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Consumer Reports' Hospital Quality Ratings Dubious
Who doesn’t know and love Consumer Reports? I personally have used this product to help me make a wide range of purchases, from child-care products to a new automobile. Consumer Reports has enjoyed a relatively unblemished reputation since its inception as an unbiased repository of invaluable information for consumers. This nonprofit advocacy organization advises consumers looking to purchase anything from small, menial items (e.g. blenders and toasters) to large, expensive ones (e.g. computers, lawn mowers, cars). It has been categorizing and publishing large-scale consumer feedback and in-house testing since 1936. According to Wikipedia, Consumer Reports has more than 7 million subscribers and runs a budget in excess of $21 million annually.
One of the reasons for its longstanding success is that it does not appear to have any hidden agenda. It does not have any partiality to a specific company or service, and therefore has maintained its impartial stance during testing and evaluation of any good or service. Its Consumer Reports magazine houses no advertisements in order to maintain its objectivity. Its only agenda is to reflect the interests and opinions of the consumers themselves, and its mission is to provide a “fair, just, and safe marketplace for all consumers and to empower consumers to protect themselves.”1 A perfect agent from which to seek advice.
And as a company, it has grown with the times, as it now hosts a variety of platforms from which consumers can seek advice. It has long hosted a website (ConsumerReports.org). Now it has Consumer Reports Television and The Consumerist blog, the latter of which accepts “tips” from anyone on what stories to cover, helpful tips for consumers, or interesting pictures. For a few years, there was also Consumer Reports WebWatch, which was aimed at improving the credibility of websites through rigorous investigative reporting.
So it seems that Consumer Reports could be a good avenue to seek advice on where to “consume” health care. And, in fact, it is now in the business of rating the health-care industry. Recent blog posts from Consumer Reports have entailed topics as wide-ranging as the number of uninsured in the U.S. to the number and types of recalls of food products.
The health part of the website covers beauty and personal care (sunscreens and anti-wrinkle serums), exercise and fitness (bikes and diet plans), foods (coffee to frozen meals), home medical supplies (heart rate and blood pressure monitors), vitamins, supplements, and, last but not least, health services. This last section rates health insurance, heart surgeons, heart screening tests, and hospitals.
It even goes so far as to “rate” medications; its Best Buy Drugs compares the cost and effectiveness of a variety of prescription drugs ranging from anti-hypertensives to diabetic agents.
In Focus: Hospitals
Consumer Reports’ latest foray into the health-care industry now includes reporting on the quality of hospitals. The current ratings evaluated more than 2,000 acute-care hospitals in the U.S. and came up with several rankings.
The first rating includes “patient outcomes,” which is a conglomerate of hospital-acquired central-line-associated bloodstream infection (CLABSI) rates, select surgical-site-infection [SSI] rates, 30-day readmission rates (for acute MI [AMI], congestive heart failure [CHF], and pneumonia), and eight “Patient Safety Indicators” (derived from definitions from the Agency for Healthcare Research & Quality [AHRQ], and includes pressure ulcers, pneumothorax, CLABSI, accidental puncture injury during surgery, and four postoperative complications, including VTE, sepsis, hip fracture, and wound dehiscence).
It also includes ratings of the patient experience (from a subset of HCAHPS questions) and two measures of hospital practices, including the use of electronic health records (from the American Hospital Association) and the use of “double scans” (simultaneous thoracic and abdominal CT scans).
From all of these ratings, Consumer Reports combined some of the metrics to arrive at a “Safety Score,” which ranges from 0 to 100 (100 being the safest), based on five categories, including infections (CLABSI and SSI), readmission rates (for AMI, CHF, and pneumonia), patient ratings of communication about their medications and about their discharge process, rate of double scans, and avoidance of the aforementioned AHRQ Patient Safety Indicators.
As to how potential patients are supposed to use this information, Consumer Reports gives the following advice to those wanting to know how the ratings can help a patient get better care: “They can help you compare hospitals in your area so you can choose the one that’s best for you. Even if you don’t have a choice of hospitals, our ratings can alert you to particular concerns so you can take steps to prevent problems no matter which hospital you go to. For example, if a hospital scores low in communicating with patients about what to do when they’re discharged, you should ask about discharge planning at the hospital you choose and make sure you know what to do when you leave.”
Overall, the average Safety Score for included hospitals was a 49, with a range from 14 to 74 across the U.S. Teaching hospitals were among the lowest scorers, with two-thirds of them rated below average.
At first blush, the numbers seem humbling, even startling, but it is not clear if they reflect bad care or bad metrics. Consumer Reports, similar to many other rating scales, has glued together a hodge-podge of different metrics and converted them into a summary score that may or may not line up with other organizational ratings (e.g. U.S. News and World Report, Leapfrog Group, Healthgrades, etc). Consumer Reports does acknowledge that none of the information for their rankings is actually collected from Consumer Reports but from other sources, such as the Centers for Medicare & Medicaid Services (CMS) and the American Hospital Association (AHA).
The Bottom Line
Despite all this attention from Consumer Reports and others, online ratings are only used by about 14% of consumers to review hospitals or health-care facilities and by about 17% of consumers to review physicians or other health-care providers.2 Although the uptick is relatively low for use of online ratings to seek health care, that likely will change as the measurements get better and are more reflective of true care quality.
The bottom line for consumers is: Where do I want to be hospitalized when I get sick, and can I tell at the front end in which aspects a hospital is going to do well?
I think the answer for consumers should be to stay informed, always have an advocate at your side, and never stop asking questions.And for now, relegate Consumer Reports to purchases, not health care.
Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].
References
- Consumer Reports. How we rate hospitals. Consumer Reports website. Available at: http://www.consumerreports.org/cro/2012/10/how-we-rate-hospitals/index.htm. Accessed May 12, 2013.
- Pew Internet & American Life Project. Peer-to-peer health care. Pew Internet website. Available at: http://www.pewinternet.org/Reports/2013/Health-online/Part-Two/Section-2.aspx. Accessed May 12, 2013.
Who doesn’t know and love Consumer Reports? I personally have used this product to help me make a wide range of purchases, from child-care products to a new automobile. Consumer Reports has enjoyed a relatively unblemished reputation since its inception as an unbiased repository of invaluable information for consumers. This nonprofit advocacy organization advises consumers looking to purchase anything from small, menial items (e.g. blenders and toasters) to large, expensive ones (e.g. computers, lawn mowers, cars). It has been categorizing and publishing large-scale consumer feedback and in-house testing since 1936. According to Wikipedia, Consumer Reports has more than 7 million subscribers and runs a budget in excess of $21 million annually.
One of the reasons for its longstanding success is that it does not appear to have any hidden agenda. It does not have any partiality to a specific company or service, and therefore has maintained its impartial stance during testing and evaluation of any good or service. Its Consumer Reports magazine houses no advertisements in order to maintain its objectivity. Its only agenda is to reflect the interests and opinions of the consumers themselves, and its mission is to provide a “fair, just, and safe marketplace for all consumers and to empower consumers to protect themselves.”1 A perfect agent from which to seek advice.
