In The News

CMS finalizes changes to the Comprehensive Care for Joint Replacement Model, cancels Episode Payment Models and Cardiac Rehabilitation Incentive Payment Model

Today, the Centers for Medicare & Medicaid Services (CMS) finalized the cancellation of the mandatory hip fracture and cardiac bundled payment models that were to be operated by the CMS Innovation Center and implemented changes to the Comprehensive Care for Joint Replacement (CJR) Model. These changes will offer greater flexibility and choice for hospitals in providing care to Medicare patients.

“While CMS continues to believe that bundled payment models offer opportunities to improve quality and care coordination while lowering spending, we believe that focusing on developing different bundled payment models and engaging more providers is the best way to drive health system change while minimizing burden and maintaining access to care. We anticipate announcing new voluntary payment bundles soon,” said CMS Administrator Seema Verma.

In the final rule, CMS is reducing the number of mandatory geographic areas participating in CJR from 67 areas to 34 areas. As part of the agency’s ongoing commitment to addressing the unique needs of rural providers, CMS is also making participation voluntary for all low volume and rural hospitals participating in the model in all 67 geographic areas. This regulation also includes an Interim Final Rule with Comment Period, in which CMS is establishing and seeking comment on a final policy to provide flexibility in determining episode costs for participant hospitals located in areas impacted by extreme and uncontrollable circumstances, such as the major hurricanes of 2017.

CMS is also finalizing the cancelation of the hip fracture and cardiac bundled payment and incentive payment models – the Episode Payment Models and the Cardiac Rehabilitation Incentive Payment Model – that were scheduled to begin on January 1, 2018. Not pursuing these models gives CMS greater flexibility to design and test innovations that will improve quality and care coordination across the in-patient and post-acute care spectrum.

Moving forward, CMS expects to increase opportunities for providers to participate in voluntary initiatives rather than large mandatory bundled payment models. The changes in the final rule will help position the agency to engage in future voluntary efforts.

For a technical fact sheet on the changes in this final rule and interim final rule with comment period, please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-11-30.html.

For more information on the Comprehensive Care for Joint Replacement Model, please visit: https://innovation.cms.gov/initiatives/cjr.

The final rule and interim final rule with comment (CMS-5524-F and IFC) can be downloaded from the Federal Register at https://www.federalregister.gov/public-inspection.

Management of Suspected Opioid Overdose with Naloxone by Emergency Medical Services Personnel

To determine optimal doses, routes of administration, and dosing strategies of naloxone for suspected opioid overdose in out-of-hospital settings, and whether transport to a hospital following successful opioid overdose reversal with naloxone is necessary.

[ FULL ARTICLE ]

Data from landmark NIH blood pressure study supports important part of new AHA/ACC hypertension guidelines

The new high blood pressure guidelines illustrate the utility and impact of NHLBI scientific studies.
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AHRQ’s EvidenceNOW Practices Named 2017 Million Hearts® Hypertension Control Champions

Five primary care practices participating in AHRQ’s EvidenceNOW project have been named as 2017 Million Hearts® Hypertension Control Champions. The award winners – three in New York, one each in Oklahoma and Wisconsin – are among 24 honorees that include primary care practices, individual clinicians and health systems. The honorees were recognized for achieving blood pressure control for at least 70 percent of their patients through innovations in health information technology and electronic health records, patient communication, and teamwork. EvidenceNOW, launched in May 2015, provides support services to 1,500 small and medium primary care practices with the objective of improving patients’ blood pressure and addressing other risk factors to improve heart health. Access more information about EvidenceNOW and the Million Hearts® Hypertension Control Champions here.  

Learn more about AHRQ research to transform primary care. Visit AHRQ’s National Center for Excellence in Primary Care Research here.

Advancing the Practice of Pain Management Under the HHS Opioid Strategy

By: Christopher M. Jones, PharmD, MPH and Vanila M. Singh, MD, MACM

Over the past 15 years, communities across America have been devastated by increasing prescription and illicit opioid abuse, addiction, and overdose.

In 2016, 11 million Americans misused prescription opioids, nearly 1 million used heroin, and 2.1 million had an opioid use disorder due to prescription opioids or heroin. And every day, an estimated 90 Americans die from an opioid overdose—resulting in more than 300,000 deaths since 2000.  Meanwhile, an estimated 25 million Americans experience pain every day. For many of these individuals, this pain interferes with their physical and mental health, work productivity, and ability to engage in social activities.

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Alzheimer’s assessment and management tools for primary care clinicians

Primary care clinicians are often the first to see older adults with memory loss or other signs of cognitive impairment. Three brief, online guides from NIA can help healthcare providers assess, manage, and support their patients with memory complaints or impairment:

Want more information and tools? See a list of practice tools, training curricula, publications, and other resources.

Back Pain: The Latest in Diagnosis and Management

Two rheumatologists review the latest in assessing and treating diseases of the spine.
[ Full article ]

EHC Program Update: Draft Report on Lower Limb Prosthesis; Final Report on Understanding Health-Systems’ Use of and Need for Evidence To Inform Decisionmaking

The Effective Health Care Program has posted the following on its Web site:

Draft Report

This draft report is available for comment until November 15, 2017.

Final Report

Effective Health Care Program https://effectivehealthcare.ahrq.gov/

New AHRQ Report Reviews Promising Strategies for Implementing Medication-Assisted Treatment for Opioid Use Disorder in Rural Primary Care

A new AHRQ report, Implementing Medication-Assisted Treatment for Opioid Use Disorder in Rural Primary Care: Environmental Scan examines factors that may limit access to medication-assisted treatment (MAT) for opioid use disorder (OUD) in rural primary care settings. Three innovative models of care, including the Vermont Hub and Spoke model, Project ECHO (Extension for Community Health Care Outcomes) from New Mexico, and the Office-Based Opioid Treatment with Buprenorphine (OBOT-B) Collaborative Care Model from Massachusetts, may help overcome a number of the challenges faced when implementing MAT services in rural primary care. Peer-reviewed articles and grey literature on implementing MAT for OUD were examined. The report also includes links and descriptions to nearly 250 tools and resources to support the delivery of MAT in rural primary care settings. Visit AHRQ’s Academy for Integrating Behavioral Health and Primary Care to download the report.

Other AHRQ Related Opioid Use Disorder Research

NIH to fund Centers of Excellence on Minority Health and Health Disparities

Twelve specialized research centers designed to conduct multidisciplinary research, research training, and community engagement activities focused on improving minority health and reducing health disparities will launch. The centers, to be funded by the National Institute on Minority Health and Health Disparities (NIMHD), part of the National Institutes of Health, will share approximately $82 million over five years, pending the availability of funds. [ FULL ARTICLE ]