Today’s Top Story
Bundled payments may be the future, but how do they affect health care?
An article in HealthLeaders Media examines the effect of bundled payments on health care. The writer states that, from 2007 to 2011, the all-cause 30-day hospital readmission rate for Medicare fee-for-service beneficiaries was about 19 percent to 19.5 percent, but those rates fell to 18.5 percent in 2012 and 17.5 percent in 2013, and argues that much of the effect has been seen in cost avoidance. However, an article in Modern Healthcare reports that some physicians in New York City public hospitals stand to lose thousands of dollars in incentive payments under standards that some argue are set too high. “As the health system takes on risk-based contracts, it is shifting some of that risk to doctors,” the writer notes. Read the HealthLeaders Media article…
Read the Modern Healthcare article…(registration may be required)
An opinion piece published in the Aug. 18 issue of The New England Journal of Medicine looks at the issue of quality metrics and physician reimbursement, noting that many physicians have had to review records for accuracy to make sure they have met compensation metrics. “As practices shift from fee for service to a focus on person-centered, high-value health care,” the writers state, “we can avoid creating systems that rob clinicians of the joy and meaning of partnering with patients to create health. Instead, we can use quality metrics wisely to create a better clinician-compensation program to drive the delivery of health.” Read more…
Other News
MedPAC submits comments on CMS proposed rule regarding ASC payments, EHR incentives.
The Medicare Payment Advisory Commission (MedPAC) has submitted comments on a U.S. Centers for Medicare & Medicaid Services (CMS) proposed rule covering, among other things, hospital outpatient prospective payment and ambulatory surgical center (ASC) payment systems, quality reporting, and electronic health record (EHR) incentive programs. MedPAC notes that CMS has proposed to increase the conversion factor in the ASC payment system by 1.2 percent during 2017. However, MedPAC recommends that Congress eliminate that increase, based on “indicators of payment adequacy for ASCs, which are positive, and the importance of maintaining financial pressure on providers to constrain costs.” In addition, MedPAC supports the establishment of a value-based purchasing program for ASCs in which high-performing ASCs would be rewarded and low-performing facilities would be penalized. Finally, the agency outlines concerns regarding CMS’ meaningful use approach of paying hospitals and clinicians to purchase EHRs, and about requirements for hospitals and clinicians to report information demonstrating that they use the EHRs. “…we are not convinced it benefits patients or improves health outcomes if CMS defines and measures meaningful use of EHRs,” MedPAC states. “… A better approach, in the Commission’s view, is to ensure that the payment system itself creates a business case for the use of EHRs and encourages vendors to market products that improve care and interoperability.” Read the comment letter (PDF)…
Read the proposed rule…
Study: Is vertebroplasty an option for pain relief among patients with acute osteoporotic spinal fractures of less than 6 weeks duration?
Findings from a study conducted in Australia and published online in the journal The Lancet suggest that vertebroplasty may be an appropriate intervention for patients with acute osteoporotic spinal fractures of less than 6 weeks duration. The authors conducted a multicenter, randomized, double-blind, placebo-controlled trial of 120 patients with one or two osteoporotic vertebral fractures of less than 6 weeks duration and Numeric Rated Scale (NRS) back pain greater than or equal to 7 out of 10, 61 of whom were treated with vertebroplasty and 59 with placebo. At 14-day follow-up, they found that 44 percent (n = 24) of patients in the vertebroplasty group and 21 percent (n = 12) of patients in the control group had an NRS pain score below 4 out of 10. Overall, there were two serious adverse events in each cohort, and three patients in each cohort died from causes judged unrelated to the procedure. Read more…
Read the abstract…
On the basis of strong evidence, AAOS Clinical Practice Guidelines recommend against vertebroplasty for patients who present with an osteoporotic spinal compression fracture on imaging with correlating clinical signs and symptoms and who are neurologically intact. Read more…
Study: Little evidence to support routine use of gabapentinoids for acute pain following TKA.
