welcomes public comments throughout the recommendation development process to ensure that final recommendations are valid, reliable, and useful for health professionals, patients, and family members.

Today, CMS announced Comprehensive Primary Care Plus (CPC+), an advanced primary care model and our largest investment in primary care transformation to date. At CMS, we know that strengthening primary care is critical to promoting healthy communities and reducing overall health care costs in the U.S. In CPC+, we have built on the foundation of the Comprehensive Primary Care (CPC) initiative by enhancing the payment and care delivery design. Our goal is to support primary care practices to deliver better care, smarter spending, and healthier people.

CPC+ is a regionally-based, multi-payer care delivery and alternative payment model (APM) that rewards value and quality through an innovative payment structure to support comprehensive primary care. The model will offer two tracks with incrementally advanced care delivery requirements and payment options to meet the diverse needs of primary care practices.

CPC+ is a five-year model that will begin in January 2017. We anticipate partnering with commercial and State payers in up to 20 regions around the country to support primary care practices. CMS will also engage directly with health information technology (health IT) vendors that provide products to advanced CPC+ practices.

Beginning on April 15, 2016, we will solicit payer proposals to partner in CPC+. Based on payer interest and coverage, we will announce the CPC+ regions in July 2016, and solicit applications from eligible practices within these geographic locales.

For questions about the model and solicitation process, please visit the Comprehensive Primary Care Plus web page or email CPCplus@cms.hhs.gov. Information about the model will be posted to the website on an ongoing basis as it becomes available.

To read the Viewpoint article on CPC+ published today in the Journal of the American Medical Association (JAMA).

All interested stakeholders are invited to attend the Comprehensive Primary Care Plus (CPC+) Announcement Events:

• Thursday, April 14, 2016 at 3pm EDT.
• Tuesday, April 19, 2016 at 3pm ET.

We are excited to share Medicare’s vision for primary care and look forward to partnering in the years ahead to enhance and support high value, comprehensive care for all Americans.

-The CPC Team

The U.S. Preventive Services Task Force released today a final recommendation statement on screening for chronic obstructive pulmonary disease (COPD). The Task Force found no benefit for screening in persons without respiratory symptoms and recommends against screening for COPD in asymptomatic adults. To view the recommendation and the evidence on which it is based, please go to http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/chronic-obstructive-pulmonary-disease-screening. A fact sheet that explains the final recommendation in plain language is available. The final recommendation statement can also be found in the April 5 online issue of JAMA.

In response to the continued interest in the Million Hearts® Cardiovascular Disease Risk Reduction Model (MH Model) CMS has re-opened the LOI and application deadline as of April 4, 2016. LOIs and RFAs are due by April 15, 2016.

Do not miss out on this exciting opportunity for your patients and practice!

• It is important to your patients: Cardiovascular disease is the leading cause of death for men and women in the United States, accounting for one in three deaths, at an annual cost of over $300 billion annually.
• It is important to your practice: The Secretary of Health and Human Services recently announced the national goal of shifting 85% of all traditional Medicare payments to quality or value by 2016 and 90% by 2018.
• It provides payment incentives without any risk of penalties: The MH Model’s value-based payment incentives will reward clinicians on a sliding scale tiered by aggregate absolute risk reduction across their high-risk patient panel.
• It is a new way of promoting prevention: The MH Model will attempt to determine whether financially rewarding reductions in 10-year predicted risk of initial heart attack or stroke across a physician’s high risk patient population is an effective approach for value-based prevention.

Start an LOI! If your organization has already submitted an LOI, proceed to completing your RFA.