And as a company, it has grown with the times, as it now hosts a variety of platforms from which consumers can seek advice. It has long hosted a website (ConsumerReports.org). Now it has Consumer Reports Television and The Consumerist blog, the latter of which accepts “tips” from anyone on what stories to cover, helpful tips for consumers, or interesting pictures. For a few years, there was also Consumer Reports WebWatch, which was aimed at improving the credibility of websites through rigorous investigative reporting.
So it seems that Consumer Reports could be a good avenue to seek advice on where to “consume” health care. And, in fact, it is now in the business of rating the health-care industry. Recent blog posts from Consumer Reports have entailed topics as wide-ranging as the number of uninsured in the U.S. to the number and types of recalls of food products.
The health part of the website covers beauty and personal care (sunscreens and anti-wrinkle serums), exercise and fitness (bikes and diet plans), foods (coffee to frozen meals), home medical supplies (heart rate and blood pressure monitors), vitamins, supplements, and, last but not least, health services. This last section rates health insurance, heart surgeons, heart screening tests, and hospitals.
It even goes so far as to “rate” medications; its Best Buy Drugs compares the cost and effectiveness of a variety of prescription drugs ranging from anti-hypertensives to diabetic agents.
In Focus: Hospitals
Consumer Reports’ latest foray into the health-care industry now includes reporting on the quality of hospitals. The current ratings evaluated more than 2,000 acute-care hospitals in the U.S. and came up with several rankings.
The first rating includes “patient outcomes,” which is a conglomerate of hospital-acquired central-line-associated bloodstream infection (CLABSI) rates, select surgical-site-infection [SSI] rates, 30-day readmission rates (for acute MI [AMI], congestive heart failure [CHF], and pneumonia), and eight “Patient Safety Indicators” (derived from definitions from the Agency for Healthcare Research & Quality [AHRQ], and includes pressure ulcers, pneumothorax, CLABSI, accidental puncture injury during surgery, and four postoperative complications, including VTE, sepsis, hip fracture, and wound dehiscence).
It also includes ratings of the patient experience (from a subset of HCAHPS questions) and two measures of hospital practices, including the use of electronic health records (from the American Hospital Association) and the use of “double scans” (simultaneous thoracic and abdominal CT scans).
From all of these ratings, Consumer Reports combined some of the metrics to arrive at a “Safety Score,” which ranges from 0 to 100 (100 being the safest), based on five categories, including infections (CLABSI and SSI), readmission rates (for AMI, CHF, and pneumonia), patient ratings of communication about their medications and about their discharge process, rate of double scans, and avoidance of the aforementioned AHRQ Patient Safety Indicators.
As to how potential patients are supposed to use this information, Consumer Reports gives the following advice to those wanting to know how the ratings can help a patient get better care: “They can help you compare hospitals in your area so you can choose the one that’s best for you. Even if you don’t have a choice of hospitals, our ratings can alert you to particular concerns so you can take steps to prevent problems no matter which hospital you go to. For example, if a hospital scores low in communicating with patients about what to do when they’re discharged, you should ask about discharge planning at the hospital you choose and make sure you know what to do when you leave.”
Overall, the average Safety Score for included hospitals was a 49, with a range from 14 to 74 across the U.S. Teaching hospitals were among the lowest scorers, with two-thirds of them rated below average.
At first blush, the numbers seem humbling, even startling, but it is not clear if they reflect bad care or bad metrics. Consumer Reports, similar to many other rating scales, has glued together a hodge-podge of different metrics and converted them into a summary score that may or may not line up with other organizational ratings (e.g. U.S. News and World Report, Leapfrog Group, Healthgrades, etc). Consumer Reports does acknowledge that none of the information for their rankings is actually collected from Consumer Reports but from other sources, such as the Centers for Medicare & Medicaid Services (CMS) and the American Hospital Association (AHA).
The Bottom Line
Despite all this attention from Consumer Reports and others, online ratings are only used by about 14% of consumers to review hospitals or health-care facilities and by about 17% of consumers to review physicians or other health-care providers.2 Although the uptick is relatively low for use of online ratings to seek health care, that likely will change as the measurements get better and are more reflective of true care quality.
The bottom line for consumers is: Where do I want to be hospitalized when I get sick, and can I tell at the front end in which aspects a hospital is going to do well?
I think the answer for consumers should be to stay informed, always have an advocate at your side, and never stop asking questions.And for now, relegate Consumer Reports to purchases, not health care.
Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].
References
- Consumer Reports. How we rate hospitals. Consumer Reports website. Available at: http://www.consumerreports.org/cro/2012/10/how-we-rate-hospitals/index.htm. Accessed May 12, 2013.
- Pew Internet & American Life Project. Peer-to-peer health care. Pew Internet website. Available at: http://www.pewinternet.org/Reports/2013/Health-online/Part-Two/Section-2.aspx. Accessed May 12, 2013.
Who doesn’t know and love Consumer Reports? I personally have used this product to help me make a wide range of purchases, from child-care products to a new automobile. Consumer Reports has enjoyed a relatively unblemished reputation since its inception as an unbiased repository of invaluable information for consumers. This nonprofit advocacy organization advises consumers looking to purchase anything from small, menial items (e.g. blenders and toasters) to large, expensive ones (e.g. computers, lawn mowers, cars). It has been categorizing and publishing large-scale consumer feedback and in-house testing since 1936. According to Wikipedia, Consumer Reports has more than 7 million subscribers and runs a budget in excess of $21 million annually.
One of the reasons for its longstanding success is that it does not appear to have any hidden agenda. It does not have any partiality to a specific company or service, and therefore has maintained its impartial stance during testing and evaluation of any good or service. Its Consumer Reports magazine houses no advertisements in order to maintain its objectivity. Its only agenda is to reflect the interests and opinions of the consumers themselves, and its mission is to provide a “fair, just, and safe marketplace for all consumers and to empower consumers to protect themselves.”1 A perfect agent from which to seek advice.
And as a company, it has grown with the times, as it now hosts a variety of platforms from which consumers can seek advice. It has long hosted a website (ConsumerReports.org). Now it has Consumer Reports Television and The Consumerist blog, the latter of which accepts “tips” from anyone on what stories to cover, helpful tips for consumers, or interesting pictures. For a few years, there was also Consumer Reports WebWatch, which was aimed at improving the credibility of websites through rigorous investigative reporting.
So it seems that Consumer Reports could be a good avenue to seek advice on where to “consume” health care. And, in fact, it is now in the business of rating the health-care industry. Recent blog posts from Consumer Reports have entailed topics as wide-ranging as the number of uninsured in the U.S. to the number and types of recalls of food products.
