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Incentives are key to patient-centered medical home success
The keys to a successful medical home may be the incentives added to the structural changes made to a practice.
“Medical home interventions that incentivize activities in addition to structural transformation may produce larger improvements in patient care,” Dr. Mark W. Friedberg of the RAND Corp. and his colleagues wrote in study published June 1 in JAMA Internal Medicine.
Dr. Friedberg and colleagues examined performance on six quality measures for diabetes care and cancer screening, as well as use of hospital, emergency department, and ambulatory care, comparing the northeast region of the Pennsylvania Chronic Care Initiative (PACCI) with the rest of the network. Unlike other PACCI regions, practices in the northeast region were eligible for shared savings – but no penalties – based on meeting quality benchmarks.
By the third year, participating practices were “statistically significantly associated with lower rates of all-cause hospitalization per 1,000 patients per month, all-cause emergency department visits, ambulatory care–sensitive emergency department visits, and ambulatory visits to specialists, and with higher rates of ambulatory primary care visits,” Dr. Friedberg and his colleagues wrote (JAMA Intern. Med. [doi:10.1001/jamainternmed.2015.2047]).
They suggested the improvements were because of the shared savings bonuses, regular feedback on utilization, and lack of an early-achievement incentive. Together, those factors “potentially [enhanced] participating practices’ abilities to focus on learning collaborative activities and other process improvement efforts.”
The researchers called for additional studies “to determine empirically whether these features or others are indeed the key ‘active ingredients’ in medical home interventions. Continuing experimentation and careful evaluation of the features of medical home interventions can inform the design of future programs intended to strengthen primary care.”
The study was sponsored by the Commonwealth Fund.
The jury remains out on the viability of the patient-centered medical home model of health care delivery, as different studies are offering varied results, according to George Jackson, Ph.D., and Dr. John Williams.
In particular, the research by Dr. Mark Friedberg does not “does not address one of the hoped-for benefits of PCMH, namely, reducing health care costs,” the two noted.
“PCMH represents a framework for changing health care systems to provide efficient, patient-centered care aimed at improving the satisfaction of patients and staff. However, changing systems requires more than just a framework,” they wrote. “It also requires a concept of what evidence-based, high-quality care looks like (e.g., through practice guidelines), a strategy for changing what actually happens on the ground (e.g., lean management or plan-do-study-act cycles), and, frequently, a learning model that will spread the changes across practices or organizations (e.g., quality improvement learning collaboratives). If a PCMH program does not lead to desired outcomes, it could be because of a breakdown in one or more of these areas.”
George Jackson, Ph.D., and Dr. John Williams are both with the Center for Health Services Research in Primary Care at the Durham (N.C.) Veterans Affairs Medical Center. Their comments were made in an editorial accompanying the study ([doi:10.1001/jamainternmed.2015.2067]). No conflicts of interest were reported.
The jury remains out on the viability of the patient-centered medical home model of health care delivery, as different studies are offering varied results, according to George Jackson, Ph.D., and Dr. John Williams.
In particular, the research by Dr. Mark Friedberg does not “does not address one of the hoped-for benefits of PCMH, namely, reducing health care costs,” the two noted.
“PCMH represents a framework for changing health care systems to provide efficient, patient-centered care aimed at improving the satisfaction of patients and staff. However, changing systems requires more than just a framework,” they wrote. “It also requires a concept of what evidence-based, high-quality care looks like (e.g., through practice guidelines), a strategy for changing what actually happens on the ground (e.g., lean management or plan-do-study-act cycles), and, frequently, a learning model that will spread the changes across practices or organizations (e.g., quality improvement learning collaboratives). If a PCMH program does not lead to desired outcomes, it could be because of a breakdown in one or more of these areas.”
George Jackson, Ph.D., and Dr. John Williams are both with the Center for Health Services Research in Primary Care at the Durham (N.C.) Veterans Affairs Medical Center. Their comments were made in an editorial accompanying the study ([doi:10.1001/jamainternmed.2015.2067]). No conflicts of interest were reported.
The jury remains out on the viability of the patient-centered medical home model of health care delivery, as different studies are offering varied results, according to George Jackson, Ph.D., and Dr. John Williams.
In particular, the research by Dr. Mark Friedberg does not “does not address one of the hoped-for benefits of PCMH, namely, reducing health care costs,” the two noted.
“PCMH represents a framework for changing health care systems to provide efficient, patient-centered care aimed at improving the satisfaction of patients and staff. However, changing systems requires more than just a framework,” they wrote. “It also requires a concept of what evidence-based, high-quality care looks like (e.g., through practice guidelines), a strategy for changing what actually happens on the ground (e.g., lean management or plan-do-study-act cycles), and, frequently, a learning model that will spread the changes across practices or organizations (e.g., quality improvement learning collaboratives). If a PCMH program does not lead to desired outcomes, it could be because of a breakdown in one or more of these areas.”
George Jackson, Ph.D., and Dr. John Williams are both with the Center for Health Services Research in Primary Care at the Durham (N.C.) Veterans Affairs Medical Center. Their comments were made in an editorial accompanying the study ([doi:10.1001/jamainternmed.2015.2067]). No conflicts of interest were reported.
The keys to a successful medical home may be the incentives added to the structural changes made to a practice.
“Medical home interventions that incentivize activities in addition to structural transformation may produce larger improvements in patient care,” Dr. Mark W. Friedberg of the RAND Corp. and his colleagues wrote in study published June 1 in JAMA Internal Medicine.
Dr. Friedberg and colleagues examined performance on six quality measures for diabetes care and cancer screening, as well as use of hospital, emergency department, and ambulatory care, comparing the northeast region of the Pennsylvania Chronic Care Initiative (PACCI) with the rest of the network. Unlike other PACCI regions, practices in the northeast region were eligible for shared savings – but no penalties – based on meeting quality benchmarks.
By the third year, participating practices were “statistically significantly associated with lower rates of all-cause hospitalization per 1,000 patients per month, all-cause emergency department visits, ambulatory care–sensitive emergency department visits, and ambulatory visits to specialists, and with higher rates of ambulatory primary care visits,” Dr. Friedberg and his colleagues wrote (JAMA Intern. Med. [doi:10.1001/jamainternmed.2015.2047]).
They suggested the improvements were because of the shared savings bonuses, regular feedback on utilization, and lack of an early-achievement incentive. Together, those factors “potentially [enhanced] participating practices’ abilities to focus on learning collaborative activities and other process improvement efforts.”
The researchers called for additional studies “to determine empirically whether these features or others are indeed the key ‘active ingredients’ in medical home interventions. Continuing experimentation and careful evaluation of the features of medical home interventions can inform the design of future programs intended to strengthen primary care.”
The study was sponsored by the Commonwealth Fund.
The keys to a successful medical home may be the incentives added to the structural changes made to a practice.
“Medical home interventions that incentivize activities in addition to structural transformation may produce larger improvements in patient care,” Dr. Mark W. Friedberg of the RAND Corp. and his colleagues wrote in study published June 1 in JAMA Internal Medicine.
Dr. Friedberg and colleagues examined performance on six quality measures for diabetes care and cancer screening, as well as use of hospital, emergency department, and ambulatory care, comparing the northeast region of the Pennsylvania Chronic Care Initiative (PACCI) with the rest of the network. Unlike other PACCI regions, practices in the northeast region were eligible for shared savings – but no penalties – based on meeting quality benchmarks.
By the third year, participating practices were “statistically significantly associated with lower rates of all-cause hospitalization per 1,000 patients per month, all-cause emergency department visits, ambulatory care–sensitive emergency department visits, and ambulatory visits to specialists, and with higher rates of ambulatory primary care visits,” Dr. Friedberg and his colleagues wrote (JAMA Intern. Med. [doi:10.1001/jamainternmed.2015.2047]).
They suggested the improvements were because of the shared savings bonuses, regular feedback on utilization, and lack of an early-achievement incentive. Together, those factors “potentially [enhanced] participating practices’ abilities to focus on learning collaborative activities and other process improvement efforts.”
The researchers called for additional studies “to determine empirically whether these features or others are indeed the key ‘active ingredients’ in medical home interventions. Continuing experimentation and careful evaluation of the features of medical home interventions can inform the design of future programs intended to strengthen primary care.”
The study was sponsored by the Commonwealth Fund.
FROM JAMA INTERNAL MEDICINE
June 2015: Click for Credit
Here are 6 articles in the June issue of Clinician Reviews (accreditation valid until January 1, 2016):
1. ACCP and CTS Issue Joint Guideline on COPD Exacerbations
To take the posttest, go to: http://bit.ly/1EIadmv
VITALS
Key clinical point: The American College of Chest Physicians and the Canadian Thoracic Society have issued a guideline for prevention of acute exacerbations of COPD.
Major finding: COPD exacerbations are acute, trajectory changing, and often deadly manifestations of a chronic disease.
Data source: A comprehensive literature review on prevention of acute COPD exacerbations and a compilation of 33 recommendations and suggestions for clinicians in clinical practice.
Disclosures: The American College of Chest Physicians, the Canadian Thoracic Society, and the American Thoracic Society supported the project. Dr Criner reported having no relevant financial disclosures; his associates reported ties to numerous industry sources.
2. GI Symptoms Common in Parkinson Disease and Related Disorders
To take the posttest, go to: http://bit.ly/1AZSaXA
VITALS
Key clinical point: GI symptoms were linked with specific motor and nonmotor features of Parkinson disease and related disorders.
Major finding: Constipation was the most common symptom among all three parkinsonian disorders.
Data source: Multicenter, cross-sectional survey of 473 patients with Parkinson disease, atypical parkinsonism, or vascular parkinsonism.
Disclosures: The Collaborative Clinical Research Fund of Boramae Medical Center partially funded the work. The authors declared no relevant conflicts of interest.
3. Aerosolized Measles Vaccine Inferior to Subcutaneous
To take the posttest, go to: http://bit.ly/1RKJizC
VITALS
Key clinical point: An aerosolized measles vaccine was immunogenic but inferior to the subcutaneous vaccine at inducing seropositivity among babies residing in rural India.
Major finding: The primary endpoint—seropositivity for antibodies against measles at 91 days after vaccination—was 85.4% for aerosolized vaccine and 94.6% for subcutaneous.
Data source: An open-label, randomized noninferiority trial comparing aerosolized vs subcutaneous measles vaccination in 2,004 infants ages 9 to 11.9 months in villages in India.
Disclosures: This study was funded by the Bill and Melinda Gates Foundation. The Serum Institute of India provided vaccines free of charge, and Aerogen provided the delivery devices free of charge. Dr Low reported several grants plus monies paid to her institution from the World Health Organization for projects about vaccines and sexually transmitted infections; her associates reported ties to the Serum Institute of India, Aerogen, and Dance Biopharm. One associate has a patent pending on an aerosol device licensed to Novartis and another has a patent pending related to vaccine nebulizers.
4. Unrecognized Diabetes Common in Acute MI
To take the posttest, go to: http://bit.ly/1IB9sC8
VITALS
Key clinical point: Many patients presenting with acute MI had unrecognized diabetes, which, in most cases, remained undiagnosed, untreated, and unrecorded.
Major finding: Of 2,854 (10%) patients enrolled in an MI registry, 287 had A1C levels of 6.5% or higher on routine laboratory testing during hospitalization for acute MI, but treating physicians recognized only 101 of these cases of diabetes (35%).
Data source: A retrospective cohort study involving 2,854 adults presenting with acute MI to 24 US medical centers in a 3.5-year period.
Disclosures: This study was sponsored by the National Heart, Lung, and Blood Institute and supported by a research grant from Genentech. Dr Arnold reported receiving honoraria from Novartis; her associates reported ties to numerous industry sources.
5. Methotrexate and Biologics Linked to Higher Zoster Risk in Psoriasis
To take the posttest, go to: http://bit.ly/1AZScyF
VITALS
Key clinical point: The combination of methotrexate and biologics for the treatment of psoriasis may increase risk for herpes zoster.
Major finding: Combination therapy with both biologic medications and methotrexate was associated with a significant 66% increase in the incidence of herpes zoster over more than 11 years of follow-up.
Data source: Analysis of medical records for 95,941 patients with psoriasis.
Disclosures: One author reported consultancies and research grants from a range of pharmaceutical companies. There were no other disclosures.
6. ACP: Avoid ECG, MPI Cardiac Screening in Low-risk Patients
To take the posttest, go to: http://bit.ly/1e3NLha
Here are 6 articles in the June issue of Clinician Reviews (accreditation valid until January 1, 2016):
1. ACCP and CTS Issue Joint Guideline on COPD Exacerbations
To take the posttest, go to: http://bit.ly/1EIadmv
VITALS
Key clinical point: The American College of Chest Physicians and the Canadian Thoracic Society have issued a guideline for prevention of acute exacerbations of COPD.
Major finding: COPD exacerbations are acute, trajectory changing, and often deadly manifestations of a chronic disease.
Data source: A comprehensive literature review on prevention of acute COPD exacerbations and a compilation of 33 recommendations and suggestions for clinicians in clinical practice.
Disclosures: The American College of Chest Physicians, the Canadian Thoracic Society, and the American Thoracic Society supported the project. Dr Criner reported having no relevant financial disclosures; his associates reported ties to numerous industry sources.
2. GI Symptoms Common in Parkinson Disease and Related Disorders
To take the posttest, go to: http://bit.ly/1AZSaXA
VITALS
Key clinical point: GI symptoms were linked with specific motor and nonmotor features of Parkinson disease and related disorders.
Major finding: Constipation was the most common symptom among all three parkinsonian disorders.
