A new study by the RAND corporation for HHS argues that HHS should create a standardized national strategy for value-based purchasing (VBP). The study recommends that HHS focus on three critical areas to drive the federal government’s effective use of VBP:
Develop a national strategy: The study recommends that HHS work with other federal agencies such as the CMS and the Agency for Healthcare Research and Quality to formulate a strategy. Included in the strategy should be clearly defined government goals for VBP and what it considers successful outcomes.
Define and coordinate a research strategy: HHS should develop well-defined research to figure out how effective VBP programs are and what factors contribute to successful VBP programs.
Create a development strategy for measures that support VBP programs: A transition to VBP requires efficient, streamlined performance measures; these measures should incorporate processes of care, patient outcomes, and proper use of services.
Experts are describing the upcoming conversion to ICD-10 as chaotic, but suggest providers can avoid this by making sure they prepare ahead of time. CMS administrators have already stated that they will not postpone the October 1, 2014 start date for the conversion. This past week, CMS authorized contractors processing Medicare claims to perform one-way testing with certain providers submitting ICD-10 coded claims; CMS officials have also stated that they plan on conducting more robust end-to-end testing during the summer. As of now, providers should invest in physician training on documentation “with the more complex and granular ICD-10 codes” as a “key mitigation strategy.” In addition, improving external and internal organizational communication between technology systems vendors, internal IT departments, health information management staff and physicians is key to a smooth transition.
President Obama will allow a two-year extension for those people whose individual health insurance policies do not comply with the ACA. Although details about the extension have not yet been discussed, it is reported that it will be valid for policies issued up to October 1, 2016. It is not yet clear how many people will be affected by this change; half the states have already allowed insurance companies to extend canceled policies for a year. It is also not yet known if policyholders will find any financial relief since some insurers (in those states where extensions are allowed for 2014) have said they plan on increasing the price of those plans.
According to a study by the Centers for Disease Control and Prevention (CDC), some hospitals reported prescribing three times more antibiotics than others. Incorrectly prescribed antibiotics contribute to the increase of antibiotic-resistant infections. Researchers concluded that hospitals could improve antibiotics prescription in 37.2 percent of the most common prescription scenarios reviewed by implementing formal programs to teach staff about how to appropriately prescribe antibiotics.
CMS is examining ways to improve its Medicare recovery audit program (RAC) and recently provided details into ways it plans on doing so. According to officials, CMS is applying a multi-pronged approach to improve the RAC program and is now in the beginning stages of re-competing the current RACs. Some of the changes CMS is considering include allowing providers more time to respond to denials (around 30 days) and ensuring RACs do not receive contingency fees until the second level of an appeal has been exhausted.
President Obama is proposing more than $400 billion in Medicare cuts over the next decade in his fiscal 2015 budget. However, most of those cuts are weighted towards future years, with only $3.5 billion occurring during 2015. In addition, the budget for HHS will be reduced by $6.1 billion, or 7.6% from the current budget. Although the President “lauds efforts to find a solution” to the Medicare SGR, he does not include an outline of a way to pay for the fix. Other incentives in the budget include increasing funding for mental health programs for children, prohibiting pharmaceutical companies from delaying the availability of generic drugs, and expanding “quality incentives” for Medicare prescription drug plans. Many national healthcare organizations oppose Medicare payment cuts, believing that they undermine providers’ ability to improve the healthcare system. The budget also notes Medicare’s transformation from a “passive payer” to an “effective purchaser of high quality, efficient care.” Furthermore, the budget highlights the ACA’s value based purchasing program and the requirement of the CMS to develop plans to implement value-based purchasing programs for SNFs, home health agencies, and ambulatory surgery centers.
According to a newly released government report, approximately 22 percent of Medicare beneficiaries experienced an adverse event during a post-hospitalization skilled nursing facility stay in fiscal year 2011. Researchers have noted that most of the these events were preventable; post-acute provider groups claim to have many initiatives currently underway to lower this percentage.
Investigators analyzed 655 Medicare beneficiaries who had a SNF stay of 35 days or less. The data was then analyzed by two panels to see if an adverse event had occurred; almost 60 percent of these events were likely preventable. In regards to the adverse effects, 37 percent were related to medications, 37 percent were related to resident care issues, and 26 percent were related to infections.
The report includes a list of recommendations; one of these recommendations is for CMS to collaborate with The Agency for Healthcare Research & Quality to compile a list of potentially reportable events for LTC facilities that can be used to educate staff.