The health part of the website covers beauty and personal care (sunscreens and anti-wrinkle serums), exercise and fitness (bikes and diet plans), foods (coffee to frozen meals), home medical supplies (heart rate and blood pressure monitors), vitamins, supplements, and, last but not least, health services. This last section rates health insurance, heart surgeons, heart screening tests, and hospitals.
It even goes so far as to “rate” medications; its Best Buy Drugs compares the cost and effectiveness of a variety of prescription drugs ranging from anti-hypertensives to diabetic agents.
In Focus: Hospitals
Consumer Reports’ latest foray into the health-care industry now includes reporting on the quality of hospitals. The current ratings evaluated more than 2,000 acute-care hospitals in the U.S. and came up with several rankings.
The first rating includes “patient outcomes,” which is a conglomerate of hospital-acquired central-line-associated bloodstream infection (CLABSI) rates, select surgical-site-infection [SSI] rates, 30-day readmission rates (for acute MI [AMI], congestive heart failure [CHF], and pneumonia), and eight “Patient Safety Indicators” (derived from definitions from the Agency for Healthcare Research & Quality [AHRQ], and includes pressure ulcers, pneumothorax, CLABSI, accidental puncture injury during surgery, and four postoperative complications, including VTE, sepsis, hip fracture, and wound dehiscence).
It also includes ratings of the patient experience (from a subset of HCAHPS questions) and two measures of hospital practices, including the use of electronic health records (from the American Hospital Association) and the use of “double scans” (simultaneous thoracic and abdominal CT scans).
From all of these ratings, Consumer Reports combined some of the metrics to arrive at a “Safety Score,” which ranges from 0 to 100 (100 being the safest), based on five categories, including infections (CLABSI and SSI), readmission rates (for AMI, CHF, and pneumonia), patient ratings of communication about their medications and about their discharge process, rate of double scans, and avoidance of the aforementioned AHRQ Patient Safety Indicators.
As to how potential patients are supposed to use this information, Consumer Reports gives the following advice to those wanting to know how the ratings can help a patient get better care: “They can help you compare hospitals in your area so you can choose the one that’s best for you. Even if you don’t have a choice of hospitals, our ratings can alert you to particular concerns so you can take steps to prevent problems no matter which hospital you go to. For example, if a hospital scores low in communicating with patients about what to do when they’re discharged, you should ask about discharge planning at the hospital you choose and make sure you know what to do when you leave.”
Overall, the average Safety Score for included hospitals was a 49, with a range from 14 to 74 across the U.S. Teaching hospitals were among the lowest scorers, with two-thirds of them rated below average.
At first blush, the numbers seem humbling, even startling, but it is not clear if they reflect bad care or bad metrics. Consumer Reports, similar to many other rating scales, has glued together a hodge-podge of different metrics and converted them into a summary score that may or may not line up with other organizational ratings (e.g. U.S. News and World Report, Leapfrog Group, Healthgrades, etc). Consumer Reports does acknowledge that none of the information for their rankings is actually collected from Consumer Reports but from other sources, such as the Centers for Medicare & Medicaid Services (CMS) and the American Hospital Association (AHA).
The Bottom Line
Despite all this attention from Consumer Reports and others, online ratings are only used by about 14% of consumers to review hospitals or health-care facilities and by about 17% of consumers to review physicians or other health-care providers.2 Although the uptick is relatively low for use of online ratings to seek health care, that likely will change as the measurements get better and are more reflective of true care quality.
The bottom line for consumers is: Where do I want to be hospitalized when I get sick, and can I tell at the front end in which aspects a hospital is going to do well?
I think the answer for consumers should be to stay informed, always have an advocate at your side, and never stop asking questions.And for now, relegate Consumer Reports to purchases, not health care.
Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].
References
- Consumer Reports. How we rate hospitals. Consumer Reports website. Available at: http://www.consumerreports.org/cro/2012/10/how-we-rate-hospitals/index.htm. Accessed May 12, 2013.
- Pew Internet & American Life Project. Peer-to-peer health care. Pew Internet website. Available at: http://www.pewinternet.org/Reports/2013/Health-online/Part-Two/Section-2.aspx. Accessed May 12, 2013.
Overtime to Reduce Backlog; Translating the Diabetes Prevention Into Native American Real Life; Movement on Mental Health; Hearing Loss: A Silent Epidemic; The Long View on Diabetes Drugs
Marketing Guide
The guide describes the pharmacy practices and related terminology of this extensive system. A copy of the 2011 Federal Marketing Guide can be purchased for $15.00 plus $2.95 for shipping and handling costs. For single or bulk orders, please contact Peter DeYoe at [email protected].
The guide describes the pharmacy practices and related terminology of this extensive system. A copy of the 2011 Federal Marketing Guide can be purchased for $15.00 plus $2.95 for shipping and handling costs. For single or bulk orders, please contact Peter DeYoe at [email protected].
The guide describes the pharmacy practices and related terminology of this extensive system. A copy of the 2011 Federal Marketing Guide can be purchased for $15.00 plus $2.95 for shipping and handling costs. For single or bulk orders, please contact Peter DeYoe at [email protected].
Nurses Joining Forces to Care for Veterans; REACHing Out for the Homeless; Expediting Claims for Long-Suffering Veterans; More Help for Smokers Who Want to Quit
New Hotline for Women Veterans; Task Force Report Out on Gulf War Illnesses
Medicare to double the penalty on 30-day readmissions
The penalties are going up in Medicare’s hospital readmission reduction program. Starting on Oct. 1, hospitals could face up to a 2% cut in Medicare payments if their 30-day readmission rates for acute myocardial infarction, heart failure, and pneumonia are too high. The program started on Oct. 1, 2012, with a 1% cap on penalties.
The penalty increase was outlined in Medicare’s proposed fiscal year 2014 inpatient prospective payment system rule released April 26.
The proposal also outlines the government’s plans to expand the readmission reduction program to include two new readmission measures. Starting on Oct. 1, 2014, the program would also include readmissions associated with an acute exacerbation of chronic obstructive pulmonary disease, as well as readmissions for elective total hip or knee arthroplasty.
The inclusion of COPD for fiscal year 2015 was expected since that condition was specifically highlighted by Congress in the Affordable Care Act (ACA), which created the readmission reduction program. However, lawmakers had also recommended adding coronary artery bypass graft (CABG) surgery, percutaneous coronary intervention (PCI), and other vascular conditions, which are not included in the Centers for Medicare and Medicaid Services (CMS) proposal.
The reasons for the switch were largely due to cost and volume, according to the proposal rule.
In 2005, annual hospital charges totaled $3.95 billion for primary total hip arthroplasty and $7.42 billion for total knee arthroplasty. When combined, the two procedures represent the largest procedures cost in the Medicare budget. At the same time, inpatient admissions for PCI and other vascular conditions have been declining, according to Medicare officials, as more of those services are being shifted to hospital outpatient departments.
The fiscal 2014 payment proposal also includes a revised methodology for calculating hospital readmission rates in an effort to do a better job of accounting for certain planned readmissions.