For questions about the application, including username and password:
Email: CMMIForceSupport@cms.hhs.gov
Phone: 888-734-6433 and select “option 5”

For questions about the Model:
Email: mhmodel@cms.hhs.gov
Phone: 703-894-4399

Notice Number: NOT-HS-16-010
Key Dates
Release Date: March 23, 2016
Related Announcements
None

Issued by

Agency for Healthcare Research and Quality (AHRQ)

Purpose

AHRQ supports research, evaluations, and demonstration projects concerning the delivery of health care in inner-city and rural areas (including frontier areas), and health care for priority populations. Priority populations include low income groups; minority groups; women; children; the elderly; and individuals with special health care needs, including individuals with disabilities and individuals who need chronic care or end-of-life health care. 42 USC 299(c). Investigators should review the document entitled, “AHRQ Policy on the Inclusion of Priority Populations,” which is available http://grants.nih.gov/grants/guide/notice-files/NOT-HS-03-010.html.

This Special Emphasis Notice (SEN) informs the research community that AHRQ intends to support research on models of shared decision making (SDM) that are tailored to the needs of low income and racial and ethnic minority patients. While models of SDM in the general population are available, models of SDM for racial and ethnic minority populations are lacking.

SDM occurs when a clinician and patient work together to make a health care decision that is best for the patient. The optimal decision takes into account evidence-based information about available health care options, the clinician’s knowledge and experience, and the patient’s values and preferences (Source: http://www.ahrq.gov/professionals/education/curriculum-tools/shareddecisionmaking/index.html. Decision support tools, namely decision aids, are often used to facilitate the decision making process.

SDM is not only intended to impart knowledge—a necessary but insufficient initiator of behavior change—but also to engage the patient in the decision making process. SDM also presents opportunities to address health literacy, cultural, language, access and trust issues that many racial and ethnic and low income groups experience, and can support the delivery of patient-centered care that is evidence-based. For example, SDM can be used to facilitate the dissemination and uptake of PCOR findings.

AHRQ is interested in understanding how SDM can be used to promote informed decision making, to increase patient engagement, and to improve the quality of care among low income and racial and ethnic minority patients. Examples of potential research include:

Development and evaluation of new models of SDM or adaptations of existing models of SDM to meet the needs of low income and racial and ethnic minority populations.
Development and evaluation of tools that support SDM, facilitate participatory decision making; and/or combine information about effectiveness, safety and opportunity costs with the burden of treatment.
Studies that provide an understanding of the patient’s perspective in SDM, and in the implementation and evaluation of SDM models in healthcare settings where low income and racial and ethnic minority populations seek care.
Development and evaluation of interventions that increase patient and clinician awareness of biases that influence decision-making and that address barriers to effective patient-clinician communication.

Further Guidance

For the purposes of this notice, AHRQ encourages that a sufficient number of research study participants be comprised of low income, racial and ethnic minorities receiving healthcare in under resourced settings (i.e., safety net hospitals and ambulatory care facilities) to ensure meaningful findings for this population.

AHRQ will use standing research program announcements for the R01 (see http://grants.nih.gov/grants/guide/pa-files/PA-14-291.html), R03 (see http://grants.nih.gov/grants/guide/pa-files/PA-15-147.html), and R18 (see http://grants.nih.gov/grants/guide/pa-files/PA-14-290.html) funding mechanisms to support this research.

Inquiries

Please direct all inquiries to:

Marian James
Agency for Healthcare Research and Quality (AHRQ)
Center for Evidence and Practice Improvement
Telephone: 301-427-1609
Email: sdm@ahrq.hhs.gov

Providing high-quality end of life care is a major commitment and responsibility faced by millions of health care professionals every day. The National Academies of Sciences, Engineering, and Medicine have partnered with ReachMD to broadcast a new podcast series for health care professionals based on the 2015 Institute of Medicine report Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life.

In this series, sponsored by the National Academy of Medicine, hear about various aspects of end of life care from the perspective of experts in the field. Topics include palliative care, interdisciplinary teamwork, clinician-patient communication and advance care planning, and policies and payment systems for care near the end of life.

The Dying in America: Conversations About Care at the End of Life podcast series can be found on the ReachMD website, and also on iHeartRadio, Tunein, Stitcher, and iTunes.

