Today’s Top Story
Study: Hospital employment of physicians may not by itself improve quality.
Findings from a study published online in the journal Annals of Internal Medicine suggest that hospital employment of physicians may not be associated with changes in quality of care. The research team conducted a retrospective cohort study of 2,888 acute care hospitals, 803 of which switched to an integration model and 2,085 that did not. Up to 2 years after conversion, they found no association between switching to an employment model and improvement in any of the following measures: risk-adjusted hospital-level mortality rate, 30-day readmission rate, length of stay, or patient satisfaction scores for common medical conditions. The research team noted that switching hospitals were more likely than comparison hospitals to be large or major teaching institutions, and less likely to be for-profit.
Read the abstract…
Other News
Would web-based tool make it easier for physicians to meet MACRA requirements?
Modern Healthcare reports that the U.S. Centers for Medicare & Medicaid Services (CMS) is considering the development of a web tool that would, among other things, help physicians estimate the impact on reimbursement under the merit-based incentive payment systems (MIPS) and evaluate their performance under the new system. Under MIPS, which is mandated under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), physician payments will be based on a compilation of quality measures and the use of electronic health records. Supporters of such a move say that it would make it easier for providers to improve performance. Critics argue that the tool could help some providers “game the system” and divert their focus from patient care to documentation.
Read more…(registration may be required)
Study: MFR may help improve pain and disability for patients with CLBP.
According to a study published online in the journal Spine, myofascial release (MFR) may be linked with improvement in pain and disability for patients with chronic low back pain (CLBP). The authors conducted a double-blind, randomized, sham-controlled trial of 54 patients with nonspecific CLBP; half the patients received four sessions of myofascial treatment and the other half received sham MFR. Compared to those in the sham cohort, patients who received MRF displayed significant improvements in pain and sensory Short Form McGill Pain questionnaire subscales, disability measured with the Roland Morris questionnaire, and fear avoidance based on the Fear-Avoidance Beliefs Questionnaire. However, the authors found no difference in pain across based on visual analogue scale. In addition, “as the minimal clinically important differences in pain and disability are included in the 95% [confidence interval], we cannot know if this improvement is clinically relevant,” they write.
Read the abstract…
CMS report on bundled care initiative finds decline in orthopaedic surgery costs.
CMS has released its annual report on the Models 2, 3, and 4 of the Bundled Payments for Care Improvement (BCPI) initiative. BPCI is designed to reward awardees for adopting practices that reduce Medicare payments for the bundle of services in the episode relative to a target price that CMS determines based on the provider’s historical payments for the same type of episode. The three models vary in definition and payment approach, with Model 2 being most widely adopted. The writers note that 74 percent of Model 2 episode initiators participated in major joint replacement of the lower extremity. The report finds that during the first year of BPCI, participating hospitals initiated 18,936 orthopaedic surgery episodes, of which approximately 90 percent were for major joint replacement of the lower extremity. Overall, average Medicare payments for the anchor hospitalization and the 90-day post-discharge period were estimated to have declined $864 (3 percent) more for orthopaedic surgery episodes initiated at BPCI hospitals than for orthopaedic surgery episodes initiated at comparison hospitals.
Read the report (PDF)…
MedPAC says CMS hospital star ratings may not offer “apples to apples” comparison; argues for simplification.
In a letter to the acting administrator of CMS, the Medicare Payment Advisory Commission (MedPAC) has offered comments on hospital star ratings found on the agency’s Hospital Compare website. Star rating is a summary score calculated using a weighted average of seven quality measure groups: mortality, readmissions, safety of care, patient experience, effectiveness of care, timeliness of care, and efficient use of medical imaging. The first four outcome groups are each weighted 22 percent of the summary score, while the last three groups are each weighted 4 percent. The agency found that, of 102 five-star hospitals, only 56 percent had a rating based on all four of the outcome groups, while of the 129 one-star hospitals, 98 percent were rated using all four of the outcome groups, suggesting that “a substantial share of the best-performing hospitals were not rated on a full set of outcome measures.” In addition, MedPAC argues that there are too many “overlapping hospital quality payment and reporting programs, which creates unneeded complexity in the Medicare program.” The agency encourages CMS to align star ratings as much as possible with existing CMS programs.
Read the letter (PDF)…
CMS webcast to help stakeholders understand 2015 Annual QRURs.
CMS will host a webcast to provide an overview of the 2015 Annual Quality and Resource Use Reports (QRURs). The 2015 Annual QRURs show how healthcare providers performed on quality and cost measures used to calculate the 2017 Value-Based Payment Modifier, and how that modifier will be applied to physician payments. The webcast will take place Thursday, Sept. 29, 2016, 1:30 – 3:00 p.m. ET. Phone lines will be available for participants who are unable to stream the webcast via computer.
Learn more and register for the webcast…
Learn more about the 2015 QRUR and the 2017 Value Modifier…
AAOS Board approves AUC on Management of Patients with Orthopaedic Implants Undergoing Dental Procedures.
The AAOS Board of Directors has approved a new set of Appropriate Use Criteria (AUC) addressing the administration of antibiotics prior to dental procedures in patients with joint replacement implants. The AUC, developed in a joint initiative with the American Dental Association, advise that most patients with replacement hip, knee, shoulder, or other implants are not at risk for periprosthetic infection following dental procedures. However, the guidelines recommend consideration of antibiotic administration for patients with severely compromised immune systems due to AIDS, uncontrolled diabetes, or recent history of joint infection; for patients taking certain medication for rheumatoid arthritis; or to prevent complications linked with organ transplant.
The AUC, available through the AAOS OrthoGuidelines website and app, include questions for clinicians to gauge risk related to the type of dental procedure, given the patient’s implant status and overall health. Each of the 64 scenarios has an antibiotic “appropriateness rating” from 1 to 9, which was determined by a 14-member voting panel of orthopaedic surgeons, dentists, oral surgeons, and epidemiologists.
Access the AUC…
View all AAOS AUC…