The change is a mixed bag for hospitals, according to the Premier healthcare alliance. While the revised methodology will likely result in a more accurate payment calculation, it fails to take into consideration socioeconomic and community factors.
"Hospitals that serve high percentages of lower-income patients will be disproportionately penalized for circumstances outside their control," Blair Childs, senior vice president of public affairs at Premier, said in a statement. "This places additional financial burdens on already stressed local health care systems in these communities."
The Medicare program is also moving forward with the Hospital-Acquired Condition Reduction Program, also created by the ACA.
The new program, which begins on Oct. 1, 2014, levies a 1% penalty on hospitals that rank in the lowest-performing quartile for eight hospital-acquired conditions. The proposed rule includes the quality measures, scoring methodology, and correction process that are planned for the program.
During the first year, officials plan to use quality measures that are calculated using claims data or are part of the Inpatient Quality Reporting program. The eight measures are divided into two domains. Hospitals will receive a score for each measure, which will then be used to calculate a domain score. The two domains will be weighted equally to get a total score under the program, according to CMS.
The measures in the first domain are pressure ulcer rate; volume of foreign object left in the body; iatrogenic pneumothorax rate; postoperative physiologic and metabolic derangement rate; postoperative pulmonary embolism or deep vein thrombosis rate; and accidental puncture and laceration rate. CMS is also considering the use of a composite patient safety indicator measure set as an alternative to the first domain.
The second domain includes two health care–associated infection measures: central line–associated bloodstream infection and catheter-associated urinary tract infection.
CMS plans to account for risk factors such as age, gender, and comorbidities when calculating the measure rates.
There are no surprises in the conditions chosen for the new program, said Erik Johnson, senior vice president at Avalere Health. However, the fact that CMS officials chose to include eight measures at the start of the program indicates how serious they are about hospital-acquired conditions, he said.
Mr. Johnson predicted that hospitals will take these quality programs seriously as well. Through the combination of the hospital-acquired condition program, the readmission reduction program, value-based purchasing, and a few other programs, hospitals now have at least 7% of their Medicare payments at risk based on performance on quality measures, he said.
"It’s already starting to move behaviors," Mr. Johnson said. "Hospitals are by and large making a good-faith effort to get better at all of those things. But there are going to be winners and losers, and the losers may end up losing big on a lot of this stuff."
The agency is scheduled to release its final rule by Aug. 1.
| Dr. Frank Pomposelli |
It’s a slippery slope at best. Take for example the mandated push towards electronic medical records (EMR). Will they improve safety and outcomes? Perhaps. Will they reduce costs? I doubt it. EMRs are costly to implement (up to a billion dollars for one very large system that I am familiar with) and reduce efficiency for physicians. The vast array of commercially available and home grown products cannot communicate with one another and HIPPA regulations make it impossible for information to be easily shared between two different health care systems caring for the same patient. The current initiatives by CMS outlined above are another example of using payment reduction mandates (AKA cost containment) in an attempt to improve outcomes.
I doubt any physician or surgeon would dispute the desire or need to reduce readmissions and the rate of hospital acquired conditions like pressure decubiti, venous thrombo-embolism, line infections etc. However, I wonder whether reducing reimbursement, even though it’s the only method available, is either fair or effective. We already spend an enormous amount of time and resources on disposition planning from the moment a patient enters the hospital until the day they leave and work feverishly to get patients out of the hospital as quickly as possible once their treatment is complete. Occasionally, the care team even finds themselves in the uncomfortable situation of nearly pushing someone they have treated out the door. It stands to reason that the pressure to reduce length of stay will result in a somewhat higher rate of readmission-a trade off that recognizes that we are not perfect and neither are our patients. In my experience, the poor and disenfranchised are especially at risk for readmission. Undoubtedly those hospitals that care for a disproportionate number of poor will be unfairly penalized. Is it reasonable to pressure hospitals simultaneously on length of stay and readmissions? I think not. Moreover, is it reasonable to pick a high volume, high reimbursement program like joint replacement just because it’s a big ticket item? Smaller programs may actually represent areas where there is more room for improvement.
My ire is less aroused with regard to hospital acquired conditions. We can and must do a better job in preventing avoidable complications to our patients. Many but not all hospital acquired morbidities result from deficiencies in the system of care that all hospitals, regardless of the demographic they serve can and must correct. Again, hospitals serving the poor may be unfairly targeted since many have less in house resources than larger wealthier systems serving a more affluent patient population. Moreover, fairness and accuracy requires risk adjusted metrics- something that policy makers don’t always recognize without input from us.
After 26 years in clinical practice, many of which have been spent working with my hospital to correct or improve these problems, I’ve come to realize that in a system as complex as a hospital, achieving success in these areas is difficult and requires not only commitment and hard work but also resources. If resources are going to be continuously cut while expecting us to reduce in hospital complications, keep down length stay and reduce the rate of admissions, I suspect all we’ll wind up with is further reductions in compensation with little or no benefit to patients. The skeptics among us undoubtedly feel that is the true motivation behind these initiatives. I hope they are wrong.
Dr. Frank Pomposelli is chair of surgery, St. Elizabeth’s Medical Center, Boston, and associate medical editor of VASCULAR SPECIALIST.
| Dr. Frank Pomposelli |
It’s a slippery slope at best. Take for example the mandated push towards electronic medical records (EMR). Will they improve safety and outcomes? Perhaps. Will they reduce costs? I doubt it. EMRs are costly to implement (up to a billion dollars for one very large system that I am familiar with) and reduce efficiency for physicians. The vast array of commercially available and home grown products cannot communicate with one another and HIPPA regulations make it impossible for information to be easily shared between two different health care systems caring for the same patient. The current initiatives by CMS outlined above are another example of using payment reduction mandates (AKA cost containment) in an attempt to improve outcomes.
I doubt any physician or surgeon would dispute the desire or need to reduce readmissions and the rate of hospital acquired conditions like pressure decubiti, venous thrombo-embolism, line infections etc. However, I wonder whether reducing reimbursement, even though it’s the only method available, is either fair or effective. We already spend an enormous amount of time and resources on disposition planning from the moment a patient enters the hospital until the day they leave and work feverishly to get patients out of the hospital as quickly as possible once their treatment is complete. Occasionally, the care team even finds themselves in the uncomfortable situation of nearly pushing someone they have treated out the door. It stands to reason that the pressure to reduce length of stay will result in a somewhat higher rate of readmission-a trade off that recognizes that we are not perfect and neither are our patients. In my experience, the poor and disenfranchised are especially at risk for readmission. Undoubtedly those hospitals that care for a disproportionate number of poor will be unfairly penalized. Is it reasonable to pressure hospitals simultaneously on length of stay and readmissions? I think not. Moreover, is it reasonable to pick a high volume, high reimbursement program like joint replacement just because it’s a big ticket item? Smaller programs may actually represent areas where there is more room for improvement.
