Reminder: Quality Payment Program Hardship Exception Application for the 2017 Transition Year Is Now Open
The Quality Payment Program Hardship Exception Application for the 2017 transition year is now available on the Quality Payment Program website.
MIPS eligible clinicians and groups may qualify for a reweighting of their Advancing Care Information performance category score to 0% of the final score, and can submit a hardship exception application, for one of the following specified reasons:
- Insufficient internet connectivity
- Extreme and uncontrollable circumstances
- Lack of control over the availability of Certified EHR Technology (CEHRT)
There are some MIPS eligible clinicians who are considered Special Status, who will be automatically reweighted (or, exempted in the case of MIPS eligible clinicians participating in a MIPS APM) and do not need to submit a Quality Payment Program Hardship Exception Application.
About the Hardship Exception Application Process
In addition to submitting an application via the Quality Payment Program website, clinicians may also contact the Quality Payment Program Service Center and work with a representative to verbally submit an application.
To submit an application, you’ll need:
- Your Taxpayer Identification Number (TIN) for group applications or National Provider Identifier (NPI) for individual applications;
- Contact information for the person working on behalf of the individual clinician or group, including first and last name, e-mail address, and telephone number; and
- Selection of hardship exception category (listed above) and supplemental information.
If you’re applying for a hardship exception based on the Extreme and Uncontrollable Circumstance category, you must select one of the following and provide a start and end date of when the circumstance occurred:
- Disaster (e.g., a natural disaster in which the CEHRT was damaged or destroyed)
- Practice or hospital closure
- Severe financial distress (bankruptcy or debt restructuring)
- EHR certification/vendor issues (CEHRT issues)
Please note: Once an application is submitted, you will receive a confirmation email that your application was submitted and is pending, approved, or dismissed. Applications will be processed on a rolling basis.
Immune system may mount an attack in Parkinson’s disease
NIH-funded study suggests role for specific immune cells in brain disease.
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. 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:
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.
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.
Predicting cognitive deficits in people with Parkinson’s disease
NIH-funded tool may improve clinical trial design and aid in treatment development.
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.
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 . On the other hand, the New York Times also wrote that opioid prescriptions have declined for the first time in two decades. 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.
CMS Releases 1991-2014 Health Care Spending by State
Data details health care spending for residents by service and major payer
Today, the Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary (OACT) released state-level health care spending data for the period 1991-2014. The data shows that while most states experienced faster growth in 2014 due to Medicaid expansion and enrollment in Exchange plans, per capita health spending in Medicaid expansion and non-expansion states grew at similar rates. The report also found that the most recent economic recession, which ended in 2009, and modest recovery since then, had a sustained impact on health spending and health insurance coverage. Every state experienced slower growth in per capita personal health care spending from 2010-2013 than experienced during the period 2004-2009.
David Lassman, the lead author of the report noted that, “recent economic and health sector factors have had clear impacts by state, both by payer and in the rates of overall per capita personal health care expenditure growth; however, during the 2009 to 2014 period, the variation in spending between the lowest and highest states was virtually unchanged.”
The report, published as a web first in Health Affairs, offers vital context for understanding how health spending varies across states. The analysis updates previous estimates published in 2011 and examines personal health care spending (or the health care goods and services consumed) through a resident-based view. These estimates are also presented both by type of goods and services (such as hospital services and retail prescription drugs) and by major payer (including Medicare, Medicaid, and private health insurance) for the individuals who reside in a state.
The topline findings from the report include:
- Considerable regional variation on personal health care spending:
- In 2014, the New England and Mideast regions had the highest levels of total per capita personal health care spending ($10,119 and $9,370, respectively), or 26 and 16 percent higher than the national average ($8,045).
- In contrast, the Rocky Mountain and Southwest regions had the lowest levels of total personal health care spending per capita in 2014 ($6,814 and $6,978, respectively) with average spending roughly 15 percent lower than the national average.
- Similar growth in Medicaid expansion and non-expansion states: While most states experienced faster growth in 2014 compared to 2013 due to Medicaid expansion and enrollment in Health Insurance Exchange plans, per capita health spending in Medicaid expansion and non-expansion states grew at similar rates, 4.4 and 4.5 percent respectively. The similar growth in per capita spending for expansion and non-expansion states was due largely to two effects:
- Faster growth in the use of healthcare goods and services in expansion states relative to non-expansion states due to a larger increase in the percent of people insured in those states.