AHRQ’s TeamSTEPPS® long-established training tools have been tailored for office-based health care providers and team members and are now available online. Team Strategies and Tools to Enhance Performance and Patient Safety, widely known as TeamSTEPPS, is an evidence-based program to produce efficient and effective health care teams that optimize the use of evidence, information, people, and resources. TeamSTEPPS for Office-Based Care takes those strategies to ambulatory medical offices and outpatient settings to achieve the best outcomes for patients. TeamSTEPPS for Office-Based Care offers techniques, tools, and strategies to assist health care professionals in developing and optimizing communication, team knowledge, and team performance. The training toolkit is available online and includes scripts, presentations, and videos that can be used to train staff.

First-of-its-Kind PSA Campaign Targets the 86 Million American Adults with Prediabetes!
Eighty-six million US adults have prediabetes, and 90% of them don’t know they have it. With prediabetes, blood sugar levels are higher than normal, but not high enough yet to be diagnosed as diabetes. Prediabetes puts people at elevated risk for type 2 diabetes, heart disease, and stroke.

Awareness and diagnosis are key. Research shows that once people are aware of their condition, they are much more likely to make the necessary lifestyle changes.

To raise awareness and help people with prediabetes know where they stand and how to prevent type 2 diabetes, the American Diabetes Association (ADA), the American Medical Association (AMA), and the Centers for Disease Control and Prevention (CDC) partnered with the Ad Council to launch the first national public service announcement (PSA) campaign about prediabetes.

Think of the typical person with type 2 diabetes. Did you imagine someone older, overweight, inactive? You’d be partly right, but the big picture is more complicated and far-reaching.

Age

People are developing type 2 diabetes younger than ever. Also, the disease progresses faster in younger people than older ones. Complications related to diabetes such blindness and kidney disease are increasingly a young person’s problem.

Weight

Being overweight is a major risk factor for developing type 2 diabetes. But the inch you can pinch (subcutaneous) isn’t the most troubling kind of fat. Hidden layers of fat around organs (visceral) are thought to drive up the risk for heart disease, diabetes, and stroke. Normal-weight people who are TOFI—thin outside, fat inside—may look healthy but still have excess visceral fat that increases their risk.

Activity

Older folks aren’t the only ones not moving enough—fewer than 3 out of 10 high school students get the recommended 60 minutes or more of physical activity every day. Getting less than 150 minutes of physical activity a week is a risk factor for diabetes. Increasing physical activity, on the other hand, is especially effective at reducing the visceral fat mentioned above.

Do you and your colleagues want to know more about health literacy? The CDC Health Literacy Training Plan features 5 courses created by CDC’s Office of the Associate Director for Communication (OADC). Learners begin with the introductory Health Literacy for Public Health Professionals course and then select one or more of the following courses to complete the plan:

• Writing for the Public
• Speaking for the Public
• Using Numbers and Explaining Risk
• Creating Easier to Understand Lists, Charts, and Graphs

OADC and CDC TRAIN created a national health literacy training plan to help build health professionals’ knowledge and skills consistent with new professional communication competencies.

Have you seen the recently published articles in Preventing Chronic Disease (PCD)? Below you will find links to all manuscripts published in February 2016. Please visit our site at www.cdc.gov/pcd, where you will find other downloadable articles and information on PCD.

PCD Articles Now Feature Altmetric Scores

PCD is excited to announce that we are now using Altmetric for Publishers to measure article impact. This month, you’ll see the Altmetric badge at the top of PCD articles. This tool tracks and scores a range of sources, including social media, media exposure, blogs, and author impact to capture and collate conversations surrounding scholarly content. The score is a calculated, weighted count of all of the attention an article has received based on volume, sources, and authors. By clicking on the article’s Altmetric badge, you can visit the Altmetric Details Page for the article and see the mentions and references that have contributed to the score. We are excited to offer this new feature.

PCD GIS Snapshots

Did you know that PCD publishes regular GIS Snapshots? These map and text articles feature Geographic Information Systems (GIS) used to display national, state, or county data for important health topics related to chronic disease. PCD publishes these Snapshots on a regular basis, so check out the GIS section of our website often for new articles. Interested in submitting your map and research for consideration as a GIS Snapshot? Visit the For Authors section on our website for more information.

