CMS proposes key provisions of MACRA physician payment system to start in 2019
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The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule implementing key provisions of the new physician payment system required by the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. Section 101 of MACRA repeals the Medicare sustainable growth rate methodology for updates to the physician fee schedule and requires CMS to establish new physician quality and value-based payment programs that start in 2019. Eligible clinicians will participate in one of two tracks – the default Merit-based Incentive Payment System (MIPS) or alternative payment models (APMs). In the rule, CMS proposes most of the requirements of the MIPS for 2019, including performance measures, data submission mechanisms, reporting timeframes, scoring methodology and various administrative processes. As part of the MIPS, the agency proposes to replace electronic health record meaningful use requirements for physicians with a more flexible set of „advancing care information” measures. The rule does not propose parallel changes for hospitals. However, the agency does propose to require that all hospitals, critical access hospitals and physicians attest to three statements that indicate they do not engage in information blocking. CMS also proposes criteria for eligible APMs. Specifically, the agency proposes that an entity that participates in an eligible APM must bear financial risk for any excess Medicare spending over projected expenditures, or be a specified medical home. For 2019 APM incentive payments, eligible models based on financial risk would be Tracks 2 and 3 of the Medicare Shared Savings Program, the Next Generation ACO model, the Comprehensive End-stage Renal Disease Care model, and the two-sided risk model in the Oncology Care program. The newly-announced Comprehensive Primary Care Plus initiative would qualify as a medical home. „We are disappointed by CMS’s narrow definition of alternative payment models, which could have a chilling effect on providers’ ability to experiment with new patient-centered, value-driven payment models,” said American Hospital Association Executive Vice President Tom Nickels in a statement. Nickels also noted that the proposed rule „fails to recognize the significant resources and risk assumed by the highly motivated, early adopters of alternative payment models.” CMS is accepting comments on the proposed rule through June 27. AHA members can access a Special Bulletin with additional information by going to www.aha.org.
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Pew report profiles 10 inpatient antibiotic stewardship programs
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A new report from the Pew Charitable Trusts profiles 10 antibiotic stewardship programs (ASPs) in inpatient settings, which provide examples to hospitals seeking to establish or improve their antibiotic stewardship efforts. „Though ASPs differ in their details, these case studies reveal themes that are critical to any successful program implementation,” the authors note, including the presence of an influential champion and shared responsibility among staff for monitoring the program and implementing new interventions. The case studies include results, where available, and discuss issues such as sustainability and „lessons learned.” Antibiotic stewardship programs are designed to minimize inappropriate or unnecessary antibiotic use and slow the spread of resistance. The AHA’s Physician Leadership Forum offers an antibiotic stewardship toolkit to help hospitals and health systems enhance their antimicrobial stewardship programs.
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AHA brief highlights telehealth benefits, urges support for more research
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Policymakers can advance care delivery and benefit patients by expanding access to telehealth in Medicare and new payment models, according to a new American Hospital Association issue brief. „A growing body of evidence shows that telehealth can not only expand access to services but also create cost savings,” the report notes. For example, the Veterans Health Administration estimates its telehealth program reduced hospital admissions and shortened hospital stays to save nearly $1 billion in 2012. A recent study of enrollees in the California Public Employees Retirement System found that telehealth patients were less likely to require a follow-up visit than patients who received their initial consult for a similar condition in an emergency department or physician’s office. Telehealth also can allow some hospital patients to receive care at home at lower cost or access specialists without the need to transfer to another hospital, and help nursing home patients avoid hospitalizations, the report notes. Additional research using larger samples sizes, diverse geographies and a broader range of conditions and services „can help policymakers better understand the full range of benefits,” the report adds.
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Impact of emotional intelligence and resiliency on health care performance focus of next PLF webinar
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Join the AHA’s Physician Leadership Forum on Thursday, June 23 beginning at 2:00 p.m. ET to learn about the the impact of emotional intelligence on high performing physician leaders.
