In The News

CMS Announcement of Proposed Rule for Implementation of the Medicare Diabetes Prevention Program (MDPP) Expanded Model

On July 13, 2017, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2018 Physician Fee Schedule (PFS) proposed rule that would make additional proposals to implement the Medicare Diabetes Prevention Program (MDPP) expanded model starting in 2018. The MDPP expanded model was announced in early 2016, when it was determined that the Diabetes Prevention Program (DPP) model test through the Center for Medicare and Medicaid Innovation’s Health Care Innovation Awards met the statutory criteria for expansion. Through expansion of this model test, more Medicare beneficiaries will be able to access evidence-based diabetes prevention services, potentially resulting in a lowered rate of progression to type 2 diabetes, improved health, and reduced costs.

The Medicare Diabetes Prevention Program expanded model is a structured intervention with the goal of preventing progression to type 2 diabetes in individuals with an indication of pre-diabetes. The clinical intervention, the result of National Institutes of Health-funded research, consists of a minimum of 16 intensive “core” sessions of a Centers for Disease Control and Prevention (CDC) approved curriculum furnished over six months in a group-based, classroom-style setting that provides practical training in long-term dietary change, increased physical activity, and behavior change strategies for weight control. After completing the core sessions, less intensive follow-up meetings furnished monthly will help ensure that the participants maintain healthy behaviors. The primary goal of the expanded model is at least 5 percent weight loss by participants.

The CY 2017 Medicare PFS final rule, published in November 2016, established the expansion and aspects of the expanded model policy framework. The CY 2018 PFS proposes additional policies necessary for suppliers to begin providing MDPP services nationally in 2018, including the MDPP payment structure, as well as additional supplier enrollment requirements and supplier compliance standards aimed to ensure program integrity. Services provided under the expanded model would largely be furnished in-person. We present a new proposal on beneficiary engagement incentives. We also include in this proposed rule amendments on previous policies finalized in the CY 2017 PFS regarding MDPP services and beneficiary eligibility.

CMS will accept comments on the proposed rule until September 11, 2017, and will respond to comments in a final rule. The proposed rule will appear in the July 13, 2017 Federal Register and can be downloaded from the Federal Register (PDF).

Final Recommendation Statement: Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Cardiovascular Risk Factors

July 11, 2017 – The U.S. Preventive Services Task Force released today a final recommendation statement on behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults without cardiovascular risk factors. The Task Force recommends that primary care professionals individualize the decision to offer or refer adults without obesity who do not have hypertension, dyslipidemia, abnormal blood glucose, or diabetes to behavioral counseling to promote a healthful diet and physical activity. To view the recommendation and the evidence on which it is based, please go to The final recommendation statement can also be found in the July 11 online issue of JAMA.

Now Available: 2017 CMS QRDA III Implementation Guide for Eligible Clinicians and Eligible Professionals, Schematron, and Sample Files

The Centers for Medicare & Medicaid Services (CMS) has published the 2017 CMS Quality Reporting Document Architecture Category III (QRDA III) Implementation Guide (IG) Version 1.0 (7/07/2017) for Eligible Clinicians and Eligible Professionals (EPs) Programs with Schematron and sample files. This version replaces the 2017 CMS QRDA III IG for Eligible Clinicians Reporting v0.1 (12/29/2016).

The 2017 CMS QRDA III IG for Eligible Clinicians and EPs provides technical instructions for QRDA III reporting for the following programs:

  • Merit-based Incentive Payment System (MIPS)
  • Comprehensive Primary Care Plus (CPC+)

The 2017 CMS QRDA III IG for Eligible Clinicians and EPs contains the following high-level changes compared with the reporting specifications in the 2016 CMS QRDA IG:

  • The 2017 IG is based on the Health Level Seven (HL7) QRDA Category III R1, Standard for Trial Use R2.1
  • For MIPS, Advancing Care Information (ACI) measures and Improvement Activities (IA) can be reported using the two new section templates: ACI Section and IA Section, respectively
  • A performance period must now be specified using the Reporting Parameters Act template that is contained within each section template for Quality (electronic clinical quality measures), ACI, and IA

The 2017 CMS QRDA III Schematron provides rules that enforce the conformance statements of the IG. QRDA III submissions to CMS for the 2017 performance period will be submitted through the new Quality Payment Program submissions API or via file upload on the Quality Payment Program website. CMS will provide immediate, clear, and actionable feedback at the time of submission which will enable submitters to be confident that they successfully submitted their data. If there is a problem with the submission, submitters will get the issue specifics right away – and be able to address them immediately. Exact validation feedback provided by the Quality Payment Program may differ, but this Schematron file will validate that a QRDA III file is properly structured and will help with file submission through the Quality Payment Program submission system.