My ire is less aroused with regard to hospital acquired conditions. We can and must do a better job in preventing avoidable complications to our patients. Many but not all hospital acquired morbidities result from deficiencies in the system of care that all hospitals, regardless of the demographic they serve can and must correct. Again, hospitals serving the poor may be unfairly targeted since many have less in house resources than larger wealthier systems serving a more affluent patient population. Moreover, fairness and accuracy requires risk adjusted metrics- something that policy makers don’t always recognize without input from us.
After 26 years in clinical practice, many of which have been spent working with my hospital to correct or improve these problems, I’ve come to realize that in a system as complex as a hospital, achieving success in these areas is difficult and requires not only commitment and hard work but also resources. If resources are going to be continuously cut while expecting us to reduce in hospital complications, keep down length stay and reduce the rate of admissions, I suspect all we’ll wind up with is further reductions in compensation with little or no benefit to patients. The skeptics among us undoubtedly feel that is the true motivation behind these initiatives. I hope they are wrong.
Dr. Frank Pomposelli is chair of surgery, St. Elizabeth’s Medical Center, Boston, and associate medical editor of VASCULAR SPECIALIST.
| Dr. Frank Pomposelli |
It’s a slippery slope at best. Take for example the mandated push towards electronic medical records (EMR). Will they improve safety and outcomes? Perhaps. Will they reduce costs? I doubt it. EMRs are costly to implement (up to a billion dollars for one very large system that I am familiar with) and reduce efficiency for physicians. The vast array of commercially available and home grown products cannot communicate with one another and HIPPA regulations make it impossible for information to be easily shared between two different health care systems caring for the same patient. The current initiatives by CMS outlined above are another example of using payment reduction mandates (AKA cost containment) in an attempt to improve outcomes.
I doubt any physician or surgeon would dispute the desire or need to reduce readmissions and the rate of hospital acquired conditions like pressure decubiti, venous thrombo-embolism, line infections etc. However, I wonder whether reducing reimbursement, even though it’s the only method available, is either fair or effective. We already spend an enormous amount of time and resources on disposition planning from the moment a patient enters the hospital until the day they leave and work feverishly to get patients out of the hospital as quickly as possible once their treatment is complete. Occasionally, the care team even finds themselves in the uncomfortable situation of nearly pushing someone they have treated out the door. It stands to reason that the pressure to reduce length of stay will result in a somewhat higher rate of readmission-a trade off that recognizes that we are not perfect and neither are our patients. In my experience, the poor and disenfranchised are especially at risk for readmission. Undoubtedly those hospitals that care for a disproportionate number of poor will be unfairly penalized. Is it reasonable to pressure hospitals simultaneously on length of stay and readmissions? I think not. Moreover, is it reasonable to pick a high volume, high reimbursement program like joint replacement just because it’s a big ticket item? Smaller programs may actually represent areas where there is more room for improvement.
My ire is less aroused with regard to hospital acquired conditions. We can and must do a better job in preventing avoidable complications to our patients. Many but not all hospital acquired morbidities result from deficiencies in the system of care that all hospitals, regardless of the demographic they serve can and must correct. Again, hospitals serving the poor may be unfairly targeted since many have less in house resources than larger wealthier systems serving a more affluent patient population. Moreover, fairness and accuracy requires risk adjusted metrics- something that policy makers don’t always recognize without input from us.
After 26 years in clinical practice, many of which have been spent working with my hospital to correct or improve these problems, I’ve come to realize that in a system as complex as a hospital, achieving success in these areas is difficult and requires not only commitment and hard work but also resources. If resources are going to be continuously cut while expecting us to reduce in hospital complications, keep down length stay and reduce the rate of admissions, I suspect all we’ll wind up with is further reductions in compensation with little or no benefit to patients. The skeptics among us undoubtedly feel that is the true motivation behind these initiatives. I hope they are wrong.
Dr. Frank Pomposelli is chair of surgery, St. Elizabeth’s Medical Center, Boston, and associate medical editor of VASCULAR SPECIALIST.
The penalties are going up in Medicare’s hospital readmission reduction program. Starting on Oct. 1, hospitals could face up to a 2% cut in Medicare payments if their 30-day readmission rates for acute myocardial infarction, heart failure, and pneumonia are too high. The program started on Oct. 1, 2012, with a 1% cap on penalties.
The penalty increase was outlined in Medicare’s proposed fiscal year 2014 inpatient prospective payment system rule released April 26.
The proposal also outlines the government’s plans to expand the readmission reduction program to include two new readmission measures. Starting on Oct. 1, 2014, the program would also include readmissions associated with an acute exacerbation of chronic obstructive pulmonary disease, as well as readmissions for elective total hip or knee arthroplasty.
The inclusion of COPD for fiscal year 2015 was expected since that condition was specifically highlighted by Congress in the Affordable Care Act (ACA), which created the readmission reduction program. However, lawmakers had also recommended adding coronary artery bypass graft (CABG) surgery, percutaneous coronary intervention (PCI), and other vascular conditions, which are not included in the Centers for Medicare and Medicaid Services (CMS) proposal.
The reasons for the switch were largely due to cost and volume, according to the proposal rule.
In 2005, annual hospital charges totaled $3.95 billion for primary total hip arthroplasty and $7.42 billion for total knee arthroplasty. When combined, the two procedures represent the largest procedures cost in the Medicare budget. At the same time, inpatient admissions for PCI and other vascular conditions have been declining, according to Medicare officials, as more of those services are being shifted to hospital outpatient departments.
The fiscal 2014 payment proposal also includes a revised methodology for calculating hospital readmission rates in an effort to do a better job of accounting for certain planned readmissions.
The change is a mixed bag for hospitals, according to the Premier healthcare alliance. While the revised methodology will likely result in a more accurate payment calculation, it fails to take into consideration socioeconomic and community factors.
"Hospitals that serve high percentages of lower-income patients will be disproportionately penalized for circumstances outside their control," Blair Childs, senior vice president of public affairs at Premier, said in a statement. "This places additional financial burdens on already stressed local health care systems in these communities."
The Medicare program is also moving forward with the Hospital-Acquired Condition Reduction Program, also created by the ACA.
The new program, which begins on Oct. 1, 2014, levies a 1% penalty on hospitals that rank in the lowest-performing quartile for eight hospital-acquired conditions. The proposed rule includes the quality measures, scoring methodology, and correction process that are planned for the program.
During the first year, officials plan to use quality measures that are calculated using claims data or are part of the Inpatient Quality Reporting program. The eight measures are divided into two domains. Hospitals will receive a score for each measure, which will then be used to calculate a domain score. The two domains will be weighted equally to get a total score under the program, according to CMS.
The measures in the first domain are pressure ulcer rate; volume of foreign object left in the body; iatrogenic pneumothorax rate; postoperative physiologic and metabolic derangement rate; postoperative pulmonary embolism or deep vein thrombosis rate; and accidental puncture and laceration rate. CMS is also considering the use of a composite patient safety indicator measure set as an alternative to the first domain.