Connect With PCD on Facebook

Share your favorite PCD articles and updates with friends and colleagues by liking and following the PCD Facebook page. Like and share article links, engage with others in the field of chronic disease, and help us spread the word about the importance of health promotion and chronic disease prevention.

Dear Dr Kim,

We are pleased to share with you an important announcement involving payment reform in Medicare. As you recall, our shared goal in the LAN is to get 30% of health care payments in alternative payment models by the end of 2016 and 50% by the end of 2018. Today, President Obama announced that Medicare met the 30% goal in January of 2016, almost a year ahead of schedule. As you can see from the note below, Patrick Conway, the CMS Principal Deputy Administrator, commented on the important role of the Health Care Payment Learning & Action Network (LAN) in helping Medicare reach this goal; indeed, the announcement relies on the LAN’s payment reform framework. While we all still have much more to do in terms of payment that supports better care for patients and lower costs, this progress reflects the contributions of many LAN members. We thank you for that, and look forward to our next steps.

Mark Smith and Mark McClellan
Co-Chairs of the LAN Guiding Committee

Dear LAN Guiding Committee Members,

Earlier today, the President announced two landmark achievements for the U.S. health care system since the passage of the Affordable Care Act. First, more than 20 million Americans have gained health insurance. We have the lowest uninsured rate ever recorded. Second, as of January 2016, more than 30% of Medicare Part A and B payments are tied to alternative payment models. This latter milestone is particularly important to our shared work with the Health Care Payment Learning & Action Network (LAN) and follows the U.S. Department of Health and Human Services’ challenge to us all to shift the way we pay for health care away from the quantity of services to the quality and value of care we provide. CMS is proud to achieve the 30% target almost a year ahead of schedule, and we appreciate that we would not have been able to do this without the help of you and the LAN. Moreover, we know that true transformation of our health system cannot be done through Medicare alone, and so we look forward to continuing to work with the LAN membership at-large to achieve the goals of tying 30% of spending to APMs by the end of 2016 and 50% by the end of 2018 for the entire U.S. health care system. We encourage anyone who has not set specific goals to consider doing so, and to join the LAN effort to track progress across the public and private sector. Working together we can implement new payment models, learn what works, scale successes, and improve patient care. We can deliver on the promise of a health system that achieves better care, smarter spending, and better health outcomes for everyone in our health system. Thank you for your service on the LAN and for your leadership in this effort.

Warm regards,
Patrick Conway

Earlier today, the President announced two landmark achievements for the U.S. health care system since the passage of the Affordable Care Act. First, more than 20 million Americans have gained health insurance. The country has the lowest uninsured rate ever recorded. Second, as of January 2016, more than 30% of Medicare Part A and B payments are tied to alternative payment models. This latter milestone follows the U.S. Department of Health and Human Services’ challenge to shift the way health care is paid for, away from the quantity of services to the quality and value of care provided. CMS is proud to achieve the 30% target almost a year ahead of schedule. Moreover, true transformation of our health system cannot be done through Medicare alone, and so CMS looks forward to continuing to work with partners across the country to achieve the goals of tying 30% of spending to APMs by the end of 2016 and 50% by the end of 2018 for the entire U.S. health care system. Any healthcare professional who has not set specific goals to consider doing so, and to join the Health Care Payment Learning and Action Network (LAN) effort to track progress across the public and private sector. Working together we can implement new payment models, learn what works, scale successes, and improve patient care. We can deliver on the promise of a health system that achieves better care, smarter spending, and better health outcomes for everyone in our health system. Thank you for your service and for your leadership in this effort.

One in every 4 men dies from heart disease every year, and African-American men—especially those who live in the southeast region of the United States—suffer from heart disease more than any other race. Why are these rates so high? Unhealthy heart habits such as poor diets, a lack of exercise, high blood pressure, smoking and not visiting the doctor regularly are just a few factors that contribute to undiagnosed heart disease.
African-American men: It isn’t too late to take control and put your heart health first. February is American Heart Month and a great time for you to take action. This month, Million Hearts is encouraging you to adopt one heart healthy lifestyle change and share your success. You can take action with a few small steps.

