The federal government seeks to pursue greater savings and an accelerated approach to value-based care through an overhaul of its programs for Medicare accountable care organizations.

The Centers for Medicare & Medicaid Services’ new “Pathways to Success” program seeks to speed up the process of providers assuming risk for costs and outcomes through the following changes from the agency’s current approach.

• A reduction in how long participating ACOs can remain in the program without assuming some responsibility for their spending.
• Modifications that CMS hopes will encourage physician groups to remain independent of hospitals and health systems.
• Greater flexibility to innovate in exchange for participating in performance-based risk.
• Permission to offer new incentives to patients to take greater responsibility for their own health.
• Incorporation of regional spending differences when setting individual ACOs’ target spending and to foster greater alignment with Medicare Advantage programs.

Learn more about CMS’s new Pathways to Success Program for Medicare ACOs by reading this program announcement and the regulation detailing how the ACO program will change.…

The 30-day mortality rate has risen for heart failure patients since Medicare’s hospital readmission reduction program was implemented.

According to a new study published in JAMA, the 30-day mortality rate for heart failure patients rose 0.49 percent between 2007-2010 and 2010-2012 and another 0.52 percent between 2010-2012 and 2012-2015.

Similar results were not found for the other types of patients whose readmission rates are measured under the program:  patients who were hospitalized for heart attacks, heart bypass surgery, pneumonia, chronic obstructive pulmonary disease, and hip or knee replacement.

The heart failure findings, though, raise the question of whether performance under the readmissions reduction program is a true barometer of the quality of care individual hospitals provide.

Learn more about the study, its findings, and their implications in the study “Association of the Hospital Readmissions Reduction Program With Mortality Among Medicare Beneficiaries Hospitalized for Heart Failure, Acute Myocardial Infarction, and Pneumonia,” which can be found here, on the JAMA web site.…

In 2019 the Centers for Medicare & Medicaid Services intends to create a new office to address regulatory reform.

CMS administrator Seema Verma recently announced her intention to create this office, but other than saying its priority would be to reduce regulatory burden, offered no details.

See a brief notice about the new office here.…

Every year the Congressional Budget Office publishes a menu of options for reducing federal spending and the federal budget deficit.  As in the past, this year’s compendium includes a number of options to reduce federal health care spending and raises federal revenue through health care initiatives.

The cost-cutting options include:

• establish caps on federal spending for Medicaid
• limit states’ taxes on health care providers
• reduce federal Medicaid matching rates
• change the cost-sharing rules for Medicare and restrict Medigap insurance
• raise the age of eligibility for Medicare to 67
• reduce Medicare’s coverage of bad debt
• consolidate and reduce federal payments for graduate medical education at teaching hospitals
• use an alternative measure of inflation to index social security and other mandatory programs

Options to raise additional revenue include:

• increase premiums for Parts B and D of Medicare
• reduce tax subsidies for employment-based health insurance
• increase the payroll tax rate for Medicare hospital insurance

Learn more about the CBO’s recommendations, how they might be implemented, and their potential implications in the CBO report Options for Reducing the Deficit: 2019 to 2028.…

The U.S. Department of Health and Human Services has issued a request for information about stakeholders’ views on regulations implementing the Health Insurance Portability and Accountability Act, popularly known as HIPAA, leading to conjecture that the administration may be planning to revise the federal government’s application of the federal health care privacy law enacted in 1996.

According to an HHS news release,

“This RFI is another crucial step in our Regulatory Sprint to Coordinated Care, which is taking a close look at how regulations like HIPAA can be fine-tuned to incentivize care coordination and improve patient care, while ensuring that we fulfill HIPAA’s promise to protect privacy and security,” said Deputy Secretary Hargan. “In addressing the opioid crisis, we’ve heard stories about how the Privacy Rule can get in the way of patients and families getting the help they need. We’ve also heard how the Rule may impede other forms of care coordination that can drive value. I look forward to hearing from the public on potential improvements to HIPAA, while maintaining the important safeguards for patients’ health information.”

“We are looking for candid feedback about how the existing HIPAA regulations are working in the real world and how we …