A study published in the Aug. 17 issue of The Journal of Bone & Joint Surgery finds no evidence to support the routine use of gabapentinoids in the management of acute pain following total knee arthroplasty (TKA). The researchers conducted a meta-analysis of 12 randomized, controlled trials of patients who underwent elective primary TKA, and which compared the use of the gabapentinoid class of drugs or pregabalin against placebo. They found no difference in pain scores across cohorts at 12, 24, 48, or 72 hours following surgery. The researchers note that use of pregabalin was associated with reduced pain scores at 24 and 48 hours following surgery, although the difference was minor and determined to be not clinically important. Similarly, gabapentinoids were associated with a small, but not clinically important, reduction in cumulative opioid consumption at 48 hours postoperative. The researchers state that there was no difference in knee flexion at 48 hours following surgery or in incidence of chronic pain at 3 months or 6 months after surgery associated with the use of gabapentinoids. In addition, they state that gabapentinoids were associated with a significant reduction in the incidence of nausea, but pregabalin was also associated with a clinically relevant increase in the risk of sedation. Read the abstract…
CMS seeks comment on rules to prevent providers from steering patients away from Medicare and Medicaid to ACA marketplaces for financial gain.
Reuters reports that CMS is seeking public comment and considering rules to prohibit or limit premium payments or cost-sharing for individual Affordable Care Act (ACA) marketplace plans. The agency states that it is improper for healthcare providers or related groups to steer patients into ACA individual insurance plans instead of Medicare or Medicaid for the purposes of financial gain. Read more…
Study: Medicaid expansion under ACA linked to reduction in uncompensated care.
According to a study published online in the journal Health Affairs, hospitals in states that chose to expand Medicaid programs under the ACA have seen a reduction in uncompensated care. The researchers reviewed data on uncompensated-care costs at 1,249 U.S. hospitals between 2011 and 2014. They found that, in states that expanded Medicaid, uncompensated care costs decreased from 4.1 percentage points to 3.1 percentage points of operating costs. Further, they estimate that uncompensated care costs would have decreased from 5.7 percentage points to 4.0 percentage points of operating costs in nonexpansion states if those states had expanded Medicaid. Read more…
Read the abstract…
CMS Open Payments review and dispute is open until Dec. 31.
CMS has already released 2015 Open Payments (Sunshine Act) data; however, physicians can still review and dispute records in the Open Payments system until Dec. 31. The Open Payments program requires that transfers of value by drug, device, biologic, and medical supply manufacturers to physicians and teaching hospitals be published on a public website. The American Association of Orthopaedic Surgeons recommends that physicians check their data every year, even when they believe no new information has been reported, as drug and device companies can continue to submit data from previous years. For assistance with the data review and dispute process, contact the CMS Open Payments Help Desk at 855-326-8366, or via email at: openpayments@cms.hhs.gov
Office team members can assist if they are nominated by physicians to be authorized representatives. Learn how to nominate an authorized representative (PDF)… Read more…
Learn more about the Open Payments system…
Access the Open Payments website…
Call for volunteers: Exhibits Committee, Orthopaedic Video Theater Committee.
Aug. 25 is the last day to submit your application for positions on two AAOS Annual Meeting-related committees. Members of the Exhibits Committee organize and develop new programs for technical exhibits at the AAOS Annual Meeting. Members of the Orthopaedic Video Theater Committee evaluate video and multimedia submissions for presentation in the Orthopaedic Video Theater at the AAOS Annual Meeting. The following member openings are available:
- Exhibits Committee (three members)
- Orthopaedic Video Theater Committee
- Adult Reconstruction Hip and Knee (two members)
- Shoulder and Elbow (one member)
- Trauma (one member)
Members of the Exhibits Committee must be active fellows, associate members orthopaedic, associate members osteopathic, international members, resident members, or candidate members. Applicants for the Orthopaedic Video Theater Committee must be active fellows, candidate members, candidate member applicants for fellowship, associate members osteopathic, or resident members with a practice emphasis in the relevant topic. Learn more and submit your application…(member login required)