Only 12 percent of U.S. adults have the health literacy skills needed to manage the demands of our complex health care system, and even these individuals’ ability to absorb and use health information can be compromised by stress or illness. Experts recommend assuming that everyone may have difficulty understanding and creating an environment where all patients can thrive. Like with blood safety, universal precautions should be taken to address health literacy because we can’t know which patients are challenged by health care information and tasks at any given time. AHRQ’s Health Literacy Universal Precautions Toolkit – 2nd edition can help primary care practices reduce the complexity of health care, increase patient understanding of health information, and enhance support for patients of all health literacy levels.

Additional tools for improving health literacy:

• AHRQ Pharmacy Health Literacy Center
• Self-Management Support Video and Library

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

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

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

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

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

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

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

CMS Guidance for CDS Interventions

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

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

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

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

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

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

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

From the NIH: Mind Your Risks raises awareness of the link between high blood pressure and cognitive impairment.

From the NIH: Mind Your Risks raises awareness of the link between high blood pressure and cognitive impairment.

Premature death rates have declined in the United States among Hispanics, blacks, and Asian/Pacific Islanders (APIs) — in line with trends in Canada and the United Kingdom — but increased among whites and American Indian/Alaska Natives (AI/ANs), according to a comprehensive study of premature death rates for the entire U.S. population from 1999 to 2014. This divergence was reported by researchers at the National Cancer Institute (NCI), and colleagues at the National Institute on Drug Abuse (NIDA), both part of the National Institutes of Health, and the University of New Mexico College of Nursing. The findings appeared Jan. 25, 2017, in The Lancet.

Declining rates of premature death (i.e., deaths among 25- to 64-year-olds) among Hispanics, blacks, and APIs were due mainly to fewer deaths from cancer, heart disease, and HIV over the time period of the study. The decline reflects successes in public health efforts to reduce tobacco use and medical advances to improve diagnosis and treatment. Whites also experienced fewer premature deaths from cancer and, for most ages, fewer deaths from heart disease over the study period. Despite these substantial improvements, overall premature death rates still remained higher for black men and women than for whites.

In contrast, overall premature death rates for whites and AI/ANs were driven up by dramatic increases in deaths from accidents (primarily drug overdoses), as well as suicide and liver disease. Among 25- to 30-year-old whites and AI/ANs, the investigators observed increases in death rates as high as 2 percent to 5 percent per year, comparable to those increases observed at the height of the U.S. AIDS epidemic.

“The results of our study suggest that, in addition to continued efforts against cancer, heart disease, and HIV, there is an urgent need for aggressive actions targeting emerging causes of death, namely drug overdoses, suicide, and liver disease,” said Meredith Shiels, Ph.D., M.H.S., Division of Cancer Epidemiology and Genetics (DCEG), NCI, lead author of the study.

“Death at any age is devastating for those left behind, but premature death is especially so, in particular for children and parents,” emphasized Amy Berrington, D.Phil., also of DCEG and senior author of the study. “We focused on premature deaths because, as Sir Richard Doll, the eminent epidemiologist and my mentor, observed: ‘Death in old age is inevitable, but death before old age is not.’ Our study can be used to target prevention and surveillance efforts to help those groups in greatest need.”

The study findings were based on death certificate data collected by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention.

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

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

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

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

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

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

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

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

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

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

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

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

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

Today, the Centers for Medicare & Medicaid Services (CMS) announced 121 new participants in Medicare Accountable Care Organization (ACO) initiatives designed to improve the care patients receive in the health care system and lower costs. With this announcement, ACOs now represent 49 states and the District of Columbia.