Data source: Multicenter, cross-sectional survey of 473 patients with Parkinson disease, atypical parkinsonism, or vascular parkinsonism.
Disclosures: The Collaborative Clinical Research Fund of Boramae Medical Center partially funded the work. The authors declared no relevant conflicts of interest.
3. Aerosolized Measles Vaccine Inferior to Subcutaneous
To take the posttest, go to: http://bit.ly/1RKJizC
VITALS
Key clinical point: An aerosolized measles vaccine was immunogenic but inferior to the subcutaneous vaccine at inducing seropositivity among babies residing in rural India.
Major finding: The primary endpoint—seropositivity for antibodies against measles at 91 days after vaccination—was 85.4% for aerosolized vaccine and 94.6% for subcutaneous.
Data source: An open-label, randomized noninferiority trial comparing aerosolized vs subcutaneous measles vaccination in 2,004 infants ages 9 to 11.9 months in villages in India.
Disclosures: This study was funded by the Bill and Melinda Gates Foundation. The Serum Institute of India provided vaccines free of charge, and Aerogen provided the delivery devices free of charge. Dr Low reported several grants plus monies paid to her institution from the World Health Organization for projects about vaccines and sexually transmitted infections; her associates reported ties to the Serum Institute of India, Aerogen, and Dance Biopharm. One associate has a patent pending on an aerosol device licensed to Novartis and another has a patent pending related to vaccine nebulizers.
4. Unrecognized Diabetes Common in Acute MI
To take the posttest, go to: http://bit.ly/1IB9sC8
VITALS
Key clinical point: Many patients presenting with acute MI had unrecognized diabetes, which, in most cases, remained undiagnosed, untreated, and unrecorded.
Major finding: Of 2,854 (10%) patients enrolled in an MI registry, 287 had A1C levels of 6.5% or higher on routine laboratory testing during hospitalization for acute MI, but treating physicians recognized only 101 of these cases of diabetes (35%).
Data source: A retrospective cohort study involving 2,854 adults presenting with acute MI to 24 US medical centers in a 3.5-year period.
Disclosures: This study was sponsored by the National Heart, Lung, and Blood Institute and supported by a research grant from Genentech. Dr Arnold reported receiving honoraria from Novartis; her associates reported ties to numerous industry sources.
5. Methotrexate and Biologics Linked to Higher Zoster Risk in Psoriasis
To take the posttest, go to: http://bit.ly/1AZScyF
VITALS
Key clinical point: The combination of methotrexate and biologics for the treatment of psoriasis may increase risk for herpes zoster.
Major finding: Combination therapy with both biologic medications and methotrexate was associated with a significant 66% increase in the incidence of herpes zoster over more than 11 years of follow-up.
Data source: Analysis of medical records for 95,941 patients with psoriasis.
Disclosures: One author reported consultancies and research grants from a range of pharmaceutical companies. There were no other disclosures.
6. ACP: Avoid ECG, MPI Cardiac Screening in Low-risk Patients
To take the posttest, go to: http://bit.ly/1e3NLha
Here are 6 articles in the June issue of Clinician Reviews (accreditation valid until January 1, 2016):
1. ACCP and CTS Issue Joint Guideline on COPD Exacerbations
To take the posttest, go to: http://bit.ly/1EIadmv
VITALS
Key clinical point: The American College of Chest Physicians and the Canadian Thoracic Society have issued a guideline for prevention of acute exacerbations of COPD.
Major finding: COPD exacerbations are acute, trajectory changing, and often deadly manifestations of a chronic disease.
Data source: A comprehensive literature review on prevention of acute COPD exacerbations and a compilation of 33 recommendations and suggestions for clinicians in clinical practice.
Disclosures: The American College of Chest Physicians, the Canadian Thoracic Society, and the American Thoracic Society supported the project. Dr Criner reported having no relevant financial disclosures; his associates reported ties to numerous industry sources.
2. GI Symptoms Common in Parkinson Disease and Related Disorders
To take the posttest, go to: http://bit.ly/1AZSaXA
VITALS
Key clinical point: GI symptoms were linked with specific motor and nonmotor features of Parkinson disease and related disorders.
Major finding: Constipation was the most common symptom among all three parkinsonian disorders.
Data source: Multicenter, cross-sectional survey of 473 patients with Parkinson disease, atypical parkinsonism, or vascular parkinsonism.
Disclosures: The Collaborative Clinical Research Fund of Boramae Medical Center partially funded the work. The authors declared no relevant conflicts of interest.
3. Aerosolized Measles Vaccine Inferior to Subcutaneous
To take the posttest, go to: http://bit.ly/1RKJizC
VITALS
Key clinical point: An aerosolized measles vaccine was immunogenic but inferior to the subcutaneous vaccine at inducing seropositivity among babies residing in rural India.
Major finding: The primary endpoint—seropositivity for antibodies against measles at 91 days after vaccination—was 85.4% for aerosolized vaccine and 94.6% for subcutaneous.
Data source: An open-label, randomized noninferiority trial comparing aerosolized vs subcutaneous measles vaccination in 2,004 infants ages 9 to 11.9 months in villages in India.
Disclosures: This study was funded by the Bill and Melinda Gates Foundation. The Serum Institute of India provided vaccines free of charge, and Aerogen provided the delivery devices free of charge. Dr Low reported several grants plus monies paid to her institution from the World Health Organization for projects about vaccines and sexually transmitted infections; her associates reported ties to the Serum Institute of India, Aerogen, and Dance Biopharm. One associate has a patent pending on an aerosol device licensed to Novartis and another has a patent pending related to vaccine nebulizers.
4. Unrecognized Diabetes Common in Acute MI
To take the posttest, go to: http://bit.ly/1IB9sC8
VITALS
Key clinical point: Many patients presenting with acute MI had unrecognized diabetes, which, in most cases, remained undiagnosed, untreated, and unrecorded.
Major finding: Of 2,854 (10%) patients enrolled in an MI registry, 287 had A1C levels of 6.5% or higher on routine laboratory testing during hospitalization for acute MI, but treating physicians recognized only 101 of these cases of diabetes (35%).
Data source: A retrospective cohort study involving 2,854 adults presenting with acute MI to 24 US medical centers in a 3.5-year period.
Disclosures: This study was sponsored by the National Heart, Lung, and Blood Institute and supported by a research grant from Genentech. Dr Arnold reported receiving honoraria from Novartis; her associates reported ties to numerous industry sources.
5. Methotrexate and Biologics Linked to Higher Zoster Risk in Psoriasis
To take the posttest, go to: http://bit.ly/1AZScyF
VITALS
Key clinical point: The combination of methotrexate and biologics for the treatment of psoriasis may increase risk for herpes zoster.
Major finding: Combination therapy with both biologic medications and methotrexate was associated with a significant 66% increase in the incidence of herpes zoster over more than 11 years of follow-up.
Data source: Analysis of medical records for 95,941 patients with psoriasis.
Disclosures: One author reported consultancies and research grants from a range of pharmaceutical companies. There were no other disclosures.
6. ACP: Avoid ECG, MPI Cardiac Screening in Low-risk Patients
To take the posttest, go to: http://bit.ly/1e3NLha
With SGR repeal, Medicare refocuses on value
It’s value over volume for Medicare now that the Medicare Access and CHIP Reauthorization Act of 2015 is law.
“This shift in what the country faces in a disease burden really aligns and is helped and facilitated by this updating Medicare to this new disease environment,” Dr. James Madara, CEO of the American Medical Association, said April 15, the day after the Senate passed H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
“There are a lot of evolving issues to take care of in this migration toward models of payment delivery that work positively toward impacting quality of care,” Dr. Madara said. “Any time a complex bill as helpful as this one is passed, there are implementation problems that sometimes arise, so one of the areas that we will be strongly attentive to at the AMA is keeping our finger on the pulse of the implementation and working with the federal government to make sure that this tracks in a correct way.”
President Obama signed the bill into law on April 16.
The new law repeals the Medicare Sustainable Growth Rate formula, negating the 21% physician fee cut that was to go into effect April 1. In its place, the law provides a 0.5% pay increase yearly for 5 years as the Medicare program makes the transition away from fee-for-service and to value-based payment.
To help get to a point of value over volume, the bill consolidates existing quality programs – including those regarding the meaningful use of electronic health records – into a single value-based performance program.
“We studied that, along with some of the other physician organizations and our House of Delegates, and the conclusion was that this was not just an improvement, but a significant improvement, over the current set of measurements,” Dr. Madara said.
The new law also incentivizes physicians to use alternate payment models that focus on care coordination and preventive care with a 5% payment bonus. It pushes for more transparency of Medicare data for physicians, providers, and patients.
MACRA also includes funding to help smaller practices participate in alternative payment models or the streamlined quality measurement program, as well as funding to help in the development of quality measures.
“The provisions that allow for continued funding of the quality measurement enterprise in H.R. 2 are a key building block of this important transition and will also facilitate work to continue advancing measurement science,” the National Quality Forum said in a statement. “Ultimately, these efforts will not only help people get better healthcare, but also will reduce costs that strain patients, purchasers, and the system overall.”
Other important provisions in the new law include the reauthorization of several key programs. CHIP (the Children’s Health Insurance Program), the Community Health Center program, the National Health Service Corps, and the Teaching Health Centers program were all reauthorized for 2 years; they had been scheduled to expire later this year. Additionally, the law continues a partial delay of the Medicare two-midnights ruleuntil Sept. 30.
Physicians also cheered provisions of the new law that allay malpractice concerns. The law specifies that the development, recognition, or implementation of any federal health care guideline or standard does not establish a duty of care in medical malpractice claims.
The provision helps distinguish government quality guidelines and payment rules from medical liability standards, according to Brian K. Atchinson, president and CEO of PIAA, a national trade association for medical malpractice liability insurers.
“None of these rules or guidelines were created with the intent to establish a legal standard for negligence, and so it makes sense for Congress to clarify that fact,” Mr. Atchinson said in an interview. “The standard of care provision in the SGR fix bill does just that, and nothing more. It does not shift the playing field to either plaintiffs or defendants. Instead, it ensures that these federal rules are not misused for purposes for which they were never intended.”
H.R. 2 ran into some trouble in the Senate because it does not have a dedicated funding mechanism to cover its full cost. The Congressional Budget Office estimated that enactment of the law will increase the deficit by $141 billion over 10 years. The CBO’s score also found that the legislation would save money, compared with the price of continued patches.
A total of $73 billion of the $214 billion cost of package is offset through spending reductions and revenue increases included in the bill, the CBO found. These include income-related premium adjustments for Medicare Parts B and D, Medigap reforms, an increase of levy authority on payments to Medicare providers with delinquent tax debt, adjustments to inpatient hospital payment rates, a delay of Medicaid Disproportionate Share Hospital changes until 2018, and a 1% market basket update for postacute care providers.
Enactment of the law also looked a bit shaky when the Office of the Actuary for the Centers for Medicare & Medicaid Services released a report April 9 that suggested physicians would see future payment cuts under the law.
“Physician payment rates under H.R. 2 would be lower than scheduled under the current SGR formula by 2048 and would continue to worsen thereafter,” according to the report. “Absent a change in the method or level of update by subsequent legislation, we expect access to Medicare-participating physicians to become a significant issue in the long term under H.R. 2.”
However, the AMA’s Dr. Madara said that he was not concerned about the projections because the report assumes no changes in coming years. “One does not make linear trajectories over a periods of decades or more and assume that that’s where we are going to end up because that assumption is that nothing happens in the interim and, as we all know, that’s just simply not the way life works,” he said.
AMA President Robert Wah noted that the report “fails to take into account the long-range impact such a drastic payment cut [due to the SGR] would have on quality and access for Medicare beneficiaries, or the many options H.R. 2 will make available to physicians for avoiding onerous penalties under current law and the significant positive updates that high performers can earn.”
The American College of Physicians applauded the Senate action.
“We all witnessed something quite extraordinary and historic today when the Senate followed the House in passing comprehensive legislation to repeal Medicare’s Sustainable Growth Rate formula (H.R. 2) and transition us to a new value-based system,” ACP President David Flemming said in a statement.
American Society of Clinical Oncology President Peter Paul Yu said in a statement that “Medicare beneficiaries and their physicians can breathe easier knowing they will no longer face the perennial threat of payment cuts that risk disruption of care and cause anxiety among patients. ... [ASCO] looks forward to working with policymakers to ensure that this new law is effectively implemented and paves the way to new payment models that foster high-quality, value-based health care for all Americans with cancer.”
Similarly, the American Society for Radiation Oncology praised the effort. “Permanently repealing the SGR and replacing it with a stabilized reimbursement plan focused on quality will strengthen Medicare and allow us to enhance cancer care for the more than one million patients treated with radiation therapy each year,” Dr. Bruce G. Haffty, chair of ASTRO’s board of directors, said in a statement.
American College of Cardiology President Kim Allan Williams Sr., in a statement applauding the actions of the Senate, noted that the members “accomplished a major feat by passing legislation that ends a cycle of delays and patches in the law, which created uncertainty for Medicare patients and clinicians for more than an decade.”
The American College of Surgeons lauded the Senate action.
“The reforms set in place by Tuesday’s historic Senate passage of H.R. 2 offers peace of mind to America’s seniors, whose access to medical care through the Medicare program has been threatened for more than 10 years,” Dr. David B. Hoyt, executive director of the American College of Surgeons, said in a statement. “The College is committed to working with policymakers to further develop policies authorized in the legislation that stress quality of care for Medicare beneficiaries.”
The American Psychiatric Association praised the work of the Senate to pass the bill. “The Senate passage of the SGR reform bill is a major step toward a reliable and rational payment system for Medicare beneficiaries and their physicians,” APA President Paul Summergrad said in a statement. “It is long overdue.”