The second domain includes two health care–associated infection measures: central line–associated bloodstream infection and catheter-associated urinary tract infection.
CMS plans to account for risk factors such as age, gender, and comorbidities when calculating the measure rates.
There are no surprises in the conditions chosen for the new program, said Erik Johnson, senior vice president at Avalere Health. However, the fact that CMS officials chose to include eight measures at the start of the program indicates how serious they are about hospital-acquired conditions, he said.
Mr. Johnson predicted that hospitals will take these quality programs seriously as well. Through the combination of the hospital-acquired condition program, the readmission reduction program, value-based purchasing, and a few other programs, hospitals now have at least 7% of their Medicare payments at risk based on performance on quality measures, he said.
"It’s already starting to move behaviors," Mr. Johnson said. "Hospitals are by and large making a good-faith effort to get better at all of those things. But there are going to be winners and losers, and the losers may end up losing big on a lot of this stuff."
The agency is scheduled to release its final rule by Aug. 1.
The penalties are going up in Medicare’s hospital readmission reduction program. Starting on Oct. 1, hospitals could face up to a 2% cut in Medicare payments if their 30-day readmission rates for acute myocardial infarction, heart failure, and pneumonia are too high. The program started on Oct. 1, 2012, with a 1% cap on penalties.
The penalty increase was outlined in Medicare’s proposed fiscal year 2014 inpatient prospective payment system rule released April 26.
The proposal also outlines the government’s plans to expand the readmission reduction program to include two new readmission measures. Starting on Oct. 1, 2014, the program would also include readmissions associated with an acute exacerbation of chronic obstructive pulmonary disease, as well as readmissions for elective total hip or knee arthroplasty.
The inclusion of COPD for fiscal year 2015 was expected since that condition was specifically highlighted by Congress in the Affordable Care Act (ACA), which created the readmission reduction program. However, lawmakers had also recommended adding coronary artery bypass graft (CABG) surgery, percutaneous coronary intervention (PCI), and other vascular conditions, which are not included in the Centers for Medicare and Medicaid Services (CMS) proposal.
The reasons for the switch were largely due to cost and volume, according to the proposal rule.
In 2005, annual hospital charges totaled $3.95 billion for primary total hip arthroplasty and $7.42 billion for total knee arthroplasty. When combined, the two procedures represent the largest procedures cost in the Medicare budget. At the same time, inpatient admissions for PCI and other vascular conditions have been declining, according to Medicare officials, as more of those services are being shifted to hospital outpatient departments.
The fiscal 2014 payment proposal also includes a revised methodology for calculating hospital readmission rates in an effort to do a better job of accounting for certain planned readmissions.
The change is a mixed bag for hospitals, according to the Premier healthcare alliance. While the revised methodology will likely result in a more accurate payment calculation, it fails to take into consideration socioeconomic and community factors.
"Hospitals that serve high percentages of lower-income patients will be disproportionately penalized for circumstances outside their control," Blair Childs, senior vice president of public affairs at Premier, said in a statement. "This places additional financial burdens on already stressed local health care systems in these communities."
The Medicare program is also moving forward with the Hospital-Acquired Condition Reduction Program, also created by the ACA.
The new program, which begins on Oct. 1, 2014, levies a 1% penalty on hospitals that rank in the lowest-performing quartile for eight hospital-acquired conditions. The proposed rule includes the quality measures, scoring methodology, and correction process that are planned for the program.
During the first year, officials plan to use quality measures that are calculated using claims data or are part of the Inpatient Quality Reporting program. The eight measures are divided into two domains. Hospitals will receive a score for each measure, which will then be used to calculate a domain score. The two domains will be weighted equally to get a total score under the program, according to CMS.
The measures in the first domain are pressure ulcer rate; volume of foreign object left in the body; iatrogenic pneumothorax rate; postoperative physiologic and metabolic derangement rate; postoperative pulmonary embolism or deep vein thrombosis rate; and accidental puncture and laceration rate. CMS is also considering the use of a composite patient safety indicator measure set as an alternative to the first domain.
The second domain includes two health care–associated infection measures: central line–associated bloodstream infection and catheter-associated urinary tract infection.
CMS plans to account for risk factors such as age, gender, and comorbidities when calculating the measure rates.
There are no surprises in the conditions chosen for the new program, said Erik Johnson, senior vice president at Avalere Health. However, the fact that CMS officials chose to include eight measures at the start of the program indicates how serious they are about hospital-acquired conditions, he said.
Mr. Johnson predicted that hospitals will take these quality programs seriously as well. Through the combination of the hospital-acquired condition program, the readmission reduction program, value-based purchasing, and a few other programs, hospitals now have at least 7% of their Medicare payments at risk based on performance on quality measures, he said.
"It’s already starting to move behaviors," Mr. Johnson said. "Hospitals are by and large making a good-faith effort to get better at all of those things. But there are going to be winners and losers, and the losers may end up losing big on a lot of this stuff."
The agency is scheduled to release its final rule by Aug. 1.
House Republicans proffer SGR fix legislation
Republicans on the House Energy and Commerce Committee have released a draft bill that would eliminate the Medicare Sustainable Growth Rate formula that they say has a good chance of being enacted.
Physician groups have been involved in the crafting of the draft, which was first circulated in early February.
"This discussion draft carries on the trend of soliciting more provider feedback than at any point in history on this issue," Rep. Michael Burgess (R-Tex.) said in a statement. "We are taking an important next step with this release by showing providers that we are committed to repealing the SGR and maintaining the option of fee-for-service for providers, while improving the Medicare program."
Rep. Burgess, who is an ob.gyn., and also vice chairman of the Energy and Commerce Health Subcommittee, said that he and his colleagues looked forward to hearing more from physicians.
The draft legislation would repeal the SGR and replace it with a fee-for-service system that would put more emphasis on rewarding quality. Physicians would have a guiding hand in developing quality measures in conjunction with the secretary of Health and Human Services. They would also be given the ability to opt out of fee-for-service and practice instead under new delivery models like accountable care organizations or patient-centered medical homes.
"We are working to restore certainty, fiscal sanity, and we will responsibly pay for these reforms," said Rep. Fred Upton (R-Mich.), chairman of the House Energy and Commerce committee, in a statement. "We will continue working closely with Ways and Means Committee Chairman [Dave] Camp [R-Mich.] as well as maintain our ongoing dialogue with committee Democrats as we work toward long-term solutions in the effort to improve quality of care."
Physician groups were cautious about the proposal at press time. In a statement, Dr. Jeremy Lazarus, president of the American Medical Association, said, "The Energy and Commerce Committee’s framework is another step in the important process of eliminating the SGR and moving toward new ways of delivering and paying for care that reward quality and reduce costs."
He said that the AMA "look[ed] forward to continuing to work to see that progress is made this year."