The new Schematron and sample files for this IG replace the 2017 CMS QRDA III Schematrons and Sample Files for Eligible Clinicians Programs v0.1. For more details regarding the changes, visit the “Change Log” sections of the IG.

Additional QRDA-Related Resources:

You can find additional QRDA related resources, as well as current and past implementation guides, on the eCQI Resource Center and the CMS eCQM Library. For questions related to the QRDA Implementation Guides and/or Schematrons, visit the ONC QRDA JIRA Issue Tracker. For questions related to Quality Payment Program/MIPS submissions, visit the Quality Payment Program website or call 1-866-288-8292.

View Recent Quality Payment Program Webinar Recordings Online

Were you unable to participate in a recent Quality Payment Program webinar?

There’s good news: You can view webinar recordings, presentations, and transcripts on the CMS Quality Payment Program Events webpage.

Recent Quality Payment Program webinars include:

CMS encourages you to stay up to date on the Quality Payment Program by visiting the website regularly and subscribing to the Quality Payment Program listserv. To subscribe, visit the Quality Payment Program website and select “Subscribe to Email Updates” in the footer.

For More Information

If you have questions on other topics related to the Quality Payment Program, please contact the Quality Payment Program Service Center at or 1-866-288-8292.

Upcoming Webinar: CMS Innovation Center Medicare Quality Payment Program Year 2 Proposed Rule – All-Payer Combination Option

On Tuesday, July 18th at 2:00 p.m. EDT, the Centers for Medicare & Medicaid Services Innovation Center will host an overview webinar on the Medicare Quality Payment Program Year 2 proposed rule, with a focus on the participation of non-Medicare payers through the All-Payer Combination Option. This event is for all CMMI model participants, their partnering providers and the general public. Join the webinar to hear CMS policy experts provide an overview of proposed All-Payer Combination Option requirements for the Quality Payment Program.

Title: CMS Innovation Center Medicare Quality Payment Program Year 2 Proposed Rule - All-Payer Combination Option

Date: Tuesday, July 18 Time: 2:00 – 3:00 PM ET


New Special Publication from the NAM Now Available: Effective Care for High-Need Patients

Today, only 5% of patients account for nearly half of the nation's spending on health care. How do we improve care management for these patients while also balancing quality of care and costs?

To advance insights and perspectives on how to improve the care of these high-need patients, the National Academy of Medicine, with the guidance from an expert planning committee, convened three workshops to explore opportunities for improving care and outcomes for high-need patients.

Summarizing and building upon the workshop discussions, Effective Care for High-Need Patients, identifies key characteristics of the high-needs population and introduces a new patient taxonomy that segments high-need patients based on the care they need and how often they need it to help provide better care management to improve their health. It also includes insights into successful models of care and opportunities for a path forward.

Improving care for high-need patients is not only possible--it also contributes to a more sustainable health system. But progress will take a coordinated effort from policy makers, payers, providers, and researchers, as well as patients and their loved ones.

Read the NAM Special Publication.

What do we know about preventing dementia and cognitive decline?

With the rise of dementia and cognitive impairment as national health concerns, there have been a wide range of programs and products, such as diets, exercise regimens, games, and supplements, which claim to keep these conditions at bay. But, how do we know what actually might prevent or reduce risk of cognitive decline or dementia as we age?

To help sort through the data and to understand the current evidence for possible interventions, NIA commissioned a committee of experts through the National Academies of Sciences, Engineering and Medicine to conduct an extensive scientific review and provide recommendations.

The committee did not find sufficient evidence to recommend specific interventions to prevent cognitive decline or dementia. However, they did note “encouraging” evidence for three types of interventions: cognitive training, blood pressure control for people with hypertension, and increased physical activity.