“It is time for a health care system in America that is focused on delivery of quality care, rather than quantity of care,” Dr. John C. Jennings, president of the American Congress of Obstetricians and Gynecologists, said in a statement. “By strengthening the ability of providers to focus on prevention, this bill will help to ensure that more Americans are able to stay healthy, avoiding serious illnesses and their related costs.”
The American College of Emergency Physicians called the move away from the SGR and toward a value-based system “essential to emergency departments. Elderly patients are more likely to need emergency care than any other age group, and the fastest growing segment of the U.S. population is people over 85 years of age. It represents a significant accomplishment for all the emergency physicians who actively made their voices heard in Congress.”
It’s value over volume for Medicare now that the Medicare Access and CHIP Reauthorization Act of 2015 is law.
“This shift in what the country faces in a disease burden really aligns and is helped and facilitated by this updating Medicare to this new disease environment,” Dr. James Madara, CEO of the American Medical Association, said April 15, the day after the Senate passed H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
“There are a lot of evolving issues to take care of in this migration toward models of payment delivery that work positively toward impacting quality of care,” Dr. Madara said. “Any time a complex bill as helpful as this one is passed, there are implementation problems that sometimes arise, so one of the areas that we will be strongly attentive to at the AMA is keeping our finger on the pulse of the implementation and working with the federal government to make sure that this tracks in a correct way.”
President Obama signed the bill into law on April 16.
The new law repeals the Medicare Sustainable Growth Rate formula, negating the 21% physician fee cut that was to go into effect April 1. In its place, the law provides a 0.5% pay increase yearly for 5 years as the Medicare program makes the transition away from fee-for-service and to value-based payment.
To help get to a point of value over volume, the bill consolidates existing quality programs – including those regarding the meaningful use of electronic health records – into a single value-based performance program.
“We studied that, along with some of the other physician organizations and our House of Delegates, and the conclusion was that this was not just an improvement, but a significant improvement, over the current set of measurements,” Dr. Madara said.
The new law also incentivizes physicians to use alternate payment models that focus on care coordination and preventive care with a 5% payment bonus. It pushes for more transparency of Medicare data for physicians, providers, and patients.
MACRA also includes funding to help smaller practices participate in alternative payment models or the streamlined quality measurement program, as well as funding to help in the development of quality measures.
“The provisions that allow for continued funding of the quality measurement enterprise in H.R. 2 are a key building block of this important transition and will also facilitate work to continue advancing measurement science,” the National Quality Forum said in a statement. “Ultimately, these efforts will not only help people get better healthcare, but also will reduce costs that strain patients, purchasers, and the system overall.”
Other important provisions in the new law include the reauthorization of several key programs. CHIP (the Children’s Health Insurance Program), the Community Health Center program, the National Health Service Corps, and the Teaching Health Centers program were all reauthorized for 2 years; they had been scheduled to expire later this year. Additionally, the law continues a partial delay of the Medicare two-midnights ruleuntil Sept. 30.
Physicians also cheered provisions of the new law that allay malpractice concerns. The law specifies that the development, recognition, or implementation of any federal health care guideline or standard does not establish a duty of care in medical malpractice claims.
The provision helps distinguish government quality guidelines and payment rules from medical liability standards, according to Brian K. Atchinson, president and CEO of PIAA, a national trade association for medical malpractice liability insurers.
“None of these rules or guidelines were created with the intent to establish a legal standard for negligence, and so it makes sense for Congress to clarify that fact,” Mr. Atchinson said in an interview. “The standard of care provision in the SGR fix bill does just that, and nothing more. It does not shift the playing field to either plaintiffs or defendants. Instead, it ensures that these federal rules are not misused for purposes for which they were never intended.”
H.R. 2 ran into some trouble in the Senate because it does not have a dedicated funding mechanism to cover its full cost. The Congressional Budget Office estimated that enactment of the law will increase the deficit by $141 billion over 10 years. The CBO’s score also found that the legislation would save money, compared with the price of continued patches.
A total of $73 billion of the $214 billion cost of package is offset through spending reductions and revenue increases included in the bill, the CBO found. These include income-related premium adjustments for Medicare Parts B and D, Medigap reforms, an increase of levy authority on payments to Medicare providers with delinquent tax debt, adjustments to inpatient hospital payment rates, a delay of Medicaid Disproportionate Share Hospital changes until 2018, and a 1% market basket update for postacute care providers.
Enactment of the law also looked a bit shaky when the Office of the Actuary for the Centers for Medicare & Medicaid Services released a report April 9 that suggested physicians would see future payment cuts under the law.
“Physician payment rates under H.R. 2 would be lower than scheduled under the current SGR formula by 2048 and would continue to worsen thereafter,” according to the report. “Absent a change in the method or level of update by subsequent legislation, we expect access to Medicare-participating physicians to become a significant issue in the long term under H.R. 2.”
However, the AMA’s Dr. Madara said that he was not concerned about the projections because the report assumes no changes in coming years. “One does not make linear trajectories over a periods of decades or more and assume that that’s where we are going to end up because that assumption is that nothing happens in the interim and, as we all know, that’s just simply not the way life works,” he said.
AMA President Robert Wah noted that the report “fails to take into account the long-range impact such a drastic payment cut [due to the SGR] would have on quality and access for Medicare beneficiaries, or the many options H.R. 2 will make available to physicians for avoiding onerous penalties under current law and the significant positive updates that high performers can earn.”
The American College of Physicians applauded the Senate action.
“We all witnessed something quite extraordinary and historic today when the Senate followed the House in passing comprehensive legislation to repeal Medicare’s Sustainable Growth Rate formula (H.R. 2) and transition us to a new value-based system,” ACP President David Flemming said in a statement.
American Society of Clinical Oncology President Peter Paul Yu said in a statement that “Medicare beneficiaries and their physicians can breathe easier knowing they will no longer face the perennial threat of payment cuts that risk disruption of care and cause anxiety among patients. ... [ASCO] looks forward to working with policymakers to ensure that this new law is effectively implemented and paves the way to new payment models that foster high-quality, value-based health care for all Americans with cancer.”
Similarly, the American Society for Radiation Oncology praised the effort. “Permanently repealing the SGR and replacing it with a stabilized reimbursement plan focused on quality will strengthen Medicare and allow us to enhance cancer care for the more than one million patients treated with radiation therapy each year,” Dr. Bruce G. Haffty, chair of ASTRO’s board of directors, said in a statement.
American College of Cardiology President Kim Allan Williams Sr., in a statement applauding the actions of the Senate, noted that the members “accomplished a major feat by passing legislation that ends a cycle of delays and patches in the law, which created uncertainty for Medicare patients and clinicians for more than an decade.”
The American College of Surgeons lauded the Senate action.
“The reforms set in place by Tuesday’s historic Senate passage of H.R. 2 offers peace of mind to America’s seniors, whose access to medical care through the Medicare program has been threatened for more than 10 years,” Dr. David B. Hoyt, executive director of the American College of Surgeons, said in a statement. “The College is committed to working with policymakers to further develop policies authorized in the legislation that stress quality of care for Medicare beneficiaries.”
The American Psychiatric Association praised the work of the Senate to pass the bill. “The Senate passage of the SGR reform bill is a major step toward a reliable and rational payment system for Medicare beneficiaries and their physicians,” APA President Paul Summergrad said in a statement. “It is long overdue.”
“It is time for a health care system in America that is focused on delivery of quality care, rather than quantity of care,” Dr. John C. Jennings, president of the American Congress of Obstetricians and Gynecologists, said in a statement. “By strengthening the ability of providers to focus on prevention, this bill will help to ensure that more Americans are able to stay healthy, avoiding serious illnesses and their related costs.”
The American College of Emergency Physicians called the move away from the SGR and toward a value-based system “essential to emergency departments. Elderly patients are more likely to need emergency care than any other age group, and the fastest growing segment of the U.S. population is people over 85 years of age. It represents a significant accomplishment for all the emergency physicians who actively made their voices heard in Congress.”
It’s value over volume for Medicare now that the Medicare Access and CHIP Reauthorization Act of 2015 is law.
“This shift in what the country faces in a disease burden really aligns and is helped and facilitated by this updating Medicare to this new disease environment,” Dr. James Madara, CEO of the American Medical Association, said April 15, the day after the Senate passed H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
“There are a lot of evolving issues to take care of in this migration toward models of payment delivery that work positively toward impacting quality of care,” Dr. Madara said. “Any time a complex bill as helpful as this one is passed, there are implementation problems that sometimes arise, so one of the areas that we will be strongly attentive to at the AMA is keeping our finger on the pulse of the implementation and working with the federal government to make sure that this tracks in a correct way.”
President Obama signed the bill into law on April 16.
The new law repeals the Medicare Sustainable Growth Rate formula, negating the 21% physician fee cut that was to go into effect April 1. In its place, the law provides a 0.5% pay increase yearly for 5 years as the Medicare program makes the transition away from fee-for-service and to value-based payment.
To help get to a point of value over volume, the bill consolidates existing quality programs – including those regarding the meaningful use of electronic health records – into a single value-based performance program.
“We studied that, along with some of the other physician organizations and our House of Delegates, and the conclusion was that this was not just an improvement, but a significant improvement, over the current set of measurements,” Dr. Madara said.
The new law also incentivizes physicians to use alternate payment models that focus on care coordination and preventive care with a 5% payment bonus. It pushes for more transparency of Medicare data for physicians, providers, and patients.
MACRA also includes funding to help smaller practices participate in alternative payment models or the streamlined quality measurement program, as well as funding to help in the development of quality measures.
“The provisions that allow for continued funding of the quality measurement enterprise in H.R. 2 are a key building block of this important transition and will also facilitate work to continue advancing measurement science,” the National Quality Forum said in a statement. “Ultimately, these efforts will not only help people get better healthcare, but also will reduce costs that strain patients, purchasers, and the system overall.”
Other important provisions in the new law include the reauthorization of several key programs. CHIP (the Children’s Health Insurance Program), the Community Health Center program, the National Health Service Corps, and the Teaching Health Centers program were all reauthorized for 2 years; they had been scheduled to expire later this year. Additionally, the law continues a partial delay of the Medicare two-midnights ruleuntil Sept. 30.
Physicians also cheered provisions of the new law that allay malpractice concerns. The law specifies that the development, recognition, or implementation of any federal health care guideline or standard does not establish a duty of care in medical malpractice claims.
The provision helps distinguish government quality guidelines and payment rules from medical liability standards, according to Brian K. Atchinson, president and CEO of PIAA, a national trade association for medical malpractice liability insurers.
“None of these rules or guidelines were created with the intent to establish a legal standard for negligence, and so it makes sense for Congress to clarify that fact,” Mr. Atchinson said in an interview. “The standard of care provision in the SGR fix bill does just that, and nothing more. It does not shift the playing field to either plaintiffs or defendants. Instead, it ensures that these federal rules are not misused for purposes for which they were never intended.”
H.R. 2 ran into some trouble in the Senate because it does not have a dedicated funding mechanism to cover its full cost. The Congressional Budget Office estimated that enactment of the law will increase the deficit by $141 billion over 10 years. The CBO’s score also found that the legislation would save money, compared with the price of continued patches.
A total of $73 billion of the $214 billion cost of package is offset through spending reductions and revenue increases included in the bill, the CBO found. These include income-related premium adjustments for Medicare Parts B and D, Medigap reforms, an increase of levy authority on payments to Medicare providers with delinquent tax debt, adjustments to inpatient hospital payment rates, a delay of Medicaid Disproportionate Share Hospital changes until 2018, and a 1% market basket update for postacute care providers.
Enactment of the law also looked a bit shaky when the Office of the Actuary for the Centers for Medicare & Medicaid Services released a report April 9 that suggested physicians would see future payment cuts under the law.
“Physician payment rates under H.R. 2 would be lower than scheduled under the current SGR formula by 2048 and would continue to worsen thereafter,” according to the report. “Absent a change in the method or level of update by subsequent legislation, we expect access to Medicare-participating physicians to become a significant issue in the long term under H.R. 2.”
However, the AMA’s Dr. Madara said that he was not concerned about the projections because the report assumes no changes in coming years. “One does not make linear trajectories over a periods of decades or more and assume that that’s where we are going to end up because that assumption is that nothing happens in the interim and, as we all know, that’s just simply not the way life works,” he said.
AMA President Robert Wah noted that the report “fails to take into account the long-range impact such a drastic payment cut [due to the SGR] would have on quality and access for Medicare beneficiaries, or the many options H.R. 2 will make available to physicians for avoiding onerous penalties under current law and the significant positive updates that high performers can earn.”
The American College of Physicians applauded the Senate action.
“We all witnessed something quite extraordinary and historic today when the Senate followed the House in passing comprehensive legislation to repeal Medicare’s Sustainable Growth Rate formula (H.R. 2) and transition us to a new value-based system,” ACP President David Flemming said in a statement.
American Society of Clinical Oncology President Peter Paul Yu said in a statement that “Medicare beneficiaries and their physicians can breathe easier knowing they will no longer face the perennial threat of payment cuts that risk disruption of care and cause anxiety among patients. ... [ASCO] looks forward to working with policymakers to ensure that this new law is effectively implemented and paves the way to new payment models that foster high-quality, value-based health care for all Americans with cancer.”
Similarly, the American Society for Radiation Oncology praised the effort. “Permanently repealing the SGR and replacing it with a stabilized reimbursement plan focused on quality will strengthen Medicare and allow us to enhance cancer care for the more than one million patients treated with radiation therapy each year,” Dr. Bruce G. Haffty, chair of ASTRO’s board of directors, said in a statement.