The American Academy of Family Physicians supports the proposal’s goal of establishing "a period of stable and predictable payment increases," and incentives to improve quality of care, said Dr. Jeffrey Cain, AAFP president, in an interview.
But by largely focusing on the fee-for-service payment system, the committee is overlooking the bigger picture of how physician payment affects health care costs and quality, he said. The AAFP would like to see an increase in pay for primary care because "investing in primary care would improve our country’s health care by increasing quality and decreasing overall costs by reducing unnecessary medical utilization," said Dr. Cain.
In early February, the American College of Physicians and several other groups lent their support to an SGR replacement bill that has elements similar to the Energy and Commerce draft. The bill, the Medicare Physician Payment Innovation Act (H.R. 574), was introduced by Reps. Allyson Schwartz (D-Penn.) and Joe Heck (R-Nev.).
In early May, Rep. Schwartz commended the Energy and Commerce bill, noting that it shared principles in common with H.R. 574. The bill also showed "that there is common ground on a framework for fixing the Medicare reimbursement system," said Rep. Schwartz in a statement.
The Energy and Commerce Committee said that comments on its draft legislation would be accepted until June 10, at [email protected].
On Twitter @aliciaault
Republicans on the House Energy and Commerce Committee have released a draft bill that would eliminate the Medicare Sustainable Growth Rate formula that they say has a good chance of being enacted.
Physician groups have been involved in the crafting of the draft, which was first circulated in early February.
"This discussion draft carries on the trend of soliciting more provider feedback than at any point in history on this issue," Rep. Michael Burgess (R-Tex.) said in a statement. "We are taking an important next step with this release by showing providers that we are committed to repealing the SGR and maintaining the option of fee-for-service for providers, while improving the Medicare program."
Rep. Burgess, who is an ob.gyn., and also vice chairman of the Energy and Commerce Health Subcommittee, said that he and his colleagues looked forward to hearing more from physicians.
The draft legislation would repeal the SGR and replace it with a fee-for-service system that would put more emphasis on rewarding quality. Physicians would have a guiding hand in developing quality measures in conjunction with the secretary of Health and Human Services. They would also be given the ability to opt out of fee-for-service and practice instead under new delivery models like accountable care organizations or patient-centered medical homes.
"We are working to restore certainty, fiscal sanity, and we will responsibly pay for these reforms," said Rep. Fred Upton (R-Mich.), chairman of the House Energy and Commerce committee, in a statement. "We will continue working closely with Ways and Means Committee Chairman [Dave] Camp [R-Mich.] as well as maintain our ongoing dialogue with committee Democrats as we work toward long-term solutions in the effort to improve quality of care."
Physician groups were cautious about the proposal at press time. In a statement, Dr. Jeremy Lazarus, president of the American Medical Association, said, "The Energy and Commerce Committee’s framework is another step in the important process of eliminating the SGR and moving toward new ways of delivering and paying for care that reward quality and reduce costs."
He said that the AMA "look[ed] forward to continuing to work to see that progress is made this year."
The American Academy of Family Physicians supports the proposal’s goal of establishing "a period of stable and predictable payment increases," and incentives to improve quality of care, said Dr. Jeffrey Cain, AAFP president, in an interview.
But by largely focusing on the fee-for-service payment system, the committee is overlooking the bigger picture of how physician payment affects health care costs and quality, he said. The AAFP would like to see an increase in pay for primary care because "investing in primary care would improve our country’s health care by increasing quality and decreasing overall costs by reducing unnecessary medical utilization," said Dr. Cain.
In early February, the American College of Physicians and several other groups lent their support to an SGR replacement bill that has elements similar to the Energy and Commerce draft. The bill, the Medicare Physician Payment Innovation Act (H.R. 574), was introduced by Reps. Allyson Schwartz (D-Penn.) and Joe Heck (R-Nev.).
In early May, Rep. Schwartz commended the Energy and Commerce bill, noting that it shared principles in common with H.R. 574. The bill also showed "that there is common ground on a framework for fixing the Medicare reimbursement system," said Rep. Schwartz in a statement.
The Energy and Commerce Committee said that comments on its draft legislation would be accepted until June 10, at [email protected].
On Twitter @aliciaault
Republicans on the House Energy and Commerce Committee have released a draft bill that would eliminate the Medicare Sustainable Growth Rate formula that they say has a good chance of being enacted.
Physician groups have been involved in the crafting of the draft, which was first circulated in early February.
"This discussion draft carries on the trend of soliciting more provider feedback than at any point in history on this issue," Rep. Michael Burgess (R-Tex.) said in a statement. "We are taking an important next step with this release by showing providers that we are committed to repealing the SGR and maintaining the option of fee-for-service for providers, while improving the Medicare program."
Rep. Burgess, who is an ob.gyn., and also vice chairman of the Energy and Commerce Health Subcommittee, said that he and his colleagues looked forward to hearing more from physicians.
The draft legislation would repeal the SGR and replace it with a fee-for-service system that would put more emphasis on rewarding quality. Physicians would have a guiding hand in developing quality measures in conjunction with the secretary of Health and Human Services. They would also be given the ability to opt out of fee-for-service and practice instead under new delivery models like accountable care organizations or patient-centered medical homes.
"We are working to restore certainty, fiscal sanity, and we will responsibly pay for these reforms," said Rep. Fred Upton (R-Mich.), chairman of the House Energy and Commerce committee, in a statement. "We will continue working closely with Ways and Means Committee Chairman [Dave] Camp [R-Mich.] as well as maintain our ongoing dialogue with committee Democrats as we work toward long-term solutions in the effort to improve quality of care."
Physician groups were cautious about the proposal at press time. In a statement, Dr. Jeremy Lazarus, president of the American Medical Association, said, "The Energy and Commerce Committee’s framework is another step in the important process of eliminating the SGR and moving toward new ways of delivering and paying for care that reward quality and reduce costs."
He said that the AMA "look[ed] forward to continuing to work to see that progress is made this year."
The American Academy of Family Physicians supports the proposal’s goal of establishing "a period of stable and predictable payment increases," and incentives to improve quality of care, said Dr. Jeffrey Cain, AAFP president, in an interview.
But by largely focusing on the fee-for-service payment system, the committee is overlooking the bigger picture of how physician payment affects health care costs and quality, he said. The AAFP would like to see an increase in pay for primary care because "investing in primary care would improve our country’s health care by increasing quality and decreasing overall costs by reducing unnecessary medical utilization," said Dr. Cain.
In early February, the American College of Physicians and several other groups lent their support to an SGR replacement bill that has elements similar to the Energy and Commerce draft. The bill, the Medicare Physician Payment Innovation Act (H.R. 574), was introduced by Reps. Allyson Schwartz (D-Penn.) and Joe Heck (R-Nev.).
In early May, Rep. Schwartz commended the Energy and Commerce bill, noting that it shared principles in common with H.R. 574. The bill also showed "that there is common ground on a framework for fixing the Medicare reimbursement system," said Rep. Schwartz in a statement.
