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In Depth Review of CMS MACRA QPP Regulations
As we continue our coverage of the MACRA Quality Payment Program (QPP) rule, the following article provides a more in-depth look at the regulations promulgated by CMS. We drafted an initial summary when the rule was released in early November.
Biggest surprise: cost category of MIPS
In its proposed rule in July 2017, CMS proposed completely removing the cost domain from MIPS for 2018, despite the underlying statute requiring that cost account for 30% of the overall MIPS score by 2019. However, in the final rule, CMS shocked many when it reversed its position and finalized a cost domain weight of 10 percent for the 2018 p...
Source: Policy and Medicine - December 28, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
5 challenges of working in a county hospital
As a trainee at a large private health system (residency) followed by a NCI-designed comprehensive cancer (fellowship) in two large metropolitan areas in the United States, I was not prepared to face the challenges of working at a university setting affiliated with a county (public) hospital in more rural west-Texas. After one and a half years of experience as a practicing urologic oncologist, these are the five challenges I have encountered:
1. Access to the latest technology. County (public) hospitals are typically more cash-conscious without access to large amounts of research money, wealthy donors, high-profile fundr...
Source: Kevin, M.D. - Medical Weblog - December 6, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/pranav-sharma" rel="tag" > Pranav Sharma, MD < /a > Tags: Policy Hospital-Based Medicine Surgery Source Type: blogs
Changes to 340B Program Reduces Hospital Reimbursement for Pharmaceutical Products by 28.5%
Recently, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule with comment period (CMS-1678-FC), which includes updates to the 2018 rates and quality provisions, and other policy changes. CMS adopted many policies that will support care delivery; reduce burdens for health care providers, especially in rural areas; lower beneficiary out of pocket drug costs for certain drugs; enhance the patient-doctor relationship; and promote flexibility in healthcare. This final rule p...
Source: Policy and Medicine - November 14, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
Why Hospitals Are Losing Serious Money And What That Means For Your Future
This article examines the economic struggles of inpatient facilities, the even harsher realities in front of them, and why hospitals are likely to aggravate, not address, healthcare’s rising cost issues.
According to the Harvard Business Review, several big-name hospitals reported significant declines and, in some cases, net losses to their FY 2016 operating margins. Among them, Partners HealthCare, New England’s largest hospital network, lost $108 million; the Cleveland Clinic witnessed a 71% decline in operating income; and MD Anderson, the nation’s largest cancer center, dropped $266 million.
How did some of the b...
Source: The Health Care Blog - November 12, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
CMS Releases Final Rule for Second Year of QPP - Includes PI-QI CME Improvement Activity
Last week, the Centers for Medicare & Medicaid Services (CMS) released a final rule that makes changes in the second year of the Quality Payment Program (QPP) under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), including the Merit-based Incentive Program (MIPS) and Advanced Payment Models (APMs). The second year of the QPP continues to build on transitional year 1 policies, noting that a “second year to ramp-up the program will continue to help build upon the iterative learning and development of year 1 in preparation for a robust program in year 3.”
In addition to the final rule, CMS als...
Source: Policy and Medicine - November 6, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
CMS Releases Final Rule for Second Year of QPP
Last week, the Centers for Medicare & Medicaid Services (CMS) released a final rule that makes changes in the second year of the Quality Payment Program (QPP) under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), including the Merit-based Incentive Program (MIPS) and Advanced Payment Models (APMs). The second year of the QPP continues to build on transitional year 1 policies, noting that a “second year to ramp-up the program will continue to help build upon the iterative learning and development of year 1 in preparation for a robust program in year 3.”
In addition to the final rule, CMS als...
Source: Policy and Medicine - November 6, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
Technologies Change Health Insurance: The Most Innovative Ventures
The accumulation of medical data enables health insurance companies to move from the 100-year-old concept of reactive care to preventive medicine. The future points to simple, fast and highly personalized insurance plans based on information from the healthcare system and data from health sensors, wearables, and trackers. Here is the changing health insurance scene and its most innovative solutions!
Health insurance systems are unsustainable partly due to costly chronic diseases
According to OECD predictions, exceeding budgets on health spending remains an issue for OECD countries. Maintaining today’s healthcare systems...
Source: The Medical Futurist - October 31, 2017 Category: Information Technology Authors: nora Tags: Future of Medicine Healthcare Design big data chronic illness digital digital health gc3 health data health insurance healthcare data technology trackers wearables Source Type: blogs
Breast Cancer Awareness for Minority Women
During Breast Cancer Awareness Month, the National Cancer Institute is focusing on educational resources for minority women. This resource is a good place for minority women to start when faced with the decision to choose breast reconstruction surgery. It provides answers to basic questions such as: What is breast reconstruction? and Will health insurance pay for breast reconstruction? It also provides information on how surgeons reconstruct breasts using implants or tissue from a woman’s own body. The information outlines the recovery, possible complications and other considerations of both surgical options. It’s also...