- Faster growth in spending per insured person in non-expansion states relative to expansion states.
- Impact of recent economic recession and recovery: The most recent economic recession, which ended in 2009, and modest recovery since then, had a sustained impact on health spending and health insurance coverage.
- For 2010-2013, per capita personal health spending grew at a rate of 2.8 percent per year on average, substantially slower than during 2004-2009, when spending averaged 5.2 percent growth per year.
- During 2010-2013, every state experienced slower growth in per capita personal health care spending with an average deceleration of just over two percentage points compared to the 2004-2009 period.
- Three Major Payers:
- Medicare: States with above average per enrollee Medicare spending were generally located in the eastern United States while states with the lowest spending were generally in the western United States.
- The State with the highest per enrollee Medicare spending in 2014 was New Jersey ($12,614) with spending levels roughly 15 percent above the national average ($10,986).
- In 2014, Montana was the State with the lowest per enrollee Medicare spending, at $8,238 per enrollee (25 percent below the national average per enrollee).
- Medicaid: The recent trends in per enrollee spending were driven by the Medicaid coverage expansion, which increased the share of relatively less expensive enrollees relative to the previous Medicaid beneficiary population mix in expansion states.
- Total Medicaid spending increased 12.3 percent from 2013 to 2014 for states that expanded Medicaid, compared with 6.2 percent for states that did not expand Medicaid.
- However, on a per enrollee basis Medicaid spending declined considerably for the expansion states (-5.1 percent) in 2014, because of the enrollment of relatively less expensive enrollees, whereas per enrollee Medicaid spending in the non-expansion states increased 5.1 percent.
- Private Health Insurance: Per enrollee private health insurance spending was $4,551 in 2014, an average annual increase of 3.3 percent since 2009 ($3,872).
- Total private health insurance spending grew more rapidly in states that did not expand Medicaid eligibility by 2014 than in states that did expand eligibility, at rates of 6.8 percent and 4.6 percent, respectively.
- A majority of this difference reflects faster private health insurance enrollment growth in non-expansion states (3.2 percent) compared to that for expansion states (1.9 percent).
- Medicare: States with above average per enrollee Medicare spending were generally located in the eastern United States while states with the lowest spending were generally in the western United States.
NIAID scientists discover rare genetic susceptibility to common cold
Unusual case provides insight into leading cause of acute illness worldwide.
NOW AVAILABLE: Driving Action and Progress on Obesity Prevention and Treatment: Proceedings of a Workshop
After decades of increases in the obesity rate among U.S. adults and children, the rate recently has dropped among some populations, particularly young children. What are the factors responsible for these changes? How can promising trends be accelerated? What else needs to be known to end the epidemic of obesity in the United States?
To examine these and other pressing questions, the Roundtable on Obesity Solutions, of the National Academies of Sciences, Engineering, and Medicine, …
New Documentary on Difficulties Faced by Patients With Chronic Pain
Dr. Lynn Webster of Utah recently produced a documentary about pain treatment. The documentary, “The Painful Truth,” can be found online and on public television stations across the country and provides insight into the difficulties patients run into when trying to find effective treatment for chronic pain.
The patients featured in “The Painful Truth” include some who are fearful of losing access to opioid treatment, as well as those who say some doctors have refused to treat them and pharmacies have balked at filling their prescriptions. The apprehension among some pain patients that they won’t be able to get opioids has been reported in several media outlets, including STAT.
Webster acknowledged that several of the patients in his documentary are “miserable” even while taking opioids, and the documentary makes the point that better treatments are desperately needed. For now, however, he said opioid medications are often the best of several flawed options.
“With all of the focus on opioid addiction, we are forgetting many people with pain who have benefited,” he said. “It’s the only thing that keeps them from suicide.”
Critical Article from STAT
I was a fan of the author David Armstrong when he wrote for Wall Street Journal. However, his recent article on Lynn Webster’s documentary starts out with guilt by association. Roughly a year ago, Lynn called me and asked for advice on how to promote this documentary. At that time, he was passionate about the way pain management patients and their physicians are being unfairly shunned by society.
Armstrong notes that Dr. Webster and several of the experts he quotes in the program have long-standing financial relationships with pain medicine makers. When asked why these relationships are not disclosed to viewers, Webster told STAT that he did not receive any drug industry funding for the documentary. He said it was funded entirely by himself and his wife.