American College of Cardiology President Kim Allan Williams Sr., in a statement applauding the actions of the Senate, noted that the members “accomplished a major feat by passing legislation that ends a cycle of delays and patches in the law, which created uncertainty for Medicare patients and clinicians for more than an decade.”
The American College of Surgeons lauded the Senate action.
“The reforms set in place by Tuesday’s historic Senate passage of H.R. 2 offers peace of mind to America’s seniors, whose access to medical care through the Medicare program has been threatened for more than 10 years,” Dr. David B. Hoyt, executive director of the American College of Surgeons, said in a statement. “The College is committed to working with policymakers to further develop policies authorized in the legislation that stress quality of care for Medicare beneficiaries.”
The American Psychiatric Association praised the work of the Senate to pass the bill. “The Senate passage of the SGR reform bill is a major step toward a reliable and rational payment system for Medicare beneficiaries and their physicians,” APA President Paul Summergrad said in a statement. “It is long overdue.”
“It is time for a health care system in America that is focused on delivery of quality care, rather than quantity of care,” Dr. John C. Jennings, president of the American Congress of Obstetricians and Gynecologists, said in a statement. “By strengthening the ability of providers to focus on prevention, this bill will help to ensure that more Americans are able to stay healthy, avoiding serious illnesses and their related costs.”
The American College of Emergency Physicians called the move away from the SGR and toward a value-based system “essential to emergency departments. Elderly patients are more likely to need emergency care than any other age group, and the fastest growing segment of the U.S. population is people over 85 years of age. It represents a significant accomplishment for all the emergency physicians who actively made their voices heard in Congress.”
Feds ID core functions for pediatric EHRs
To ensure quality pediatric medical care, electronic health records for use with children need to be able to reflect and track patients’ changing physiology and maturity as well as the relationship between pediatric patients and their parents.
That’s according to a report from the federal Agency for Healthcare Research and Quality (AHRQ).
As part of the report, researchers from AHRQ’s Evidence-Based Practice Center at Vanderbilt University, Nashville, Tenn., assembled a panel of experts representing clinical, policy, research, and vendor perspectives. The panel noted that many functionalities overlap with adult care, but agreed that “given the nuances associated with longitudinal and coordinated care for the pediatric population, some functionalities will be more critical than in adults.”
The panel also emphasized “the importance of a flexible, longitudinal record that integrates critical information about the child, the family, and family history as it affects health, capabilities tailored to the needs of the clinician treating the child, and agile information display that shows the right information at the right time, despite the high volume nature of pediatrics.”
The report put vaccine management at the top of its list of core functions. Experts viewed it as “a necessity, and felt that it was well established as a need for pediatric EHRs due to its prominence both in public and personal health.”
Vaccine functionality has its challenges, they noted, because of factors such as noncentralized, proprietary databases that can fragment vaccination records, hindering clinical decision support tools and leading to improper immunizations.
Routine health care maintenance, another core function, requires that EHRs reflect standards and guidelines, including those by the American Academy of Pediatrics.
“A translation process has to occur to move general clinical guidelines, intended to provide evidence-based recommendations for provisions of care across a variety of practices, into specific algorithms that can be implemented into the available technology,” the panel recommended.
The panel called for more research into needed pediatric-specific functions in EHRs to help with their development and implementation, noting that there is a limited number of studies that provide an evidence base for what works best.
“We hope this report encourages all stakeholders to collaborate on this effort to improve electronic health records, ensuring we provide the best possible care for children,” the report concluded.
Most EHRs work very well for pediatrics, especially those we use in family medicine where a large proportion of our patients are children. There’s no question with regard to either decision support with guidelines or decision support with medication doses, specific functionalities are important to address pediatric issues.
But regarding most of the functionality of the EHRs, which is recording information, being able to retrieve information, and the specific diagnostic entities that are in the EHR, I think they are covered in the current EHR systems, with the area of growth being [clinical] decision support.
Most of the EHRs that I am aware of have a nice vaccine component, as is true in general. Can that area be made more easy to use? Of course. But they have vaccine functionality, which is critical. They probably could do a better job in terms of being able to record developmental issues, but other than that, in terms of well visits and disease specific visits, I think that many of the EHRs have already incorporated that.
Dr. Neil Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University in Philadelphia.
Most EHRs work very well for pediatrics, especially those we use in family medicine where a large proportion of our patients are children. There’s no question with regard to either decision support with guidelines or decision support with medication doses, specific functionalities are important to address pediatric issues.
But regarding most of the functionality of the EHRs, which is recording information, being able to retrieve information, and the specific diagnostic entities that are in the EHR, I think they are covered in the current EHR systems, with the area of growth being [clinical] decision support.
Most of the EHRs that I am aware of have a nice vaccine component, as is true in general. Can that area be made more easy to use? Of course. But they have vaccine functionality, which is critical. They probably could do a better job in terms of being able to record developmental issues, but other than that, in terms of well visits and disease specific visits, I think that many of the EHRs have already incorporated that.
Dr. Neil Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University in Philadelphia.
Most EHRs work very well for pediatrics, especially those we use in family medicine where a large proportion of our patients are children. There’s no question with regard to either decision support with guidelines or decision support with medication doses, specific functionalities are important to address pediatric issues.
But regarding most of the functionality of the EHRs, which is recording information, being able to retrieve information, and the specific diagnostic entities that are in the EHR, I think they are covered in the current EHR systems, with the area of growth being [clinical] decision support.
Most of the EHRs that I am aware of have a nice vaccine component, as is true in general. Can that area be made more easy to use? Of course. But they have vaccine functionality, which is critical. They probably could do a better job in terms of being able to record developmental issues, but other than that, in terms of well visits and disease specific visits, I think that many of the EHRs have already incorporated that.
Dr. Neil Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University in Philadelphia.
To ensure quality pediatric medical care, electronic health records for use with children need to be able to reflect and track patients’ changing physiology and maturity as well as the relationship between pediatric patients and their parents.
That’s according to a report from the federal Agency for Healthcare Research and Quality (AHRQ).
As part of the report, researchers from AHRQ’s Evidence-Based Practice Center at Vanderbilt University, Nashville, Tenn., assembled a panel of experts representing clinical, policy, research, and vendor perspectives. The panel noted that many functionalities overlap with adult care, but agreed that “given the nuances associated with longitudinal and coordinated care for the pediatric population, some functionalities will be more critical than in adults.”
The panel also emphasized “the importance of a flexible, longitudinal record that integrates critical information about the child, the family, and family history as it affects health, capabilities tailored to the needs of the clinician treating the child, and agile information display that shows the right information at the right time, despite the high volume nature of pediatrics.”
The report put vaccine management at the top of its list of core functions. Experts viewed it as “a necessity, and felt that it was well established as a need for pediatric EHRs due to its prominence both in public and personal health.”
Vaccine functionality has its challenges, they noted, because of factors such as noncentralized, proprietary databases that can fragment vaccination records, hindering clinical decision support tools and leading to improper immunizations.
Routine health care maintenance, another core function, requires that EHRs reflect standards and guidelines, including those by the American Academy of Pediatrics.
“A translation process has to occur to move general clinical guidelines, intended to provide evidence-based recommendations for provisions of care across a variety of practices, into specific algorithms that can be implemented into the available technology,” the panel recommended.
The panel called for more research into needed pediatric-specific functions in EHRs to help with their development and implementation, noting that there is a limited number of studies that provide an evidence base for what works best.
“We hope this report encourages all stakeholders to collaborate on this effort to improve electronic health records, ensuring we provide the best possible care for children,” the report concluded.
To ensure quality pediatric medical care, electronic health records for use with children need to be able to reflect and track patients’ changing physiology and maturity as well as the relationship between pediatric patients and their parents.
That’s according to a report from the federal Agency for Healthcare Research and Quality (AHRQ).
As part of the report, researchers from AHRQ’s Evidence-Based Practice Center at Vanderbilt University, Nashville, Tenn., assembled a panel of experts representing clinical, policy, research, and vendor perspectives. The panel noted that many functionalities overlap with adult care, but agreed that “given the nuances associated with longitudinal and coordinated care for the pediatric population, some functionalities will be more critical than in adults.”
The panel also emphasized “the importance of a flexible, longitudinal record that integrates critical information about the child, the family, and family history as it affects health, capabilities tailored to the needs of the clinician treating the child, and agile information display that shows the right information at the right time, despite the high volume nature of pediatrics.”
The report put vaccine management at the top of its list of core functions. Experts viewed it as “a necessity, and felt that it was well established as a need for pediatric EHRs due to its prominence both in public and personal health.”
Vaccine functionality has its challenges, they noted, because of factors such as noncentralized, proprietary databases that can fragment vaccination records, hindering clinical decision support tools and leading to improper immunizations.
Routine health care maintenance, another core function, requires that EHRs reflect standards and guidelines, including those by the American Academy of Pediatrics.
“A translation process has to occur to move general clinical guidelines, intended to provide evidence-based recommendations for provisions of care across a variety of practices, into specific algorithms that can be implemented into the available technology,” the panel recommended.
The panel called for more research into needed pediatric-specific functions in EHRs to help with their development and implementation, noting that there is a limited number of studies that provide an evidence base for what works best.
“We hope this report encourages all stakeholders to collaborate on this effort to improve electronic health records, ensuring we provide the best possible care for children,” the report concluded.
Emergency physicians’ poll indicates increased volume of emergency visits
Emergency department visits are on the rise, based on an American College of Emergency Physicians’ survey.
According to the results of ACEP’s March 2015 poll of 2.099 emergency physicians, 75% have noted an increase in the volume of ED visits since the implementation of the Affordable Care Act in 2014; 47% have noticed a slight increase, and 28% said that volumes have greatly increased.
Additionally, 70% of respondents said their emergency departments are not adequately prepared for potentially significant increases in patient volume.
Dr. Ryan A. Stanton, an emergency physician with MESA Medical Group in Lexington, Ky., said in an interview that respondents likely have data to back up their opinions. Data from his hospital shows ED volume increases of 20% in 2014.
The poll results were “not surprising at all,” he said, and reflect a need “to bolster up the health care system that is going to support” the increased patient volume that comes with greater coverage due to the ACA.
Emergency department visits are on the rise, based on an American College of Emergency Physicians’ survey.
According to the results of ACEP’s March 2015 poll of 2.099 emergency physicians, 75% have noted an increase in the volume of ED visits since the implementation of the Affordable Care Act in 2014; 47% have noticed a slight increase, and 28% said that volumes have greatly increased.
Additionally, 70% of respondents said their emergency departments are not adequately prepared for potentially significant increases in patient volume.
Dr. Ryan A. Stanton, an emergency physician with MESA Medical Group in Lexington, Ky., said in an interview that respondents likely have data to back up their opinions. Data from his hospital shows ED volume increases of 20% in 2014.
The poll results were “not surprising at all,” he said, and reflect a need “to bolster up the health care system that is going to support” the increased patient volume that comes with greater coverage due to the ACA.
Emergency department visits are on the rise, based on an American College of Emergency Physicians’ survey.
According to the results of ACEP’s March 2015 poll of 2.099 emergency physicians, 75% have noted an increase in the volume of ED visits since the implementation of the Affordable Care Act in 2014; 47% have noticed a slight increase, and 28% said that volumes have greatly increased.
Additionally, 70% of respondents said their emergency departments are not adequately prepared for potentially significant increases in patient volume.
Dr. Ryan A. Stanton, an emergency physician with MESA Medical Group in Lexington, Ky., said in an interview that respondents likely have data to back up their opinions. Data from his hospital shows ED volume increases of 20% in 2014.
The poll results were “not surprising at all,” he said, and reflect a need “to bolster up the health care system that is going to support” the increased patient volume that comes with greater coverage due to the ACA.
CMS: Stage 3 meaningful use by 2018
All physicians and hospitals would need to meet stage 3 meaningful use beginning in 2018, according to a recent proposal by the Centers for Medicare & Medicaid Services.
In the agency’s Stage 3 proposed rule, there would be no transition period from earlier stages for those just starting or those who were in an earlier stage. CMS said that this is “expected to be the final stage” and will incorporate elements of the previous two stages.
That change comes along with the proposal beginning in 2017 to permanently make the attestation period a full year, with a few exceptions. A full-year attestation period was supposed to go into effect for 2015 with Stage 2, but CMS announced that it would reduce attestation to a 90-day period because of low participation.
The final year in which participants in the EHR Incentive Programs can receive bonus payments for meeting meaningful use criteria is 2017; penalties for failing to meet criteria have already begun.
The proposed rule also contains a number of more stringent requirements. On the patient engagement front, the proposed rule calls for 25% of patients to access their data, although it also allows for third-party providers to access a patient’s account as a means of satisfying the requirement.
Patient-generated data also are highlighted, with a proposed requirement that physicians collect information via mobile devices or apps from 15% of their patients.
Under the proposed Stage 3 of meaningful use, physicians and eligible hospitals must meet two of three criteria: that more than 50% of referrals or transitions of care involve the passing of information by the referring provider; that more than 40% of transitions or referrals received by a provider seeing a patient for the first time include information imported into that new provider’s EHR; or that for more than 80% of those new patients seen in transition or by referral for the first time, a clinical reconciliation be done on the information received during the health information exchange, including a review of current medications, medication allergies, and current and active diagnoses.
The proposed rule is scheduled to be published in the Federal Register on March 30; comments will be accepted at www.regulations.gov until May 29.
[email protected]
All physicians and hospitals would need to meet stage 3 meaningful use beginning in 2018, according to a recent proposal by the Centers for Medicare & Medicaid Services.
