Today’s Top Story
CMS issues final rule that prevents increases in pass-through payments in Medicaid managed care.
The U.S. Centers for Medicare & Medicaid Services (CMS) has issued a final rule regarding pass-through payments in Medicaid managed care. The rule prevents increases in pass-through payments and the addition of new pass-through payments beyond those in place when the pass-through payment transition periods were established, under regulations that took effect July 5, 2016. According to Modern Healthcare, such payments “are paid to Medicaid managed care plans on top of the base capitation rate. The plans are required to pass these payments to contracted providers that treat a disproportionate share of Medicaid or uninsured patients with complex or costly cases.” A spokesperson for the American Hospital Association states that the new rule “could adversely affect both those hospitals dependent on supplemental payments and the patients they serve.” However, CMS states that the rule “flows from and reinforces the intent of the May 6, 2016 final rule to phase out pass-through payments under Medicaid managed care contracts,” and that “any delay [in implementation] would undermine the goals of that rule and make the transition to an actuarially sound approach more difficult.”
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Read the rule…
Other News
Study: Prior multiligament knee surgery linked to increased risk of complication and reduced survivorship for TKA patients.
A study published online in the journal Clinical Orthopaedics and Related Research (CORR) suggests that patients with a history of multiligament surgery may be at increased risk of major complications and lower long-term implant survivorship following total knee arthroplasty (TKA). The researchers reviewed information on 59 TKAs performed at a single center on patients with a history of previous multiliagment knee surgery, and a matched cohort of control patients. Follow-up data were available for 39 patients at 5 years, 18 patients at 10 years, and 6 patients at 15 years. Compared to controls, they found that patients with prior multiligament knee surgery had reduced 15-year revision-free implant survival, increased risk of reoperation for any cause, and increased risk of infection. In addition, varus-valgus constraint implant design was used for more patients in the multiligament cohort at index TKA compared to the control group. The researchers found no significant difference across cohorts in frequency of manipulation under anesthesia after TKA, Knee Society Scores (KSS) improvement after TKA, or final KSS and Knee Society Function Score.
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Study: Does value-based care reduce access for older patients with more comorbidities?
Findings from a study published online in CORR suggest that value-based care models may negatively affect access to care for older patients who seek to undergo primary total hip arthroplasty (THA) because these patients may be more likely to have comorbidities. The research team reviewed a subset of national Medicare administrative claims data, and found an 81 percent increase in the number of octogenarians who underwent THA from 1998 to 2013. Compared with patients aged 65 to 69 years, they found that octogenarian patients were more likely to have a Charlson score of 3 or higher, were more likely to have coronary artery disease or congestive heart failure, and were at increased risk of dislocation, readmission, and mortality. “Because octogenarians are at increased risk of dislocation, venous thromboembolism, medical complications, and mortality after THA,” the research team writes, “value-based care models that penalize hospitals for readmissions and complications may inadvertently result in loss of access to care for this group of patients as a result of the financial makeup of these bundled care models.”
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Study: Children with higher BMI may be at increased risk of SSI.
According to a study published online in the journal Surgical Infections, elevated body mass index (BMI) may increase risk of surgical site infection (SSI) for pediatric patients. The authors reviewed data on 66,671 patients aged 2 to 18 years from the National Surgical Quality Improvement Program-Pediatric database. They identified 1,380 SSIs. A multivariable analysis revealed overweight and obese BMI to be risk factors for SSI. Surgical specialties with the most SSIs were pediatric surgery and pediatric orthopedics.
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FDA issues draft guidance documents on medical product communications.
The U.S. Food and Drug Administration (FDA) has announced two new draft guidance documents designed to offer clarity regarding the agency’s thinking on communications about medical products. The first addresses recommendations on firms’ communication of healthcare economic information (HCEI) about approved drugs, and answers common questions regarding firms’ communications to payers about investigational drugs and devices that are not yet approved or cleared for any use. The second explains FDA’s current thinking about how the agency evaluates firms’ medical product communications that include data and information that are not contained in their products’ FDA-required labeling, but that concern the approved or cleared uses of their products. FDA will accept public comments on the draft guidances through April 10, 2017.
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Read the draft guidance, “Drug and Device Manufacturer Communications with Payors, Formulary Committees, and Similar Entities”…
Read the draft guidance, “Medical Product Communications That Are Consistent With the FDA-Required Labeling”…
FDA has also posted a memorandum that provides additional background on the issues the agency is considering as part of a comprehensive review of its rules and policies relating to firm communications regarding unapproved uses of approved or cleared medical products, including a discussion of First Amendment considerations.
Read the memorandum…
Study: Out-of-network charges vary widely across specialties.
A research letter published in the Jan. 17 issue of The Journal of the American Medical Association examines variation in the cost of out-of-network specialists. The researchers reviewed Medicare payment data on 429,273 physicians across 54 specialties and calculated physician excess charges, defined as total charges divided by total Medicare allowable amount for medical services. They found that anesthesiologists had the highest median ratios (5.8 times the Medicare allowable amount), followed by interventional radiology (4.5 times), emergency medicine (4.0 times), pathology (4.0 times), and neurosurgery (4.0 times). Orthopaedic surgery was in the second quartile, at 3.2 times the Medicare allowable amount.
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Read an excerpt of the research letter…
Call for volunteers: CMS Technical Expert Panel on Hospital Quality Star Ratings on Hospital Compare.
AAOS seeks to nominate members to the CMS Technical Expert Panel on Hospital Quality Star Ratings on Hospital Compare. The Star Rating project is designed to create a picture of current measures publicly reported on the Hospital Compare website so that aspects of quality are presented in a meaningful and accessible way. Panel recommendations and discussion will inform the refinement of this methodology. Applicants for this position must be active members, candidate members, candidate members osteopathic, candidate member applicants for fellowship, or candidate member applicants for fellowship osteopathic. In addition, all applicants must provide the following: an online AAOS CAP application, a current curriculum vitae (10 pages maximum), a 100-word biosketch, a statement of interest (not to exceed two pages) highlighting experience/knowledge relevant to the expertise described above, and a nomination form (available from the email below). All supporting materials must be submitted by Jan. 25, 2017 at 11:59 p.m. (CT), to Kyle Shah at shah@aaos.org.
Learn more and submit your application…(member login required)