“I am cognizant of that issue, but I think I dealt with it as carefully as I could,” he said in an interview. If viewers want to know whether any of the individual doctors associated with the documentary have financial relationships with pharmaceutical makers, Webster said they can search for that information on the web.
Dr. Webster Paid for the Documentary Himself
I encourage the media to call Lynn and hear why he did this documentary and paid for it out of his own pocket. Yes, Lynn worked for industry but that is by no means his primary motivation to do this documentary. Go spend some time in a pain clinic and meet some patients who are truly in pain, this is by no means a binary issue.
“There are dozens of important stories about people with opioid addiction almost daily but rarely is there a story about people in pain,” Webster said in an email to STAT.
Does the Media Own Some Part of the Opioid Crisis?
It hit me recently that the Media needs to take some responsibility for the Opioid crisis, in 2004 when the Cox 2 inhibitors were slammed as “unsafe” there was no thought to what other alternative therapies that were available to alleviate pain. Had the media or the medical community for that matter, paid just a little attention and thought, the best Cox 2 inhibitors would have been hugely successful and companies would have reaped the benefit, but the opioid crisis might never have happened.
Comments from Tom Fogarty, MD
We reached out to Tom Fogarty, Founder of the Fogarty Institute and inventor of the catheter, who stated,
Opioid addiction is a serious and worldwide problem that is ever increasing. The reasons are multi-factorial, unfortunately a minority of physicians are responsible for this. A doctor’s sole purpose is to relieve pain and suffering and the vast majority adhere to that doctrine. The minority who knowingly do not, should be investigated and corrected. Continued excessive use of opioid prescriptions (easily documented) should be followed by fines and some other forms of punishment imposed upon the responsible physician. Chronic addiction to opioids and other drugs should be handled by specialists in the field of pain management. Dr. Lynn Webster and others should be looked to for resolution of these problems. The majority should not be punished, that is our patients, by inappropriate laws or recommendations.
Viewpoints Should Not Be Discounted Because of Past Work History
It always bothers me when I see someone’s viewpoints discounted simply because they have worked for industry in the past. The author is capable of doing better work.
Further, Aaron Pruitt, director of content at MontanaPBS, said he was “not aware” of any financial connections between Webster and companies that make opioid pain relievers. “If there is some evidence of that, I have seen nothing,” he said. After being directed to public disclosures of those relationships, Pruitt wrote in an email, “As far as I can tell, he has been working with companies to find safer, less addictive treatments for patients.”
In a pitch to television stations offered the documentary, the distributors write that “NETA and MontanaPBS have carefully reviewed The Painful Truth, and the credentials of Dr. Webster. We have found Dr. Webster to be one of the country’s experts on pain treatment, a past president of the American Academy of Pain Medicine, and an advocate for the safe prescription of opioids.”
Disclosure: the company I own, Rockpointe, receives grants from pharmaceutical and device manufacturers for accredited educational programs.
AHRQ Works: Building Bridges Between Research and Practice
Accelerating learning and innovation in health care delivery is what AHRQ does—every day. AHRQ tools take the “what” and translate it into the “how” by providing research-backed, practical tools that doctors and nurses can use to improve care.
Read and share this infographic about forgetfulness
Many people worry about becoming forgetful as they age. They think it is the first sign of Alzheimer’s disease. But forgetfulness can be a normal part of aging. Check out this infographic to see examples of mild forgetfulness versus signs of serious memory problems, like Alzheimer’s disease. Be sure to talk to your doctor if you have concerns.
Addressing Public Health Crises: Suicide and Opioid Addiction are Preventable
By: Judy Sarasohn, HHS (Public Affairs)
During National Public Health Week, April 3-9, we celebrate the progress we’ve made helping people live healthier lives and those public health professionals who have helped us make that progress. But one hallmark of public health is life expectancy, and the United States just experienced a drop in overall life expectancy for the first time since 1993. This was due in part to increases in two of the nation’s most heart-breaking and yet preventable public health issues facing us: the increasing rate of suicide and the increasing misuse of opioid drugs.
HHS Launches Webpage Highlighting Administrative Actions to Empower Patients
This week the Health and Human Services Department launched a new page on HHS.gov highlighting the regulatory and administrative actions the Department is taking to relieve the burden of the current healthcare law and support a patient-centered healthcare system.
“We’re taking action to improve choices for patients, stabilize the individual and small-group insurance markets, and expand access to more affordable coverage,” said Secretary Tom Price, M.D. “This page will be the place to go for updates on our ongoing efforts.”