In the agency’s Stage 3 proposed rule, there would be no transition period from earlier stages for those just starting or those who were in an earlier stage. CMS said that this is “expected to be the final stage” and will incorporate elements of the previous two stages.
That change comes along with the proposal beginning in 2017 to permanently make the attestation period a full year, with a few exceptions. A full-year attestation period was supposed to go into effect for 2015 with Stage 2, but CMS announced that it would reduce attestation to a 90-day period because of low participation.
The final year in which participants in the EHR Incentive Programs can receive bonus payments for meeting meaningful use criteria is 2017; penalties for failing to meet criteria have already begun.
The proposed rule also contains a number of more stringent requirements. On the patient engagement front, the proposed rule calls for 25% of patients to access their data, although it also allows for third-party providers to access a patient’s account as a means of satisfying the requirement.
Patient-generated data also are highlighted, with a proposed requirement that physicians collect information via mobile devices or apps from 15% of their patients.
Under the proposed Stage 3 of meaningful use, physicians and eligible hospitals must meet two of three criteria: that more than 50% of referrals or transitions of care involve the passing of information by the referring provider; that more than 40% of transitions or referrals received by a provider seeing a patient for the first time include information imported into that new provider’s EHR; or that for more than 80% of those new patients seen in transition or by referral for the first time, a clinical reconciliation be done on the information received during the health information exchange, including a review of current medications, medication allergies, and current and active diagnoses.
The proposed rule is scheduled to be published in the Federal Register on March 30; comments will be accepted at www.regulations.gov until May 29.
[email protected]
All physicians and hospitals would need to meet stage 3 meaningful use beginning in 2018, according to a recent proposal by the Centers for Medicare & Medicaid Services.
In the agency’s Stage 3 proposed rule, there would be no transition period from earlier stages for those just starting or those who were in an earlier stage. CMS said that this is “expected to be the final stage” and will incorporate elements of the previous two stages.
That change comes along with the proposal beginning in 2017 to permanently make the attestation period a full year, with a few exceptions. A full-year attestation period was supposed to go into effect for 2015 with Stage 2, but CMS announced that it would reduce attestation to a 90-day period because of low participation.
The final year in which participants in the EHR Incentive Programs can receive bonus payments for meeting meaningful use criteria is 2017; penalties for failing to meet criteria have already begun.
The proposed rule also contains a number of more stringent requirements. On the patient engagement front, the proposed rule calls for 25% of patients to access their data, although it also allows for third-party providers to access a patient’s account as a means of satisfying the requirement.
Patient-generated data also are highlighted, with a proposed requirement that physicians collect information via mobile devices or apps from 15% of their patients.
Under the proposed Stage 3 of meaningful use, physicians and eligible hospitals must meet two of three criteria: that more than 50% of referrals or transitions of care involve the passing of information by the referring provider; that more than 40% of transitions or referrals received by a provider seeing a patient for the first time include information imported into that new provider’s EHR; or that for more than 80% of those new patients seen in transition or by referral for the first time, a clinical reconciliation be done on the information received during the health information exchange, including a review of current medications, medication allergies, and current and active diagnoses.
The proposed rule is scheduled to be published in the Federal Register on March 30; comments will be accepted at www.regulations.gov until May 29.
[email protected]
Docs need all tools, better education to combat opioid addiction
WASHINGTON– Doctors need a variety of options to treat opioid addiction and more training on safe opioid prescribing, according to experts called to testify before the House Energy & Commerce Committee’s Subcommittee on Oversight and Investigations.
One of the primary options – medication-assisted treatment (MAT) utilizing buprenorphine – was criticized by Subcommittee Chairman Tim Murphy (R-Pa.).
Increased availability of MAT is among the recommendations made in late March by the Health & Human Services department.
“We are not going to end this opioid epidemic by increasing the use of opioids,” Rep. Murphy said at the April 23 hearing. “We need an exit strategy that enables Americans to become opioid free altogether. We can do better than addiction maintenance.”
Physicians testifying to the subcommittee unanimously suggested that MAT needs to be a vital part of the treatment toolbox, noting that for some patients, it is an essential component of recovery.
Witnesses called for recognition that opioid addiction is a long-term issue; patients can need life-long treatment to help prevent relapse.
“Opiate dependence is not like the common cold. It does not go away” Dr. Robert DuPont, president of the Institute for Behavior and Health, testified. “It is a lifetime problem. A person who has opiate dependence is going to deal with that problem one way or another for his or her lifetime. People are not fixed in treatment.”
Treatment options, including MAT, almost always are short term, and that needs to change, Dr. DuPont said, adding that it is critically important to get health insurers to recognize longer-term treatment.
Dr. Anna Lembke of the departments of psychiatry and behavioral science at Stanford (Calif.) University, testified regarding the difficulty in getting Medicaid and private insurers to cover addiction treatment.
“When you try to get coverage for addiction treatment, they give you the huge runaround,” she said, noting that ironically, that it’s fairly easy to prescribe opioids and have those covered by most insurers.
“What that means is that if you want to get addiction treatment for patients who are struggling with the disease addiction, you can’t insurance to pay for it, which means that patients don’t access the treatment,” Dr. Lembke said, adding that it leaves patients to find and pay for treatments themselves.
While many insurers cover MAT, their utilization management techniques can make it challenging to get and keep patients in the programs, she said. “Once you start someone on buprenorphine, you don’t want to just suddenly not have it available to them, but that happens frequently because all of a sudden you have been denied coverage.”
Witnesses also called for better guidance on prescribing opioids. Dr. Patrice A. Harris, secretary of the American Medical Association board of trustees, highlighted some of her organizations efforts to improve education and awareness of the dangers of overprescribing opioid pain medications for physicians as well as patients. She noted, and other panelists agreed, that addiction needs to be looked at and treated as any other chronic condition. That shift in perspective could help alleviate the stigma attached to seeking treatment.
Dr. Lembke called for changes to Medicare to lead private insurance to better incentivize the proper use of addiction treatment, including both medication and non–medication based treatments, including setting quality measures to ensure proper use of opioids, removing any connection in customer satisfaction surveys to whether or not they receive prescription opioids, and to incentivize greater use of prescription drug monitoring programs.
She also called for changes in federal regulations to make it easier for doctors to communicate with one another on such issues as addiction and what medications they might be on to help better coordinate treatment and to prevent patients from getting opioid prescriptions from one doctor while getting treatment from another.
WASHINGTON– Doctors need a variety of options to treat opioid addiction and more training on safe opioid prescribing, according to experts called to testify before the House Energy & Commerce Committee’s Subcommittee on Oversight and Investigations.
One of the primary options – medication-assisted treatment (MAT) utilizing buprenorphine – was criticized by Subcommittee Chairman Tim Murphy (R-Pa.).
Increased availability of MAT is among the recommendations made in late March by the Health & Human Services department.
“We are not going to end this opioid epidemic by increasing the use of opioids,” Rep. Murphy said at the April 23 hearing. “We need an exit strategy that enables Americans to become opioid free altogether. We can do better than addiction maintenance.”
Physicians testifying to the subcommittee unanimously suggested that MAT needs to be a vital part of the treatment toolbox, noting that for some patients, it is an essential component of recovery.
Witnesses called for recognition that opioid addiction is a long-term issue; patients can need life-long treatment to help prevent relapse.
“Opiate dependence is not like the common cold. It does not go away” Dr. Robert DuPont, president of the Institute for Behavior and Health, testified. “It is a lifetime problem. A person who has opiate dependence is going to deal with that problem one way or another for his or her lifetime. People are not fixed in treatment.”
Treatment options, including MAT, almost always are short term, and that needs to change, Dr. DuPont said, adding that it is critically important to get health insurers to recognize longer-term treatment.
Dr. Anna Lembke of the departments of psychiatry and behavioral science at Stanford (Calif.) University, testified regarding the difficulty in getting Medicaid and private insurers to cover addiction treatment.
“When you try to get coverage for addiction treatment, they give you the huge runaround,” she said, noting that ironically, that it’s fairly easy to prescribe opioids and have those covered by most insurers.
“What that means is that if you want to get addiction treatment for patients who are struggling with the disease addiction, you can’t insurance to pay for it, which means that patients don’t access the treatment,” Dr. Lembke said, adding that it leaves patients to find and pay for treatments themselves.
While many insurers cover MAT, their utilization management techniques can make it challenging to get and keep patients in the programs, she said. “Once you start someone on buprenorphine, you don’t want to just suddenly not have it available to them, but that happens frequently because all of a sudden you have been denied coverage.”
Witnesses also called for better guidance on prescribing opioids. Dr. Patrice A. Harris, secretary of the American Medical Association board of trustees, highlighted some of her organizations efforts to improve education and awareness of the dangers of overprescribing opioid pain medications for physicians as well as patients. She noted, and other panelists agreed, that addiction needs to be looked at and treated as any other chronic condition. That shift in perspective could help alleviate the stigma attached to seeking treatment.
Dr. Lembke called for changes to Medicare to lead private insurance to better incentivize the proper use of addiction treatment, including both medication and non–medication based treatments, including setting quality measures to ensure proper use of opioids, removing any connection in customer satisfaction surveys to whether or not they receive prescription opioids, and to incentivize greater use of prescription drug monitoring programs.
She also called for changes in federal regulations to make it easier for doctors to communicate with one another on such issues as addiction and what medications they might be on to help better coordinate treatment and to prevent patients from getting opioid prescriptions from one doctor while getting treatment from another.
WASHINGTON– Doctors need a variety of options to treat opioid addiction and more training on safe opioid prescribing, according to experts called to testify before the House Energy & Commerce Committee’s Subcommittee on Oversight and Investigations.
One of the primary options – medication-assisted treatment (MAT) utilizing buprenorphine – was criticized by Subcommittee Chairman Tim Murphy (R-Pa.).
Increased availability of MAT is among the recommendations made in late March by the Health & Human Services department.
“We are not going to end this opioid epidemic by increasing the use of opioids,” Rep. Murphy said at the April 23 hearing. “We need an exit strategy that enables Americans to become opioid free altogether. We can do better than addiction maintenance.”
Physicians testifying to the subcommittee unanimously suggested that MAT needs to be a vital part of the treatment toolbox, noting that for some patients, it is an essential component of recovery.
Witnesses called for recognition that opioid addiction is a long-term issue; patients can need life-long treatment to help prevent relapse.
“Opiate dependence is not like the common cold. It does not go away” Dr. Robert DuPont, president of the Institute for Behavior and Health, testified. “It is a lifetime problem. A person who has opiate dependence is going to deal with that problem one way or another for his or her lifetime. People are not fixed in treatment.”
Treatment options, including MAT, almost always are short term, and that needs to change, Dr. DuPont said, adding that it is critically important to get health insurers to recognize longer-term treatment.
Dr. Anna Lembke of the departments of psychiatry and behavioral science at Stanford (Calif.) University, testified regarding the difficulty in getting Medicaid and private insurers to cover addiction treatment.
“When you try to get coverage for addiction treatment, they give you the huge runaround,” she said, noting that ironically, that it’s fairly easy to prescribe opioids and have those covered by most insurers.
“What that means is that if you want to get addiction treatment for patients who are struggling with the disease addiction, you can’t insurance to pay for it, which means that patients don’t access the treatment,” Dr. Lembke said, adding that it leaves patients to find and pay for treatments themselves.
While many insurers cover MAT, their utilization management techniques can make it challenging to get and keep patients in the programs, she said. “Once you start someone on buprenorphine, you don’t want to just suddenly not have it available to them, but that happens frequently because all of a sudden you have been denied coverage.”
Witnesses also called for better guidance on prescribing opioids. Dr. Patrice A. Harris, secretary of the American Medical Association board of trustees, highlighted some of her organizations efforts to improve education and awareness of the dangers of overprescribing opioid pain medications for physicians as well as patients. She noted, and other panelists agreed, that addiction needs to be looked at and treated as any other chronic condition. That shift in perspective could help alleviate the stigma attached to seeking treatment.
Dr. Lembke called for changes to Medicare to lead private insurance to better incentivize the proper use of addiction treatment, including both medication and non–medication based treatments, including setting quality measures to ensure proper use of opioids, removing any connection in customer satisfaction surveys to whether or not they receive prescription opioids, and to incentivize greater use of prescription drug monitoring programs.
She also called for changes in federal regulations to make it easier for doctors to communicate with one another on such issues as addiction and what medications they might be on to help better coordinate treatment and to prevent patients from getting opioid prescriptions from one doctor while getting treatment from another.
AT A HOUSE ENERGY & COMMERCE SUBCOMMITTEE HEARING
SGR repeal refocuses CMS on value
It’s value over volume for Medicare now that the Medicare Access and CHIP Reauthorization Act of 2015 is law.
“AGA is pleased that the SGR repeal has finally happened and puts physicians on a pathway toward value-based care,” said Dr. John I. Allen, MBA, AGAF, president, AGA Institute. “AGA will continue to work with Medicare and private payers on developing bundled payment models and other alternative payment models that demonstrate the value of GI services that we provide.”
“There are a lot of evolving issues to take care of in this migration toward models of payment delivery that work positively toward impacting quality of care,” Dr. James Madara, CEO of the American Medical Association, said April 15, the day after the Senate passed H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). “Anytime a complex bill as helpful as this one is passed, there are implementation problems that sometimes arise, so one of the areas that we will be strongly attentive to at the AMA is keeping our finger on the pulse of the implementation and working with the federal government to make sure that this tracks in a correct way.”
President Obama signed the bill into law on April 16.
The new law repeals the Medicare Sustainable Growth Rate formula, negating the 21% physician fee cut that was to go into effect April 1. In its place, the law provides a 0.5% pay increase yearly for 5 years as the Medicare program makes the transition away from fee-for-service and to value-based payment.