In this webinar, presenters Larry McEvoy, MD, FACEP, Co-Founder of PracticingExcellence and an executive-in-residence at the Center for Creative Leadership, and Tracy Duberman, PhD, MPH, FACHE, President & CEO of The Leadership Development Group, will discuss the strategic impact of emotional intelligence and resilience in crafting high-value health care organizations and will review approaches to developing emotional intelligence and resiliency in physician leaders.
To register for this complimentary webinar, click here.
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CDC reports on trends in racial and ethnic health disparities
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Racial and ethnic differences in life expectancy, infant mortality, female cigarette smoking, flu vaccinations for seniors, and health insurance coverage narrowed between 1999 and 2014, according to the Centers for Disease Control and Prevention’s latest annual report on the nation’s health, which features a special section on health disparities. Racial and ethnic differences in the number of low-risk births delivered by cesarean section, flu vaccinations for adults under age 65, and unmet dental care needs widened over the period. „Results indicate that trends in health were generally positive for the overall population and several graphs illustrate success in narrowing gaps in health by racial and ethnic group,” the report notes.
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NIH research program to target health disparities in surgical outcomes
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The National Institute on Minority Health and Health Disparities (NIMHD), part of the National Institutes of Health (NIH), recently announced an initiative that will fund research on disparities in surgical care and outcomes for disadvantaged populations. The program will collaborate with NIH and the Agency for Healthcare Research and Quality, and build on efforts by the American College of Surgeons and its national research agenda to address surgical disparities. „Racial and ethnic minority and low-income population groups are often times disproportionately affected by access, availability and affordability to the most advanced health care services,” said NIMHD Director Eliseo Pérez-Stable, MD. „We need to better understand the integral role of optimal access to safe surgical care and medical management, which has not been well studied in health services or health disparities research.”
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The evolution of continuing medical education
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In a recent perspective piece for the New England Journal of Medicine, Graham McMahon, MD, MMSc, president and CEO of the Accreditation Council for Continuing Medical Education, calls upon clinicians, educators, health care institutions, and regulators to contribute to the transformation of continuing medical education (CME). He recommends that clinicians become more aware of their own strengths and weaknesses and choose CME activities that help them grow. He suggests educators create more clinician-friendly and effective learning environments and that regulators and accreditors create conditions that maximize educators’ flexibility and promote innovation.
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AAMC updates physician shortage projections
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The nation faces a shortage of between 61,700 and 94,700 physicians by 2025, according to updated projections by the Association of American Medical Colleges (AAMC). The projected shortfalls range from 14,900-35,600 for primary care physicians and 37,400-60,300 for physicians in non-primary care specialties. The findings are largely consistent with projections reported by the association last year. „These updated projections confirm that the physician shortage is real, it’s significant, and the nation must begin to train more doctors now if patients are going to be able to receive the care they need when they need it in the near future,” said AAMC President and CEO Darrell Kirch, MD. The American Hospital Association supports the Resident Physician Shortage Reduction Act (S. 1148/H.R. 2124), legislation that would end the 19-year freeze on Medicare-funded residency positions.
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AHA Solutions to host webinar on physician engagement and leadership
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How can your health care organization take the first steps to clinical and cultural transformation related to physician engagement and leadership? Join AHA Solutions on Wednesday, May 11 beginning at 1:00 p.m. ET for a webinar on how to engage physicians and turn them into leaders and indispensable allies in achieving health care transformation.
Presenter Mo Kasti, MS, MBB, MCA, CEO and founder of the Physician Leadership Institute, will provide a step-by-step plan for hospital executive teams to follow. It includes anticipated obstacles and how to overcome them, real-life case studies, best practices and tips to maximize resources and optimize outcomes. Attendees will take away a clear understanding of what physician engagement and leadership really means and how it benefits the health care organization in practical, tangible ways.
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The most popular article from our last issue:
American College of Surgeons releases principles on intraoperative responsibility of primary surgeon
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