Archive for December, 2016


New Study: Social Risk Factors Affect Provider Performance and Patient Outcomes

Medicare patients with social risk factors fare worse than others in programs that measure quality and the providers that serve them also perform worse than others on quality measures.

This news comes from a new report presented to Congress by the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Planning Evaluation.

The report, mandated by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, focused on nine Medicare payment programs:

  1. the hospital readmissions reduction program
  2. the hospital value-based purchasing program
  3. the hospital acquired condition reduction program
  4. the Medicare Advantage (Part C) quality star rating program
  5. the Medicare shared savings program
  6. the physician value-based payment modifier program
  7. the end-stage renal disease quality incentive program
  8. the skilled nursing facility value-based purchasing program
  9. the home health value-based purchasing program

APSE concluded that:

  • Beneficiaries with social risk factors had worse outcomes on many quality measures, regardless of the providers they saw, and dual enrollment status was the most powerful predictor of poor outcomes.
  • Providers that disproportionately served beneficiaries with social risk factors tended to have worse performance on quality measures, even after accounting for their beneficiary mix. Under all five value-based purchasing programs in which penalties are currently

PA Chosen for Behavioral Health Services Demo

Pennsylvania will be one of eight states to participate in a new federal two-year Certified Community Behavioral Health Clinic demonstration program.

According to the federal Substance Abuse and Mental Health Services Administration, the program is

designed to improve behavioral health services in their communities. This demonstration is part of a comprehensive effort to integrate behavioral health with physical health care, increase consistent use of evidence-based practices, and improve access to high quality care for people with mental and substance use disorders.

A federal spokesperson explained that

The demonstration program will improve access to behavioral health services for Medicaid and CHIP beneficiaries, and will help individuals with mental and substance use disorders obtain the health care they need to maintain their health and well-being.

The program is authorized under Section 223 of the Protecting Access to Medicare Act of 2014. Last year the federal government awarded 24 states planning grants under the law. Nineteen of those states applied to participate in the program and eight, including Pennsylvania, were ultimately chosen.  The other states that will participate are Minnesota, Missouri, New York, New Jersey, Nevada, Oklahoma, and Oregon.

As part of its application, Pennsylvania designated ten sites for program implementation:

  • Berks

Medicare Program Biased Against Selected Hospitals

Medicare’s hospital-acquired conditions program unfairly penalizes large, large urban, and teaching hospitals, according to a new study.

According to “Complication Rates, Hospital Size, and Bias in the CMS Hospital-Acquired Condition Reduction Program,” published recently in the American Journal of Medical Quality, the hospital-acquired conditions program, which last year penalized nearly 800 hospitals, disproportionately penalizes large, large urban, and teaching hospitals because its threshold for identifying poor-performing hospitals is too broad, it relies on results that in many cases are not statistically different, and it fails to recognize when hospital performance improves.

To correct these biases, the study’s authors recommend adding risk-adjustment components, such as hospital size, to identify poor performers.

Learn more about the study, its findings, and its recommendation in this Fierce Healthcare article or go here to read the study on the web site of the American Journal of Medical Quality.…

Feds Launch Medicare-Medicaid ACO Model

The Center for Medicare and Medicaid Innovation has announced a new Medicare-Medicaid Accountable Care Organization Model that it says

…is focused on improving quality of care and reducing costs for Medicare-Medicaid enrollees. The MMACO Model builds on the Medicare Shared Savings Program (Shared Savings Program), in which groups of providers take on accountability for the Medicare costs and quality of care for Medicare patients. Through the Model, CMS will partner with interested states to offer new and existing Shared Savings Program ACOs the opportunity to take on accountability for the Medicaid costs for their assigned Medicare-Medicaid enrollees.

In this new model, the Innovation Center

… seeks to encourage participation from safety-net providers in Alternative Payment Models. Medicare-Medicaid ACOs that qualify as “Safety-Net ACOs” will be eligible to receive pre-payment of Medicare shared savings to support the ACO’s investment in care coordination infrastructure.

The Innovation Center envisions pursuing such undertakings with six states, which will be chosen on a competitive basis.

Learn more about the Medicare-Medicaid Accountable Care Organization model here, on the Innovation Center’s web site.…

New Sites Chart Rehab and Long-Term Hospital Quality

New web sites launched by the Centers for Medicare & Medicaid Services enable prospective patients to compare the quality of care at inpatient rehabilitation hospitals and long-term acute-care hospitals throughout the country.

The new sites are similar to the “Compare” site CMS operates for acute-care hospitals. The rehab hospital site compares quality performance measures for 1100 rehab hospitals and the long-term-care hospitals site facilitate such review and analysis for 420 such hospitals.

To learn more about the venture, go here for a CMS blog article on the new sites. Find the inpatient rehabilitation hospital Compare site here and the long-term acute-care Compare hospital site here.…