To help get to a point of value over volume, the bill consolidates existing quality programs – including those regarding the meaningful use of electronic health records – into a single value-based performance program.
“We studied that, along with some of the other physician organizations and our House of Delegates, and the conclusion was that this was not just an improvement, but a significant improvement, over the current set of measurements,” Dr. Madara said. The new law also incentivizes physicians to use alternate payment models that focus on care coordination and preventive care with a 5% payment bonus. It pushes for more transparency of Medicare data for physicians, providers, and patients.
MACRA also includes funding to help smaller practices participate in alternative payment models or the streamlined quality measurement program, as well as funding to help in the development of quality measures.
“The provisions that allow for continued funding of the quality measurement enterprise in H.R. 2 are a key building block of this important transition and will also facilitate work to continue advancing measurement science,” the National Quality Forum said in a statement. “Ultimately, these efforts will not only help people get better healthcare, but also will reduce costs that strain patients, purchasers, and the system overall.”
Other important provisions in the new law include the reauthorization of several key programs. CHIP (the Children’s Health Insurance Program), the Community Health Center program, the National Health Service Corps, and the Teaching Health Centers program were all reauthorized for 2 years; they had been scheduled to expire later this year. Additionally, the law continues a partial delay of the Medicare two-midnights ruleuntil Sept. 30.
Physicians also cheered provisions of the new law that allay malpractice concerns. The law specifies that the development, recognition, or implementation of any federal health care guideline or standard does not establish a duty of care in medical malpractice claims.
The provision helps distinguish government quality guidelines and payment rules from medical liability standards, according to Brian K. Atchinson, president and CEO of PIAA, a national trade association for medical malpractice liability insurers.
“None of these rules or guidelines were created with the intent to establish a legal standard for negligence, and so it makes sense for Congress to clarify that fact,” Mr. Atchinson said in an interview. “The standard of care provision in the SGR fix bill does just that, and nothing more. It does not shift the playing field to either plaintiffs or defendants. Instead, it ensures that these federal rules are not misused for purposes for which they were never intended.”
H.R. 2 ran into some trouble in the Senate because it does not have a dedicated funding mechanism to cover its full cost. The Congressional Budget Office estimated that enactment of the law will increase the deficit by $141 billion over 10 years. The CBO’s score also found that the legislation would save money, compared with the price of continued patches.
A total of $73 billion of the $214 billion cost of the package is offset through spending reductions and revenue increases included in the bill, the CBO found. These include income-related premium adjustments for Medicare Parts B and D, Medigap reforms, an increase of levy authority on payments to Medicare providers with delinquent tax debt, adjustments to inpatient hospital payment rates, a delay of Medicaid Disproportionate Share Hospital changes until 2018, and a 1% market basket update for postacute care providers.
Enactment of the law also looked a bit shaky when the Office of the Actuary for CMS released a report April 9 that suggested physicians would see future payment cuts under the law.
“Physician payment rates under H.R. 2 would be lower than scheduled under the current SGR formula by 2048 and would continue to worsen thereafter,” according to the report. “Absent a change in the method or level of update by subsequent legislation, we expect access to Medicare-participating physicians to become a significant issue in the long term under H.R. 2.”
However, the AMA’s Dr. Madara said that he was not concerned about the projections because the report assumes no changes in coming years. “One does not make linear trajectories over a period of decades or more and assume that that’s where we are going to end up because that assumption is that nothing happens in the interim and, as we all know, that’s just simply not the way life works,” he said.
AMA President Robert Wah noted that the report “fails to take into account the long-range impact such a drastic payment cut [due to the SGR] would have on quality and access for Medicare beneficiaries, or the many options H.R. 2 will make available to physicians for avoiding onerous penalties under current law and the significant positive updates that high performers can earn.”
It’s value over volume for Medicare now that the Medicare Access and CHIP Reauthorization Act of 2015 is law.
“AGA is pleased that the SGR repeal has finally happened and puts physicians on a pathway toward value-based care,” said Dr. John I. Allen, MBA, AGAF, president, AGA Institute. “AGA will continue to work with Medicare and private payers on developing bundled payment models and other alternative payment models that demonstrate the value of GI services that we provide.”
“There are a lot of evolving issues to take care of in this migration toward models of payment delivery that work positively toward impacting quality of care,” Dr. James Madara, CEO of the American Medical Association, said April 15, the day after the Senate passed H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). “Anytime a complex bill as helpful as this one is passed, there are implementation problems that sometimes arise, so one of the areas that we will be strongly attentive to at the AMA is keeping our finger on the pulse of the implementation and working with the federal government to make sure that this tracks in a correct way.”
President Obama signed the bill into law on April 16.
The new law repeals the Medicare Sustainable Growth Rate formula, negating the 21% physician fee cut that was to go into effect April 1. In its place, the law provides a 0.5% pay increase yearly for 5 years as the Medicare program makes the transition away from fee-for-service and to value-based payment.
To help get to a point of value over volume, the bill consolidates existing quality programs – including those regarding the meaningful use of electronic health records – into a single value-based performance program.
“We studied that, along with some of the other physician organizations and our House of Delegates, and the conclusion was that this was not just an improvement, but a significant improvement, over the current set of measurements,” Dr. Madara said. The new law also incentivizes physicians to use alternate payment models that focus on care coordination and preventive care with a 5% payment bonus. It pushes for more transparency of Medicare data for physicians, providers, and patients.
MACRA also includes funding to help smaller practices participate in alternative payment models or the streamlined quality measurement program, as well as funding to help in the development of quality measures.
“The provisions that allow for continued funding of the quality measurement enterprise in H.R. 2 are a key building block of this important transition and will also facilitate work to continue advancing measurement science,” the National Quality Forum said in a statement. “Ultimately, these efforts will not only help people get better healthcare, but also will reduce costs that strain patients, purchasers, and the system overall.”
Other important provisions in the new law include the reauthorization of several key programs. CHIP (the Children’s Health Insurance Program), the Community Health Center program, the National Health Service Corps, and the Teaching Health Centers program were all reauthorized for 2 years; they had been scheduled to expire later this year. Additionally, the law continues a partial delay of the Medicare two-midnights ruleuntil Sept. 30.
Physicians also cheered provisions of the new law that allay malpractice concerns. The law specifies that the development, recognition, or implementation of any federal health care guideline or standard does not establish a duty of care in medical malpractice claims.
The provision helps distinguish government quality guidelines and payment rules from medical liability standards, according to Brian K. Atchinson, president and CEO of PIAA, a national trade association for medical malpractice liability insurers.
“None of these rules or guidelines were created with the intent to establish a legal standard for negligence, and so it makes sense for Congress to clarify that fact,” Mr. Atchinson said in an interview. “The standard of care provision in the SGR fix bill does just that, and nothing more. It does not shift the playing field to either plaintiffs or defendants. Instead, it ensures that these federal rules are not misused for purposes for which they were never intended.”
H.R. 2 ran into some trouble in the Senate because it does not have a dedicated funding mechanism to cover its full cost. The Congressional Budget Office estimated that enactment of the law will increase the deficit by $141 billion over 10 years. The CBO’s score also found that the legislation would save money, compared with the price of continued patches.
A total of $73 billion of the $214 billion cost of the package is offset through spending reductions and revenue increases included in the bill, the CBO found. These include income-related premium adjustments for Medicare Parts B and D, Medigap reforms, an increase of levy authority on payments to Medicare providers with delinquent tax debt, adjustments to inpatient hospital payment rates, a delay of Medicaid Disproportionate Share Hospital changes until 2018, and a 1% market basket update for postacute care providers.
Enactment of the law also looked a bit shaky when the Office of the Actuary for CMS released a report April 9 that suggested physicians would see future payment cuts under the law.
“Physician payment rates under H.R. 2 would be lower than scheduled under the current SGR formula by 2048 and would continue to worsen thereafter,” according to the report. “Absent a change in the method or level of update by subsequent legislation, we expect access to Medicare-participating physicians to become a significant issue in the long term under H.R. 2.”
However, the AMA’s Dr. Madara said that he was not concerned about the projections because the report assumes no changes in coming years. “One does not make linear trajectories over a period of decades or more and assume that that’s where we are going to end up because that assumption is that nothing happens in the interim and, as we all know, that’s just simply not the way life works,” he said.
AMA President Robert Wah noted that the report “fails to take into account the long-range impact such a drastic payment cut [due to the SGR] would have on quality and access for Medicare beneficiaries, or the many options H.R. 2 will make available to physicians for avoiding onerous penalties under current law and the significant positive updates that high performers can earn.”
It’s value over volume for Medicare now that the Medicare Access and CHIP Reauthorization Act of 2015 is law.
“AGA is pleased that the SGR repeal has finally happened and puts physicians on a pathway toward value-based care,” said Dr. John I. Allen, MBA, AGAF, president, AGA Institute. “AGA will continue to work with Medicare and private payers on developing bundled payment models and other alternative payment models that demonstrate the value of GI services that we provide.”
“There are a lot of evolving issues to take care of in this migration toward models of payment delivery that work positively toward impacting quality of care,” Dr. James Madara, CEO of the American Medical Association, said April 15, the day after the Senate passed H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). “Anytime a complex bill as helpful as this one is passed, there are implementation problems that sometimes arise, so one of the areas that we will be strongly attentive to at the AMA is keeping our finger on the pulse of the implementation and working with the federal government to make sure that this tracks in a correct way.”
President Obama signed the bill into law on April 16.
The new law repeals the Medicare Sustainable Growth Rate formula, negating the 21% physician fee cut that was to go into effect April 1. In its place, the law provides a 0.5% pay increase yearly for 5 years as the Medicare program makes the transition away from fee-for-service and to value-based payment.
To help get to a point of value over volume, the bill consolidates existing quality programs – including those regarding the meaningful use of electronic health records – into a single value-based performance program.
“We studied that, along with some of the other physician organizations and our House of Delegates, and the conclusion was that this was not just an improvement, but a significant improvement, over the current set of measurements,” Dr. Madara said. The new law also incentivizes physicians to use alternate payment models that focus on care coordination and preventive care with a 5% payment bonus. It pushes for more transparency of Medicare data for physicians, providers, and patients.
MACRA also includes funding to help smaller practices participate in alternative payment models or the streamlined quality measurement program, as well as funding to help in the development of quality measures.
“The provisions that allow for continued funding of the quality measurement enterprise in H.R. 2 are a key building block of this important transition and will also facilitate work to continue advancing measurement science,” the National Quality Forum said in a statement. “Ultimately, these efforts will not only help people get better healthcare, but also will reduce costs that strain patients, purchasers, and the system overall.”
Other important provisions in the new law include the reauthorization of several key programs. CHIP (the Children’s Health Insurance Program), the Community Health Center program, the National Health Service Corps, and the Teaching Health Centers program were all reauthorized for 2 years; they had been scheduled to expire later this year. Additionally, the law continues a partial delay of the Medicare two-midnights ruleuntil Sept. 30.
Physicians also cheered provisions of the new law that allay malpractice concerns. The law specifies that the development, recognition, or implementation of any federal health care guideline or standard does not establish a duty of care in medical malpractice claims.
The provision helps distinguish government quality guidelines and payment rules from medical liability standards, according to Brian K. Atchinson, president and CEO of PIAA, a national trade association for medical malpractice liability insurers.
“None of these rules or guidelines were created with the intent to establish a legal standard for negligence, and so it makes sense for Congress to clarify that fact,” Mr. Atchinson said in an interview. “The standard of care provision in the SGR fix bill does just that, and nothing more. It does not shift the playing field to either plaintiffs or defendants. Instead, it ensures that these federal rules are not misused for purposes for which they were never intended.”
H.R. 2 ran into some trouble in the Senate because it does not have a dedicated funding mechanism to cover its full cost. The Congressional Budget Office estimated that enactment of the law will increase the deficit by $141 billion over 10 years. The CBO’s score also found that the legislation would save money, compared with the price of continued patches.
A total of $73 billion of the $214 billion cost of the package is offset through spending reductions and revenue increases included in the bill, the CBO found. These include income-related premium adjustments for Medicare Parts B and D, Medigap reforms, an increase of levy authority on payments to Medicare providers with delinquent tax debt, adjustments to inpatient hospital payment rates, a delay of Medicaid Disproportionate Share Hospital changes until 2018, and a 1% market basket update for postacute care providers.
Enactment of the law also looked a bit shaky when the Office of the Actuary for CMS released a report April 9 that suggested physicians would see future payment cuts under the law.
“Physician payment rates under H.R. 2 would be lower than scheduled under the current SGR formula by 2048 and would continue to worsen thereafter,” according to the report. “Absent a change in the method or level of update by subsequent legislation, we expect access to Medicare-participating physicians to become a significant issue in the long term under H.R. 2.”
However, the AMA’s Dr. Madara said that he was not concerned about the projections because the report assumes no changes in coming years. “One does not make linear trajectories over a period of decades or more and assume that that’s where we are going to end up because that assumption is that nothing happens in the interim and, as we all know, that’s just simply not the way life works,” he said.
AMA President Robert Wah noted that the report “fails to take into account the long-range impact such a drastic payment cut [due to the SGR] would have on quality and access for Medicare beneficiaries, or the many options H.R. 2 will make available to physicians for avoiding onerous penalties under current law and the significant positive updates that high performers can earn.”
NIPN builds the quality focus
As the era of quality-focused health care descends upon the health care landscape, the National Improvement Partnership Network is laying a foundation to help pediatricians and family physicians improve the quality of care they deliver.
