Today’s Top Story
CMS Releases MACRA/Quality Payment Program Final Rule.
The Centers for Medicare & Medicaid Services (CMS) today released the final rule for Medicare’s Quality Payment Program, which implements the Medicare Access and CHIP Reauthorization Act (MACRA) and replaces the Sustainable Growth Rate (SGR) formula. In a CMS blog post, Acting CMS Administrator Andy Slavitt stressed that the Quality Payment Program “aims to create a more modern, patient-centered Medicare program by promoting quality patient care while controlling escalating costs through the Merit-Based Incentive Payment System (MIPS) and incentive payments for Advanced Alternative Payment Models (Advanced APMs).” The American Association of Orthopaedic Surgeons (AAOS) in June submitted comments to CMS that outlined a number of areas of concern with the original proposal, including the implementation timeline, restrictive requirements for Advanced APMs, and the impact on smaller or solo practices. While it appears that CMS has been responsive to some of these concerns, AAOS leadership and staff are closely reviewing today’s final rule and will be providing CMS with additional comments. AAOS will also be providing detailed analyses and updates to all AAOS members. Read the CMS blog post…
Read the AAOS press release…
Visit the CMS Quality Payment Program webpage…
Visit the AAOS MACRA resource page for all materials and updates…
Other News
CMS launches pilot aimed at reducing medical record review under MACRA.
Prior to issuing the MACRA final rule, CMS announced an 18-month pilot that will test out ways to reduce medical record review for providers practicing within certain Advanced Alternative Payment Models (Advanced APMs). According to CMS, this effort will be part of an initiative to improve the clinician experience with the Medicare program. The pilot will involve the following Advanced APMs that share financial risk with Medicare, with resultant incentives for efficient delivery of care:
- Next-generation Accountable Care Organizations (ACOs)
- Medicare Shared Savings Programs Track 2 and 3 participants
- Pioneer ACOs
- Oncology Care Model 2-sided Track participants.
The first phase of the program, to run from Jan. 1, 2017, to June 1, 2018, will see CMS directing medical review contractors to place low priority on post-payment medical review claims from providers participating in Advanced APMs for beneficiaries aligned to the model. In Phase 2—from April 1, 2017, to June 1, 2018—providers in certain Advanced APMs will also be considered as a low priority for prepayment medical record review by Medicare Administrative Contractors. Claims from physicians and hospitals not aligned with the Advanced APMs are not included in the pilot, nor are claims from durable medical equipment suppliers, home health agencies, and other types of providers. Over the next 6 months, each of CMS’s 10 regional offices will hold local meetings to hear input from physician practices. Read more…
Read the CMS Fact Sheet…
GAO report recommends steps to address misalignment of healthcare quality measures.
A report from the U.S. Government Accountability Office (GAO) recommends that the U.S. Department of Health & Human Services (HHS) take steps to address misalignment of healthcare quality measures. GAO conducted interviews with HHS officials and experts, which yielded suggestions that three interrelated factors drive misalignment of healthcare quality measures:
- Dispersed decision making
- Variation in data collection and reporting systems
- Few meaningful measures adopted by payers, providers, and other stakeholders
GAO writes that misalignment among healthcare quality measures can have adverse effects on providers and efforts to improve quality of care. The agency states that HHS should prioritize development of electronic healthcare quality measures for core measures that HHS and private payers have agreed to use, and initiate efforts to develop more meaningful quality measures. Read more (PDF)…
Read the complete report (PDF)…
Study: Antibiotic use patterns may vary widely across smaller hospitals.
A study published online in the journal Clinical Infectious Diseases finds substantial variation in patterns of antibiotic use among small community hospitals (SCHs). The researchers reviewed antibiotic use reports for 19 hospitals within a single healthcare system. They found that total antibiotic use rates varied widely across the 15 SCHs, with overall use similar to rates in the 4 large community hospitals (LCHs), despite the larger hospitals treating more complex patients. The researchers state that use of broad-spectrum antibiotics ranged from 8 percent to 36 percent across SCHs, and from 26 percent to 37 percent among LCHs. They note that antibiotic stewardship programs were present in the LCHs but not the SCHs. Overall, case mix index, proportion of patient-days in specific unit types, and season were significant predictors of antibiotic use. Read more…
Read the abstract…
Florida.
HealthLeaders Media reports that, from September 2015 to September 2016, 5,283 instances of patient harm were prevented and $28.7 million was saved under the Florida Hospital Association Hospital Engagement Network (HEN) program. The HEN is part of the CMS Partnership for Patients initiative, made up of 77 hospitals that collaborate to improve bedside care, eliminate care disparities, create a culture of safety, and promote appropriate use of antibiotics. Participating hospitals focused on reducing infections and falls, improving medication safety, increasing safety for mothers and babies and preventing hospital readmissions. Read more…
Call for volunteers: NQF Admissions and Readmissions Standing Committee.
AAOS seeks to nominate members to the National Quality Forum (NQF) Admissions and Readmissions Standing Committee. The project will evaluate measures that can be used for accountability and public reporting of all-cause admissions and hospital readmissions. Applicants for this position must be active fellows, 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, a 100-word biosketch, and a letter of interest highlighting his or her expertise in the subject area. All supporting materials must be submitted to Kyle Shah by Nov. 1, 2016, at 11:59 p.m. CT, at: shah@aaos.org .
Learn more and submit your application…(member login required)
Call for volunteers: Work group on performance measures for the management of carpal tunnel syndrome.
The AAOS and the American Society for Surgery of the Hand (ASSH) are beginning a collaborative process of developing performance measures based on the 2016 Management of Carpal Tunnel Syndrome Clinical Practice Guideline. Subject matter experts are encouraged to apply no later than November 7, 2016. If you are a fellow, a member of one or both of these societies, and interested in participating on this work group, please contact Ryan Pezold for more details at: pezold@aaos.org.