Visit our website to read more about these findings.

Comment on National Quality Forum Framework to Measure Diagnostic Safety

A proposed measurement framework for diagnostic quality and safety developed by the National Quality Forum has been posted for public comment. Comments will inform recommendations for the development of priority measures to address measurement gaps in diagnostic accuracy. Public comment on this draft report and measurement framework is open through July 12. Please submit your comments on the project page or contact the NQF project team at with any questions.

Shining a Spotlight on the Opioid Crisis Through the Power of Data

By Anne Elixhauser, Ph.D.

As an AHRQ researcher, I get to dive into topics that matter to the American people using one of the most comprehensive health care databases—AHRQ's Healthcare Cost and Utilization Project, or HCUP. HCUP is the Nation’s most complete source of hospital-based data, including information on hospitalizations and emergency department (ED) visits for all patients, including those paid by government and private insurance as well as the uninsured.

Learning about data trends to help improve lives can mean swimming through very scary waters. Take the opioids crisis, for instance. There has been widespread attention given to opioid-related deaths in the media. A New York Times article recently estimated that nearly 60,000 people died from using an opioid drug in 2016 Link to Exit Disclaimer. On the other hand, the New York Times also wrote that opioid prescriptions have declined for the first time in two decades Link to Exit Disclaimer. These articles illustrate two very important aspects of the opioid crisis. But what about the people who don't die or are still being prescribed too many pills? And what about those who turn to heroin or other illicit opioids and overdose, but survive thanks to a visit to the hospital or emergency department (ED)?

It's hard to defeat a problem like the opioid epidemic until you know how bad the problem really is and what subgroups are affected disproportionately. That is what AHRQ is uniquely suited to provide—data on opioid hospitalizations and ED visits for specific population subgroups from our HCUP Fast Stats database. HCUP allows Secretary Price, other HHS agencies, policymakers, and frontline providers to best define the challenge, and ultimately, begin to measure how opioid addiction treatment and reduction efforts are working.

So what are the numbers? We highlighted some in a press release that is based on data in a new statistical brief on opioid-related hospitalizations and ED visits, by patient sex and age (PDF, 343 KB). The data are sobering:

  • Men and women were hospitalized at virtually the same rate nationwide in 2014—about 225 hospitalizations per 100,000 people. That's a 75 percent increase for women between 2005 and 2014, compared to only a 55 percent increase for men.
  • An infographic shows that in three-quarters of all States with available data, women had a higher rate of an opioid-related hospitalization than men in 2014.
  • However, men were still more likely to make opioid-related ED visits in 2014.
  • Individuals 25–44 years had the highest opioid-related ED visit rate in every State. But people 65 and older had the largest increases in opioid-related hospital stays and ED visits.

In July, we plan to release another statistical brief on opioid-related hospitalizations and ED visits by patient residence and income. This may also be a disturbing read, as the data will show, for example, that opioid-related ED visits increased the most in the lowest income communities from 2005 to 2014.

While none of these data are very encouraging, it is critical to have a better idea of why women are being hospitalized more than men or why 25–44 year-olds are visiting the ED more than other age groups, especially since we have 2015 and 2016 data for many States in the database and we are continuing to see the trend line for hospitalizations and ED visits going up.

That's why I am heartened by Secretary Price's request for additional funding for opioid abuse research. Recently, the Secretary awarded more than $70 million in grants to help prevent opioid overdose deaths. About $28 million of the grant money will go to medication-assisted treatment (MAT). AHRQ is investing about $12 million over 3 years in grants to explore how best to deliver MAT opioid abuse in rural areas and remove barriers to using MAT. Also, the recently enacted 21st Century Cures Act authorized the Substance Abuse and Mental Health Services Administration to award $485 million in grants for opioid abuse prevention, treatment, and recovery.

All these grants show HHS' dedication to halt the opioid epidemic. AHRQ will continue to play an important role monitoring the national and State data for opioid-related hospitalizations and ED visits—because that's our job.

Dr. Elixhauser is a Senior Researcher at AHRQ. She has worked with HCUP data for more than 20 years and is the author of more than 200 articles and reports.