NIPN began as a state-based initiative in Vermont and has evolved into an umbrella organization that is helping pediatricians and family physicians across 22 states, with more working to come on board.
Back in 1999, a state-based program called the Vermont Child Health Improvement Program (VCHIP) was launched by a group of individuals as well as representatives from the state department of health and the state Medicaid agency, explained NIPN associate director Dr. Wendy Davis.
The three groups were “thinking together about what were the things that needed to be improved in terms of children’s health care delivery and population health outcomes,” Dr. Davis said in an interview. “What was our data telling us in the state about where we were doing well and where there were areas for improvement?”
Over the years, VCHIP morphed into a program that had participation from pediatricians and family physicians as well as those in the obstetric community, and looked beyond physical care to encompass mental and behavioral health as well.
But, as a starting point, to prove the value of the partnership, the group took a simple topic – preventive health care – and adopted scientific methods of quality improvement, particularly those used in the manufacturing sector, to help find ways to improve health care.
“If you want physicians to change their behavior and how they deliver care, you need to have them take a very practical approach,” said Dr. Davis, who also is a professor of pediatrics at the University of Vermont, Burlington. You need to “examine what they are doing in their offices and test out some of the best practice strategies in a very systematic way, and always examine what the data on their patients is showing them in terms of figuring out whether they’ve made improvements or not.”
The framework employed by VCHIP, and ultimately NIPN, is a basic strategy of using the Plan-Do-Study-Act (PDSA) model. This pathway starts with setting an objective, testing a new way of doing something, studying the results, and finally implementing changes.
To illustrate it, Dr. Davis used the example of immunization rates. Pediatricians would be asked to determine if they were following national guidelines to get their pediatric patients immunized. They could look at their records in a systematic way to determine what percentage of patients were receiving their shots at the right times. Then they examine the processes used to get patients in the office, and finally, test ways to improve processes and get more children into the office for immunization.
“What organizations like ours do then is teach the clinicians and the practice staff how to look at and analyze and break down their process, and what they can do that is going to make that process better,” Dr. Davis said. “So we run them through a series of PDSA cycles to see if they can get better and better at not missing any of the kids [who] are coming through, and at the end of the project, we have them look at their data again, and hopefully, if we’ve done a good job, they’ve done a good job.”
Dr. Davis stressed that this is not a one-size-fits-all approach to quality improvement. She noted that when it comes time to offer ideas for best practices to test out, many factors can determine what might work best for a given office, so the group likes to offer a number of best practice options that physicians can use to improve their work.
And as word started spreading about the work of VCHIP at various medical conferences, other states started approaching Vermont to build their own version. From there, NIPN was born.
“In 2009, we realized that we had a good critical mass of states, and it would be helpful to have an organization as an umbrella supporting all of these different state-based organizations so that we could begin to share and learn from each other,” Dr. Davis said.
NIPN allows for the easy transfer of knowledge between states and the sharing of ideas on how to improve quality of care, helping doctors learn from each other, all the while maintaining that local focus. The organization also helps pediatricians in other ways, such as by helping them meet maintenance of certification requirements.
“One of the things that we’d like to say is all improvement is local,” Dr. Davis said. “That is why we’ve approached this with the state-based concept because we can share the general concepts and the tools and materials. But when it comes to helping physicians and other health care professionals improve their practice, there are often individual twists and unique features of a particular state that mean that you really have to have people on the ground in that state helping to foster this work so that it can be responsive to the climate of that particular state.”
For those looking to build a partnership within the state, Dr. Davis said there are four key elements to have at the table; state health departments, state Medicaid agencies, state chapters of the American Academy of Pediatrics and the American Academy of Family Physicians (to help bring clinicians into the partnership), and the local academic community. Additionally, it is important to have patients at the table as well, she added.
“NIPN has been an essential mentor organization for our improvement partnership,” Dr. Cason Benton, director of the primary care clinic at the University of Alabama at Birmingham, said in an interview. “Because of NIPN, we created here in Alabama the Alabama Child Health Improvement Alliance (ACHIA). Prior to NIPN being involved, Alabama had been very active in bringing quality improvement work to pediatricians in the state, but we had sort of hit a wall of where we could go through one of the main organizations – the Alabama chapter of the AAP.”
NIPN’s guidance helped ACHIA bring together all the key stakeholders around improving children’s health: Children’s Hospital of Alabama, the University of Alabama at Birmingham, Alabama Medicaid, Blue Cross Blue Shield (one of the largest payers in the state), and the Alabama Department of Public Health.
In the year that ACHIA has been up and running, it already is starting to make a difference. Earlier, the group had hosted two learning collaboratives – one on screening for developmental delays and autism and the other on obesity prevention and treatment.
In the area of developmental screening, “standardized screens for the practices we were working with were not commonly used at the health supervision visits,” Dr. Benton said. “But through the collaborative, they were able to incorporate the screens into their practice work flow so that close to 100% of the children were receiving and completing the screens at their recommended ages, and the appropriate number of referrals to early intervention increased threefold.”
Results on ACHIA’s learning collaborative on obesity prevention will be presented at an upcoming state AAP meeting.
“With the collaborative model, we bring in both the administrative and the clinical staff as well as the physician, and with everybody working together, you are able to create more sustainable changes to the practice and to the work flow,” Dr. Benton said. “It’s well beyond the essential piece of just medical knowledge, but actually transforming the practice to be able to deliver this care in a reliable way.”
Dr. Davis said that in the past, private payers also have shown an interest, and their participation, along with that of Medicaid, is important, especially as payment is becoming more and more focused on quality. Understanding what quality measures payers are looking for can help set the agenda for areas that NIPN and its state partners look at to help ensure they will get paid for their work in the future.
As the era of quality-focused health care descends upon the health care landscape, the National Improvement Partnership Network is laying a foundation to help pediatricians and family physicians improve the quality of care they deliver.
NIPN began as a state-based initiative in Vermont and has evolved into an umbrella organization that is helping pediatricians and family physicians across 22 states, with more working to come on board.
Back in 1999, a state-based program called the Vermont Child Health Improvement Program (VCHIP) was launched by a group of individuals as well as representatives from the state department of health and the state Medicaid agency, explained NIPN associate director Dr. Wendy Davis.
The three groups were “thinking together about what were the things that needed to be improved in terms of children’s health care delivery and population health outcomes,” Dr. Davis said in an interview. “What was our data telling us in the state about where we were doing well and where there were areas for improvement?”
Over the years, VCHIP morphed into a program that had participation from pediatricians and family physicians as well as those in the obstetric community, and looked beyond physical care to encompass mental and behavioral health as well.
But, as a starting point, to prove the value of the partnership, the group took a simple topic – preventive health care – and adopted scientific methods of quality improvement, particularly those used in the manufacturing sector, to help find ways to improve health care.
“If you want physicians to change their behavior and how they deliver care, you need to have them take a very practical approach,” said Dr. Davis, who also is a professor of pediatrics at the University of Vermont, Burlington. You need to “examine what they are doing in their offices and test out some of the best practice strategies in a very systematic way, and always examine what the data on their patients is showing them in terms of figuring out whether they’ve made improvements or not.”
The framework employed by VCHIP, and ultimately NIPN, is a basic strategy of using the Plan-Do-Study-Act (PDSA) model. This pathway starts with setting an objective, testing a new way of doing something, studying the results, and finally implementing changes.
To illustrate it, Dr. Davis used the example of immunization rates. Pediatricians would be asked to determine if they were following national guidelines to get their pediatric patients immunized. They could look at their records in a systematic way to determine what percentage of patients were receiving their shots at the right times. Then they examine the processes used to get patients in the office, and finally, test ways to improve processes and get more children into the office for immunization.
“What organizations like ours do then is teach the clinicians and the practice staff how to look at and analyze and break down their process, and what they can do that is going to make that process better,” Dr. Davis said. “So we run them through a series of PDSA cycles to see if they can get better and better at not missing any of the kids [who] are coming through, and at the end of the project, we have them look at their data again, and hopefully, if we’ve done a good job, they’ve done a good job.”
Dr. Davis stressed that this is not a one-size-fits-all approach to quality improvement. She noted that when it comes time to offer ideas for best practices to test out, many factors can determine what might work best for a given office, so the group likes to offer a number of best practice options that physicians can use to improve their work.
And as word started spreading about the work of VCHIP at various medical conferences, other states started approaching Vermont to build their own version. From there, NIPN was born.
“In 2009, we realized that we had a good critical mass of states, and it would be helpful to have an organization as an umbrella supporting all of these different state-based organizations so that we could begin to share and learn from each other,” Dr. Davis said.
NIPN allows for the easy transfer of knowledge between states and the sharing of ideas on how to improve quality of care, helping doctors learn from each other, all the while maintaining that local focus. The organization also helps pediatricians in other ways, such as by helping them meet maintenance of certification requirements.
“One of the things that we’d like to say is all improvement is local,” Dr. Davis said. “That is why we’ve approached this with the state-based concept because we can share the general concepts and the tools and materials. But when it comes to helping physicians and other health care professionals improve their practice, there are often individual twists and unique features of a particular state that mean that you really have to have people on the ground in that state helping to foster this work so that it can be responsive to the climate of that particular state.”
For those looking to build a partnership within the state, Dr. Davis said there are four key elements to have at the table; state health departments, state Medicaid agencies, state chapters of the American Academy of Pediatrics and the American Academy of Family Physicians (to help bring clinicians into the partnership), and the local academic community. Additionally, it is important to have patients at the table as well, she added.
“NIPN has been an essential mentor organization for our improvement partnership,” Dr. Cason Benton, director of the primary care clinic at the University of Alabama at Birmingham, said in an interview. “Because of NIPN, we created here in Alabama the Alabama Child Health Improvement Alliance (ACHIA). Prior to NIPN being involved, Alabama had been very active in bringing quality improvement work to pediatricians in the state, but we had sort of hit a wall of where we could go through one of the main organizations – the Alabama chapter of the AAP.”
NIPN’s guidance helped ACHIA bring together all the key stakeholders around improving children’s health: Children’s Hospital of Alabama, the University of Alabama at Birmingham, Alabama Medicaid, Blue Cross Blue Shield (one of the largest payers in the state), and the Alabama Department of Public Health.
In the year that ACHIA has been up and running, it already is starting to make a difference. Earlier, the group had hosted two learning collaboratives – one on screening for developmental delays and autism and the other on obesity prevention and treatment.
In the area of developmental screening, “standardized screens for the practices we were working with were not commonly used at the health supervision visits,” Dr. Benton said. “But through the collaborative, they were able to incorporate the screens into their practice work flow so that close to 100% of the children were receiving and completing the screens at their recommended ages, and the appropriate number of referrals to early intervention increased threefold.”
Results on ACHIA’s learning collaborative on obesity prevention will be presented at an upcoming state AAP meeting.
“With the collaborative model, we bring in both the administrative and the clinical staff as well as the physician, and with everybody working together, you are able to create more sustainable changes to the practice and to the work flow,” Dr. Benton said. “It’s well beyond the essential piece of just medical knowledge, but actually transforming the practice to be able to deliver this care in a reliable way.”
Dr. Davis said that in the past, private payers also have shown an interest, and their participation, along with that of Medicaid, is important, especially as payment is becoming more and more focused on quality. Understanding what quality measures payers are looking for can help set the agenda for areas that NIPN and its state partners look at to help ensure they will get paid for their work in the future.
As the era of quality-focused health care descends upon the health care landscape, the National Improvement Partnership Network is laying a foundation to help pediatricians and family physicians improve the quality of care they deliver.
NIPN began as a state-based initiative in Vermont and has evolved into an umbrella organization that is helping pediatricians and family physicians across 22 states, with more working to come on board.
Back in 1999, a state-based program called the Vermont Child Health Improvement Program (VCHIP) was launched by a group of individuals as well as representatives from the state department of health and the state Medicaid agency, explained NIPN associate director Dr. Wendy Davis.
The three groups were “thinking together about what were the things that needed to be improved in terms of children’s health care delivery and population health outcomes,” Dr. Davis said in an interview. “What was our data telling us in the state about where we were doing well and where there were areas for improvement?”
Over the years, VCHIP morphed into a program that had participation from pediatricians and family physicians as well as those in the obstetric community, and looked beyond physical care to encompass mental and behavioral health as well.
But, as a starting point, to prove the value of the partnership, the group took a simple topic – preventive health care – and adopted scientific methods of quality improvement, particularly those used in the manufacturing sector, to help find ways to improve health care.
“If you want physicians to change their behavior and how they deliver care, you need to have them take a very practical approach,” said Dr. Davis, who also is a professor of pediatrics at the University of Vermont, Burlington. You need to “examine what they are doing in their offices and test out some of the best practice strategies in a very systematic way, and always examine what the data on their patients is showing them in terms of figuring out whether they’ve made improvements or not.”
The framework employed by VCHIP, and ultimately NIPN, is a basic strategy of using the Plan-Do-Study-Act (PDSA) model. This pathway starts with setting an objective, testing a new way of doing something, studying the results, and finally implementing changes.
To illustrate it, Dr. Davis used the example of immunization rates. Pediatricians would be asked to determine if they were following national guidelines to get their pediatric patients immunized. They could look at their records in a systematic way to determine what percentage of patients were receiving their shots at the right times. Then they examine the processes used to get patients in the office, and finally, test ways to improve processes and get more children into the office for immunization.
“What organizations like ours do then is teach the clinicians and the practice staff how to look at and analyze and break down their process, and what they can do that is going to make that process better,” Dr. Davis said. “So we run them through a series of PDSA cycles to see if they can get better and better at not missing any of the kids [who] are coming through, and at the end of the project, we have them look at their data again, and hopefully, if we’ve done a good job, they’ve done a good job.”