The actions are part of a broader plan to repeal and replace the Affordable Care Act.
New measures will be announced as soon as is allowable by law. In particular, future actions will:
Lower costs and increase choices by providing relief from the burdensome regulations and fostering competition in insurance markets;
Work to ensure a stable transition period;
Offer states greater flexibility of their Medicaid programs to meet the needs of their most vulnerable populations; and
Increase the opportunities for patients to get the care they need when they need it.
Download New Resources to Guide Advanced Illness Care
NQP’s Case Study, Integrating Personal Preferences in Advanced Illness Care, follows Hazel, a 63-year-old-woman diagnosed with advanced lung cancer as she transitions through the healthcare system, from inpatient and post-acute care to palliative and hospice care. The case study illustrates how measures can support the six key preferences of person-centered advanced illness care identified in the NQP issue brief. More than 400 people participated in the March 15 launch of this case study. Listen to and share the virtual forum recording.
According to JAMA, 68% of physicians report feeling inadequately trained to discuss end-of-life care with patients. NQP’s Fact Sheet, Strategies for Change—A Collaborative Journey to Transform Advanced Illness Care, gives physicians, clinicians, and other providers questions to help guide conversations with patients, their families, and caregivers and further support person-centered advanced illness care.
NQP’s Advanced Illness Care Action Team (PDF) has issued a national call to action for healthcare systems, communities, policymakers, and other stakeholders to ensure that individuals with advanced illness, their families, and caregivers are at the center of care decisions.
Secretary Price Statement on CBO Report
Health and Human Services Secretary Tom Price, M.D., released the following statement today on the Congressional Budget Office (CBO) report on the American Health Care Act:
“The CBO report’s coverage numbers defy logic. They project that zeroing out the individual mandate – allowing Americans to choose whether to have insurance – will result in 14 million Americans opting out of coverage in one year. For there to be the reductions in coverage they project in just the first year, they assume five million Americans on Medicaid will drop off of health insurance for which they pay very little, and another nine million will stop participating in the individual and employer markets. These types of assumptions do not translate to the real world, and they do not accurately estimate the effects of this bill.
“The CBO report also does not incorporate two-thirds of the healthcare reform plan President Trump has called for – specifically the regulatory relief HHS can provide and the additional legislative reforms Congress is and will be pursuing. Our three-pronged approach will free patients to purchase coverage that works best for them at a price they can afford. Doctors and patients understand that, especially under current law, having coverage is not the same thing as having access to the care one wants or needs. Our approach will provide Americans with relief from the collapsing healthcare law, which never delivered on the benefits projected by the Congressional Budget Office in the first place.”
Offering states flexibility to increase market stability and affordable choices
Today, the Department of Health and Human Services (HHS), in partnership with the Department of the Treasury, suggested ways to help foster healthcare innovation by giving states greater flexibility.
“States need the flexibility to develop innovative healthcare models that will improve patient access to care, increase affordability and choices offered, lower premiums, and improve market stability,” said Health and Human Services Secretary Tom Price, M.D. “Today’s letter highlights State Innovation Waivers as opportunities for states to modify existing laws or create something entirely new to meet the unique needs of their communities.”
This World Kidney Day, pledge to maintain a healthy weight
NIH statement from Dr. Griffin P. Rodgers, Director, National Institute of Diabetes and Digestive and Kidney Diseases.
Roles of CMS and CDC in the Medicare Diabetes Prevention Program (MDPP) Expansion – March 22 Webinar Announced
The Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) will be hosting a co-led webinar on Wednesday, March 22nd from 1:00-2:00 p.m. EDT. The webinar will provide an overview of Medicare Diabetes Prevention Program Model (MDPP) expansion and the CDC Diabetes Prevention Recognition Program (DPRP), the requirements for pending and full CDC DPRP recognition, review the CDC recognition in the 2017 Physician Fee Schedule (PFS), and next steps for organizations thinking of offering MDPP. Registration is now open.
Opioids for chronic pain: a new clinical guideline from the VA and Department of Defense
The Veterans Administration and Department of Defense issue a clinical practice guideline regarding opioid therapy for chronic pain in veterans.