ACOs are delivering better care, and they continue to show promising results on cost savings. In 2014, they had a combined total net program savings of $411 million for 333 Medicare Shared Savings Program (Shared Savings Program) ACOs and 20 Pioneer ACOs. Based on 2014 quality and financial performance results for Shared Savings Program ACOs who started the program in 2012, 2013, and 2014, those that reported in both 2013 and 2014 improved on 27 of the 33 quality measures, including patients’ ratings of clinicians’ communication, beneficiaries’ rating of their doctors, screening for tobacco use and cessation, screening for high blood pressure, and Electronic Health Record use. Shared Savings Program ACOs also outperformed group practices reporting quality on 18 out of 22 measures.

CMS also announced today that providers and hospitals have signed up to join new types of ACOs, which in addition to being paid for positive patient outcomes will also receive penalties for negative ones. With new participants in the Shared Savings Program (SSP), the Next Generation ACO Model, Pioneer ACO Model, and the Comprehensive ESRD Care Model, there will now be:

• Nearly 8.9 million beneficiaries served
• A total of 477 ACOs across SSP, Pioneer ACO Model, Next Generation ACO Model, and Comprehensive ESRD Care Model
• 64 ACOs are in a risk-bearing track including SSP, Pioneer ACO Model, Next Generation ACO Model , and Comprehensive ESRD Care Model

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

Due to an error found in the logic, the Centers for Medicare & Medicaid Services (CMS) is providing guidance on measure CMS122 (Diabetes: Hemoglobin A1c Poor Control), which is included in the 2014 measure set for the Electronic Health Record (EHR) Incentive Program for eligible professionals (EPs). Version CMS122v3 of the measure was posted on the CMS website in May 2014. A subsequent posting of this measure in 2015 (CMS122v4) resolved this issue for the 2016 program year.

Background

CMS122 measures the percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement year. A patient meets the numerator condition if any of the following are true:

1. The most recent HbA1c reading is > 9.0%;
2. The most recent HbA1c result is missing; or
3. If there are no HbA1c tests performed and results documented during the measurement period.

CMS122 is an inverse measure, meaning that lower scores indicate better performance. In 2014, this measure was updated as CMS122v3 to include logic and specifications for numerator condition (2), where there is evidence of a laboratory test’s having been performed, but the result of the test was not recorded. This logic introduced an error, which results in patients with HbA1c laboratory results of less than 9.0% as being numerator compliant, artificially inflating the (inverse) performance score.

What should you do if you report this measure?

Version CMS122v3 affects the 2015 program year and 2017 payment year for several programs including the Physician Quality Reporting System (PQRS), the Medicare EHR Incentive Program, the Value-Based Payment Modifier (VM) and the Comprehensive Primary Care (CPC) initiative. Guidance for each program is provided below.

• PQRS
  Reporting CMS122v3 will count as one of the nine measures required to satisfactorily report for the PQRS program. For PQRS questions regarding CMS122v3, please contact the QualityNet Help Desk at Qnetsupport@hcqis.org or 1-866-288-8912, TTY: 1-877-715-6222.
• 
  EHR Incentive Programs
  Reporting CMS122v3 will count as one of the nine measures required to satisfactorily report for the EHR Incentive Programs. For questions regarding CMS122v3, please contact the EHR Incentive Programs Information Center at 1-888-734-6433 or TTY 1-888-734-6563.
• Value Modifier (VM) Program
  Based on this logic error, CMS will not include CMS122v3 in the calculation of the Quality Composite for the CY 2017 Value Modifier. For VM questions regarding CMS122v3, please contact the Physician Value Help Desk at pvhelpdesk@cms.hhs.gov or 1-888-734-6433 (press option 3).
• Comprehensive Primary Care Initiative (CPC)
  All practices are required to report 9 measures from the 13 CPC eCQM measures. If a practice is unable to report on a different CPC eCQM, then they should report this measure to meet the 9 measure reporting requirement for the CPC program. For 2015 CPC Medicare shared savings, CMS will not include this measure in performance calculations for quality scoring purposes. Practices that report on CMS122v3 will still be eligible to receive any Medicare shared savings based on their other reported eCQMs. For CPC questions regarding CMS122v3, please contact the CPC Support at: cpcisupport@telligen.org or 1-800-381-4724.

For more information on eCQMs, visit the
eCQM Library.