Source: BHIC - October 12, 2017 Category: Databases & Libraries Authors: Patricia Devine Tags: Minority Health Concerns Source Type: blogs
Sorry. Health Care Reform Can ’t Wait for Quality Measures to Be Perfect
By BINDER, MARCOTTE, FILDES and THOMPSON
There’s a debate in the United States about whether the current measures of health care quality are adequate to support the movement away from fee-for-service toward value-based payment. Some providers advocate slowing or even halting payment reform efforts because they don’t believe that quality can be adequately measured to determine fair payment. Employers and other purchasers, however, strongly support the currently available quality measures used in payment reform efforts to reward higher-performing providers. So far, the Trump administration has not weighed in.
The four ...
Source: The Health Care Blog - October 6, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized AHRQ CMS PSI Quality measure value-based care Source Type: blogs
The CHRONIC Care Act Passes Senate, Obstacles Remain
Late last Tuesday night, only hours after Republican leaders announced they were pulling the Graham-Cassidy repeal and replace bill from Senate consideration, the body unanimously passed the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 (the Act).
Aiming to improve care for seniors with chronic conditions, the Act first passed the Senate Finance Committee in May of this year. A Health Affairs blog post by former Senators Tom Daschle and Bill Frist, along with in-depth analysis from the Bipartisan Policy Committee, helpfully outline the need for a bipartisan effort to add...
Source: Health Affairs Blog - October 5, 2017 Category: Health Management Authors: Billy Wynne Tags: Costs and Spending Insurance and Coverage Medicaid and CHIP Medicare Organization and Delivery ACA ACO bipartisanship chronic CHRONIC Care Act dual eligibles Long-Term Care Medicare Advantage Telehealth Source Type: blogs
Taking Center Stage - Washington State ’s Medicaid Fraud Control Unit, the False Claims Act and Celgene
On July 26, 2017, the Washington State Attorney General (“AG”) Bob Ferguson (“Ferguson”) announced one of the State’s largest recoveries against the Pharmaceutical Company Celgene (“Celgene”) for allegations involving violations of the Medicaid False Claims Act, in particulars claims related to the company’s off-label marketing, fraudulent billing and providing kickbacks to doctors. The Washington State AG recovery represents a pivotal point in life science compliance, where State AGs similar to Seattle, are actively seeking recoveries against companies ...
Source: Policy and Medicine - September 27, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
Graham-Cassidy Could Be an Additional Financial Blow to Smaller and Rural Hospitals
I have blogged previously about the shaky financial status of small and rural hospitals (see:Rural Hospitals Fighting for Survival; How Can Care in Them Be Improved?) and similar stories are common on the web (see: A Hospital Crisis Is Killing Rural Communities. This State Is ‘Ground Zero.’) A recent article suggested that theGraham-Cassidy bill will increase the financial pressure on rural and small hospitals (see:Rural hospitals see Graham-Cassidy as latest threat to survival). Below is an excerpt from it:Leaders of cash-strapped rural hospitals worry that the latest proposal to repeal and replace the Aff...
Source: Lab Soft News - September 25, 2017 Category: Laboratory Medicine Authors: Bruce Friedman Tags: Cost of Healthcare Healthcare Business Healthcare Delivery Healthcare Insurance Hospital Financial Source Type: blogs
The Cost of Public Reporting
ANISH KOKA MD
In an age where big data is king and doctors are urged to treat populations, the journey of one man still has much to tell us. This is a tale of a man named Joe.
Joseph Carrigan was a bear of a man – though his wife would say he was more teddy than bear. He loved guitar playing, and camp horror movies. Those who knew him well said he had a kind heart, a quick wit and loved cats.
I knew none of these things when I met Joe in the Emergency Department on a Sunday afternoon. I had been called because of an abnormal electrocardiogram – the ER team was worried he could be having a heart attack. ...
Source: The Health Care Blog - September 18, 2017 Category: Consumer Health News Authors: anish_koka Tags: Uncategorized Source Type: blogs
The High Cost of Public Reporting
ANISH KOKA MD
In an age where big data is king and doctors are urged to treat populations, the journey of one man still has much to tell us. This is a tale of a man named Joe.
Joseph Carrigan was a bear of a man – though his wife would say he was more teddy than bear. He loved guitar playing, and camp horror movies. Those who knew him well said he had a kind heart, a quick wit and loved cats.
I knew none of these things when I met Joe in the Emergency Department on a Sunday afternoon. I had been called because of an abnormal electrocardiogram – the ER team was worried he could be having a heart attack. ...
Source: The Health Care Blog - September 18, 2017 Category: Consumer Health News Authors: anish_koka Tags: Uncategorized Cardiac surgery High-risk Quality Reporting Source Type: blogs
Flu Season: Remember That Flu Can Kill Older Adults
Flu isn’t just an inconvenience, especially among the elderly population. For expert information on how caregivers can help their elders stay healthy and if possible avoid the flu, I reached out to Martie Moore, R.N., MAOM, CPHQ, who is Chief Nursing Officer, Medline Industries, Inc. for some answers.
**Q. Martie, what steps should be taken short of hibernation to avoid getting the flu in the first place?
Read full article on HealthCentral about the flu season and what you can do to help your elderly loved one:
Support a caregiver or jump start discussion in support groups with real stories - ...
Source: Minding Our Elders - September 9, 2017 Category: Geriatrics Authors: Carol Bradley Bursack Source Type: blogs