Dr. Davis stressed that this is not a one-size-fits-all approach to quality improvement. She noted that when it comes time to offer ideas for best practices to test out, many factors can determine what might work best for a given office, so the group likes to offer a number of best practice options that physicians can use to improve their work.
And as word started spreading about the work of VCHIP at various medical conferences, other states started approaching Vermont to build their own version. From there, NIPN was born.
“In 2009, we realized that we had a good critical mass of states, and it would be helpful to have an organization as an umbrella supporting all of these different state-based organizations so that we could begin to share and learn from each other,” Dr. Davis said.
NIPN allows for the easy transfer of knowledge between states and the sharing of ideas on how to improve quality of care, helping doctors learn from each other, all the while maintaining that local focus. The organization also helps pediatricians in other ways, such as by helping them meet maintenance of certification requirements.
“One of the things that we’d like to say is all improvement is local,” Dr. Davis said. “That is why we’ve approached this with the state-based concept because we can share the general concepts and the tools and materials. But when it comes to helping physicians and other health care professionals improve their practice, there are often individual twists and unique features of a particular state that mean that you really have to have people on the ground in that state helping to foster this work so that it can be responsive to the climate of that particular state.”
For those looking to build a partnership within the state, Dr. Davis said there are four key elements to have at the table; state health departments, state Medicaid agencies, state chapters of the American Academy of Pediatrics and the American Academy of Family Physicians (to help bring clinicians into the partnership), and the local academic community. Additionally, it is important to have patients at the table as well, she added.
“NIPN has been an essential mentor organization for our improvement partnership,” Dr. Cason Benton, director of the primary care clinic at the University of Alabama at Birmingham, said in an interview. “Because of NIPN, we created here in Alabama the Alabama Child Health Improvement Alliance (ACHIA). Prior to NIPN being involved, Alabama had been very active in bringing quality improvement work to pediatricians in the state, but we had sort of hit a wall of where we could go through one of the main organizations – the Alabama chapter of the AAP.”
NIPN’s guidance helped ACHIA bring together all the key stakeholders around improving children’s health: Children’s Hospital of Alabama, the University of Alabama at Birmingham, Alabama Medicaid, Blue Cross Blue Shield (one of the largest payers in the state), and the Alabama Department of Public Health.
In the year that ACHIA has been up and running, it already is starting to make a difference. Earlier, the group had hosted two learning collaboratives – one on screening for developmental delays and autism and the other on obesity prevention and treatment.
In the area of developmental screening, “standardized screens for the practices we were working with were not commonly used at the health supervision visits,” Dr. Benton said. “But through the collaborative, they were able to incorporate the screens into their practice work flow so that close to 100% of the children were receiving and completing the screens at their recommended ages, and the appropriate number of referrals to early intervention increased threefold.”
Results on ACHIA’s learning collaborative on obesity prevention will be presented at an upcoming state AAP meeting.
“With the collaborative model, we bring in both the administrative and the clinical staff as well as the physician, and with everybody working together, you are able to create more sustainable changes to the practice and to the work flow,” Dr. Benton said. “It’s well beyond the essential piece of just medical knowledge, but actually transforming the practice to be able to deliver this care in a reliable way.”
Dr. Davis said that in the past, private payers also have shown an interest, and their participation, along with that of Medicaid, is important, especially as payment is becoming more and more focused on quality. Understanding what quality measures payers are looking for can help set the agenda for areas that NIPN and its state partners look at to help ensure they will get paid for their work in the future.
ACA improves contraception access with exceptions
WASHINGTON – Women are generally experiencing better access to contraception thanks to the Affordable Care Act, but more needs to be done to ensure that health plans aren’t implementing overly restrictive policies, according to a new report from the Kaiser Family Foundation.
As part of the ACA, most private health plans are required to provide no-cost coverage of women’s preventive health care, including all prescription contraceptives approved by the Food and Drug Administration. The federal guidance issued on preventive services coverage requirements, however, adds that plans can apply reasonable medical management techniques to “control cost and promote efficient delivery of care.”
The April 16 Kaiser Family Foundation report, which examines contraception coverage trends in five states, found that, since the provision became effective in August 2012, “there have been ongoing anecdotal reports of some women experiencing difficulties in securing no-cost coverage from their plans.”
Although Kaiser researchers found that most insurance carriers “are complying with the spirit of the contraceptive coverage requirement, there are some exceptions that appear to be attributable to the carriers’ interpretation of the [Health & Human Services department] regulations.”
During a panel discussion on the report, Dr. Peggy Peng Ye, an ob.gyn. at Medstar Washington (D.C.) Hospital Center, said the finding mirrors what she is seeing in her practice.
“I think this really confirms our experience in that the contraceptive mandate is really working well,” Dr. Ye said. “There are certainly some small pockets where there’s kind of idiosyncratic methods that really aren’t covered for kind of strange reasons that don’t necessarily have a real medical basis. But overall I think that it’s made a great impact.”
The report focused on 12 contraceptive methods, excluding oral contraceptives, and found a wide variation between 20 carrier offerings in the five states (California, Georgia, Michigan, New Jersey, and Texas).
For example, the vaginal ring NuvaRing was covered by 12 of the 20 insurance carriers without any medical management limitations or cost sharing. The remaining carriers, however, varied in their approaches, with some covering the ring with cost sharing, while others had no cost sharing but applied step therapy. One plan offered no coverage of the ring.
The rationale from plan officials for applying cost sharing to the NuvaRing was that contraceptives with the same progestin are equivalent to each other regardless of the delivery method, according to the report. Since the plan has no cost sharing for oral contraceptives, which have the same chemical composition, they decided to impose cost sharing for the NuvaRing.
Wider variations were seen for injections, implants, intrauterine devices (both hormonal and nonhormonal), emergency contraceptive pills, and sterilization.
The Kaiser researchers also raised concerns about the lack of an expedited waiver or appeals process in cases for which emergency contraception is not covered or cost sharing is required. None of the carriers interviewed for the report had an expedited process other than the expedited appeal process required for all other benefits, “which may not be timely enough for women seeking emergency contraceptives,” according to the report.
Ms. Gretchen Borchelt, vice president for health and reproductive rights at the National Women’s Law Center, called the ACA provision requiring contraception “a huge game changer.”
“Millions of women with private insurance now are able to choose the method of birth control that is best for them without having to factor cost into the equation. That makes a huge difference,” Ms. Borchelt said. “But, on the other side, what your report finds is basically what we know to be true, that there are still some women who are not fully benefiting from this tremendous advance for women’s health.”
She called on state and federal regulators to step up enforcement of the contraception coverage requirement.
The report’s lead author, Ms. Laurie Sobel, senior policy analyst for women’s health policy at the Kaiser Family Foundation, suggested that clearer guidance on coverage would help to limit some of the variation. She pointed to a 2014 law in California that more clearly defines coverage of FDA-approved contraceptive products as a template.
WASHINGTON – Women are generally experiencing better access to contraception thanks to the Affordable Care Act, but more needs to be done to ensure that health plans aren’t implementing overly restrictive policies, according to a new report from the Kaiser Family Foundation.
As part of the ACA, most private health plans are required to provide no-cost coverage of women’s preventive health care, including all prescription contraceptives approved by the Food and Drug Administration. The federal guidance issued on preventive services coverage requirements, however, adds that plans can apply reasonable medical management techniques to “control cost and promote efficient delivery of care.”
The April 16 Kaiser Family Foundation report, which examines contraception coverage trends in five states, found that, since the provision became effective in August 2012, “there have been ongoing anecdotal reports of some women experiencing difficulties in securing no-cost coverage from their plans.”
Although Kaiser researchers found that most insurance carriers “are complying with the spirit of the contraceptive coverage requirement, there are some exceptions that appear to be attributable to the carriers’ interpretation of the [Health & Human Services department] regulations.”
During a panel discussion on the report, Dr. Peggy Peng Ye, an ob.gyn. at Medstar Washington (D.C.) Hospital Center, said the finding mirrors what she is seeing in her practice.
“I think this really confirms our experience in that the contraceptive mandate is really working well,” Dr. Ye said. “There are certainly some small pockets where there’s kind of idiosyncratic methods that really aren’t covered for kind of strange reasons that don’t necessarily have a real medical basis. But overall I think that it’s made a great impact.”
The report focused on 12 contraceptive methods, excluding oral contraceptives, and found a wide variation between 20 carrier offerings in the five states (California, Georgia, Michigan, New Jersey, and Texas).
For example, the vaginal ring NuvaRing was covered by 12 of the 20 insurance carriers without any medical management limitations or cost sharing. The remaining carriers, however, varied in their approaches, with some covering the ring with cost sharing, while others had no cost sharing but applied step therapy. One plan offered no coverage of the ring.
The rationale from plan officials for applying cost sharing to the NuvaRing was that contraceptives with the same progestin are equivalent to each other regardless of the delivery method, according to the report. Since the plan has no cost sharing for oral contraceptives, which have the same chemical composition, they decided to impose cost sharing for the NuvaRing.
Wider variations were seen for injections, implants, intrauterine devices (both hormonal and nonhormonal), emergency contraceptive pills, and sterilization.
The Kaiser researchers also raised concerns about the lack of an expedited waiver or appeals process in cases for which emergency contraception is not covered or cost sharing is required. None of the carriers interviewed for the report had an expedited process other than the expedited appeal process required for all other benefits, “which may not be timely enough for women seeking emergency contraceptives,” according to the report.
Ms. Gretchen Borchelt, vice president for health and reproductive rights at the National Women’s Law Center, called the ACA provision requiring contraception “a huge game changer.”
“Millions of women with private insurance now are able to choose the method of birth control that is best for them without having to factor cost into the equation. That makes a huge difference,” Ms. Borchelt said. “But, on the other side, what your report finds is basically what we know to be true, that there are still some women who are not fully benefiting from this tremendous advance for women’s health.”
She called on state and federal regulators to step up enforcement of the contraception coverage requirement.
The report’s lead author, Ms. Laurie Sobel, senior policy analyst for women’s health policy at the Kaiser Family Foundation, suggested that clearer guidance on coverage would help to limit some of the variation. She pointed to a 2014 law in California that more clearly defines coverage of FDA-approved contraceptive products as a template.
WASHINGTON – Women are generally experiencing better access to contraception thanks to the Affordable Care Act, but more needs to be done to ensure that health plans aren’t implementing overly restrictive policies, according to a new report from the Kaiser Family Foundation.
As part of the ACA, most private health plans are required to provide no-cost coverage of women’s preventive health care, including all prescription contraceptives approved by the Food and Drug Administration. The federal guidance issued on preventive services coverage requirements, however, adds that plans can apply reasonable medical management techniques to “control cost and promote efficient delivery of care.”
The April 16 Kaiser Family Foundation report, which examines contraception coverage trends in five states, found that, since the provision became effective in August 2012, “there have been ongoing anecdotal reports of some women experiencing difficulties in securing no-cost coverage from their plans.”
Although Kaiser researchers found that most insurance carriers “are complying with the spirit of the contraceptive coverage requirement, there are some exceptions that appear to be attributable to the carriers’ interpretation of the [Health & Human Services department] regulations.”
During a panel discussion on the report, Dr. Peggy Peng Ye, an ob.gyn. at Medstar Washington (D.C.) Hospital Center, said the finding mirrors what she is seeing in her practice.
“I think this really confirms our experience in that the contraceptive mandate is really working well,” Dr. Ye said. “There are certainly some small pockets where there’s kind of idiosyncratic methods that really aren’t covered for kind of strange reasons that don’t necessarily have a real medical basis. But overall I think that it’s made a great impact.”
The report focused on 12 contraceptive methods, excluding oral contraceptives, and found a wide variation between 20 carrier offerings in the five states (California, Georgia, Michigan, New Jersey, and Texas).
For example, the vaginal ring NuvaRing was covered by 12 of the 20 insurance carriers without any medical management limitations or cost sharing. The remaining carriers, however, varied in their approaches, with some covering the ring with cost sharing, while others had no cost sharing but applied step therapy. One plan offered no coverage of the ring.
The rationale from plan officials for applying cost sharing to the NuvaRing was that contraceptives with the same progestin are equivalent to each other regardless of the delivery method, according to the report. Since the plan has no cost sharing for oral contraceptives, which have the same chemical composition, they decided to impose cost sharing for the NuvaRing.
Wider variations were seen for injections, implants, intrauterine devices (both hormonal and nonhormonal), emergency contraceptive pills, and sterilization.
The Kaiser researchers also raised concerns about the lack of an expedited waiver or appeals process in cases for which emergency contraception is not covered or cost sharing is required. None of the carriers interviewed for the report had an expedited process other than the expedited appeal process required for all other benefits, “which may not be timely enough for women seeking emergency contraceptives,” according to the report.
Ms. Gretchen Borchelt, vice president for health and reproductive rights at the National Women’s Law Center, called the ACA provision requiring contraception “a huge game changer.”
“Millions of women with private insurance now are able to choose the method of birth control that is best for them without having to factor cost into the equation. That makes a huge difference,” Ms. Borchelt said. “But, on the other side, what your report finds is basically what we know to be true, that there are still some women who are not fully benefiting from this tremendous advance for women’s health.”
She called on state and federal regulators to step up enforcement of the contraception coverage requirement.
The report’s lead author, Ms. Laurie Sobel, senior policy analyst for women’s health policy at the Kaiser Family Foundation, suggested that clearer guidance on coverage would help to limit some of the variation. She pointed to a 2014 law in California that more clearly defines coverage of FDA-approved contraceptive products as a template.