AHRQ’s EvidenceNOW Initiative Estimates Heart Health Needs in Primary Care
AHRQ’s EvidenceNow, an initiative that supports smaller primary care practices’ efforts to improve heart health, has found that participating practices regularly provide evidence-based care while recognizing the potential to improve on one or more of the heart health clinical services known as the ABCS: Aspirin use for high-risk individuals, Blood pressure control, Cholesterol management, and Smoking cessation counseling. EvidenceNOW provides support services typically not available to smaller primary care practices to help them improve the care they deliver. Baseline data from more than 1,000 primary care practices participating in EvidenceNOW indicate that while an average of more than 50 percent of patients are receiving each of the ABCS services, many practices have not yet reached the EvidenceNOW goal of 70 percent.
NIH consortium takes aim at vascular disease-linked cognitive impairment and dementia
MarkVCID brings team science approach to small vessel disease biomarkers in the brain.
Health Policy and Clinical Practice in the New Era of Quality
April 27th, 2016 executive notice by the US Department of Health and Human Services issued key provisions to the Medicare Access and Summary CHIP Reauthorization Act of 2015, (MACRA). MACRA replaced the 1997 Sustainable Growth Rate formula for determining Medicare reimbursement. MACRA provides a new approach in Medicare reimbursement based on value and quality care. MACRA legislation is guided by the Quality Payment Program, directing two paths for Medicare reimbursement: The Merit-based Incentive Payment System (MIPS), or the Advanced Alternative Payment Model (APM). Nurse Practitioners, require knowledge and information to prepare for MIPS and APM to begin January 1, 2017.
February is American Heart Month
Heart disease is the leading cause of death for men and women in the United States. February is American Heart Month, a great time for health care providers to share the facts about heart health with their patients, especially those who may be at high risk of heart attacks.
AHRQ has fact sheets for primary care health professionals to help their high-risk patients adopt the ABCS of heart disease prevention: Aspirin use by high-risk individuals, control their Blood pressure, lower their Cholesterol, and quit Smoking.
Native Americans Turning the Tide Against Diabetes
The tribal elder at Fort Berthold Reservation in western North Dakota had struggled with his diabetes for years. His blood glucose level was about twice what’s considered normal, his blood pressure was dangerously high, and he was overweight.
His health care provider talked to him about the need to address his diabetes and he was included in the tribal clinic’s diabetes registry, so they wouldn’t lose track of him. But he just didn’t take the steps necessary to manage his condition. Until one day, it apparently clicked.
Jared Eagle, Director of the Indian Health Service’s Special Diabetes Program for Indians (SPDI) at the reservation in New Town, said the man finally started taking advantage of the resources and care provided through the clinic. He started walking more; lost 20 to 30 pounds; and reduced his blood glucose and blood pressure levels.
“You can see him walking every day. He’s walking his dog every day, even in the winter,” Eagle said.
The story of this elder of the Mandan, Hidatsa and Arikara Nation (also known as the Three Affiliated Tribes) reflects the significant progress being made in Indian Country where Native Americans have a greater chance of having diabetes and kidney failure resulting from diabetes than any other U.S. racial or ethnic group, according to the Centers for Disease Control and Prevention. Nonetheless, the CDC also reported recently that kidney failure among Native Americans dropped by 54 percent between 1996 and 2013, the fastest rate for any racial or ethnic group in the U.S.
New Issue Brief Guides Advance Care Planning Conversations
In January 2016, the Centers for Medicare & Medicaid Services issued a final rule reimbursing physicians and other providers for discussing advanced care planning with patients and their families. However, studies show that nearly two-thirds of physicians feel inadequately trained to engage in end-of-life counseling. A new issue brief from National Quality Partners (NQP) helps healthcare providers better navigate these conversations through the lens of six key preferences of high-quality, person-centered advanced illness care.
NQP’s Advanced Illness Care Action Team—which includes more than 25 patient advocates, physicians, hospital systems, and other stakeholders from the public and private sectors—identified purpose and connection, physical comfort, emotional and psychological well-being, family and caregiver support, financial security, and peaceful death and dying as key preferences of individuals with advanced illness. By placing individuals at the center as the guiding North Star of all healthcare decisions, this initiative calls on the nation to transform advanced illness care and to engage patients, families, and caregivers as true partners in care planning.
Download the issue brief now to explore these key preferences in depth, along with snapshots of organizations that have embraced one or more of these preferences. Register for NQP’s March 15 webinar to delve into case studies demonstrating how physicians, nursing homes, and home health agencies can integrate these preferences into existing quality efforts.