The Energy and Commerce Committee said that comments on its draft legislation would be accepted until June 10, at [email protected].
On Twitter @aliciaault
Double penalty on 30-day readmissions
The penalties are going up in Medicare’s hospital readmission reduction program.
Starting on Oct. 1, hospitals could face up to a 2% cut in Medicare payments if their 30-day readmission rates for acute myocardial infarction, heart failure, and pneumonia are too high. The program started on Oct. 1, 2012, with a 1% cap on penalties.
The penalty increase was outlined in Medicare’s proposed fiscal year 2014 inpatient prospective payment system rule, which was released April 26.
The Medicare proposal also outlines the government’s plans to expand the readmission reduction program to include two new readmission measures.
Starting on Oct. 1, 2014, the program would also include readmissions associated with an acute exacerbation of chronic obstructive pulmonary disease, as well as readmissions for elective total hip or knee arthroplasty.
The inclusion of COPD for fiscal year 2015 was expected since that condition was specifically highlighted by Congress in the Affordable Care Act (ACA), which created the readmission reduction program. However, lawmakers had also recommended adding coronary artery bypass graft (CABG) surgery, percutaneous coronary intervention (PCI), and other vascular conditions, which are not included in the Centers for Medicare and Medicaid Services (CMS) proposal.
The reasons for the switch were largely due to cost and volume, according to the proposal rule.
In 2005, annual hospital charges totaled $3.95 billion for primary total hip arthroplasty and $7.42 billion for total knee arthroplasty. When combined, the two procedures represent the largest procedures cost in the Medicare budget.
At the same time, inpatient admissions for PCI and other vascular conditions have been declining, according to Medicare officials, as more of those services are being shifted to hospital outpatient departments.
The fiscal 2014 payment proposal also includes a revised methodology for calculating hospital readmission rates in an effort to do a better job of accounting for certain planned readmissions.
The change is a mixed bag for hospitals, according to the Premier healthcare alliance. While the revised methodology will likely result in a more accurate payment calculation, it fails to take into consideration socioeconomic and community factors.
"Hospitals that serve high percentages of lower-income patients will be disproportionately penalized for circumstances outside their control," Blair Childs, senior vice president of public affairs at Premier, said in a statement.
"This places additional financial burdens on already stressed local health care systems in these communities."
The Medicare program is also moving forward with the Hospital-Acquired Condition Reduction Program, which was also created by the ACA.
The new program, which begins on Oct. 1, 2014, levies a 1% penalty on hospitals that rank in the lowest-performing quartile for eight hospital-acquired conditions. The proposed rule includes the quality measures, scoring methodology, and correction process that are planned for the program.
During the first year, officials plan to use quality measures that are calculated using claims data or are part of the Inpatient Quality Reporting program.
The eight measures are divided into two domains. Hospitals will receive a score for each measure, which will then be used to calculate a domain score. The two domains will be weighted equally to get a total score under the program, according to CMS.
The measures in the first of the two domains are pressure ulcer rate; volume of foreign object left in the body; iatrogenic pneumothorax rate; postoperative physiologic and metabolic derangement rate; postoperative pulmonary embolism or deep vein thrombosis rate; and accidental puncture and laceration rate.
CMS is also considering the use of a composite patient safety indicator measure set as an alternative to the first domain.
The second domain being used to get a total score under the new program includes two health care–associated infection measures: central line–associated bloodstream infection and catheter-associated urinary tract infection.
CMS plans to account for risk factors such as age, gender, and comorbidities when calculating the measure rates.
There are no surprises in the conditions chosen for the new program, said Erik Johnson, senior vice president at Avalere Health. However, the fact that CMS officials chose to include eight measures at the start of the program indicates how serious they are about hospital-acquired conditions, he said.
Mr. Johnson predicted that hospitals will take these quality programs seriously as well.
Through the combination of the hospital-acquired condition program, the readmission reduction program, value-based purchasing, and a few other programs, hospitals now have at least 7% of their Medicare payments at risk based on performance on quality measures, he said.
"It’s already starting to move behaviors," he added.
"Hospitals are by and large making a good-faith effort to get better at all of those things. But there are going to be winners and losers, and the losers may end up losing big on a lot of this stuff," according to Mr. Johnson
CMS will accept public comments on the proposal until June 25 at www.regulations.gov. The agency is scheduled to release its final rule by Aug. 1.
Medicare continues to drive hospitals toward greater transparency and financial accountability, with the goal being the delivery of higher-value care to our patients. This is a noble pursuit. As a health care system we must embrace the need to do better for our patients – greater effectiveness, safer care, and more efficient care.
To date, measures of success have largely been based upon process of care measures, such as the core measures for pneumonia, heart failure, and surgical patients. Hospitals (and hospitalists) will now begin to see a rapid movement toward accountability for outcomes and not just performance in processes of care. The inclusion of standardized and risk-adjusted hospital-acquired conditions such as central-line bloodstream infections and patient safety indicators (PSIs) are important examples.
Readmission rates are also included in these measured and reported outcomes. At first glance, penalizing hospitals for 30-day readmissions seems like an appropriate and laudable goal. However, this goal assumes that readmissions are avoidable.
Although some readmissions are clearly related to inefficient and unsafe care delivery that is amenable to intervention, many (if not most) are related to patient condition, poor compliance, and suboptimal post–acute care options in the community. Because of these complex clinical and socioeconomic factors, our understanding of how to effectively reduce readmissions remains limited, is generally resource intensive, and is not well compensated in the current payment structure.
These issues will present real challenges to hospitals in trying to meaningfully meet the goals laid out by CMS. For now, embracing approaches such as Project BOOST (Better Outcomes for Older Adults Through Safer Transitions) or Project RED (Re-Engineered Discharge), fostering greater patient engagement in the care transition process, and partnering more closely with our community clinic providers will begin making a positive impact.
However, only through a better understanding of the posthospital syndrome (N. Engl. J. Med. 2013;368:100-2) and meaningful payment reform will we gain the necessary additional tools to make a truly meaningful impact.
Dr. Robert Pendleton is chief medical quality officer for University of Utah Health Care, Salt Lake City.
Medicare continues to drive hospitals toward greater transparency and financial accountability, with the goal being the delivery of higher-value care to our patients. This is a noble pursuit. As a health care system we must embrace the need to do better for our patients – greater effectiveness, safer care, and more efficient care.
To date, measures of success have largely been based upon process of care measures, such as the core measures for pneumonia, heart failure, and surgical patients. Hospitals (and hospitalists) will now begin to see a rapid movement toward accountability for outcomes and not just performance in processes of care. The inclusion of standardized and risk-adjusted hospital-acquired conditions such as central-line bloodstream infections and patient safety indicators (PSIs) are important examples.
Readmission rates are also included in these measured and reported outcomes. At first glance, penalizing hospitals for 30-day readmissions seems like an appropriate and laudable goal. However, this goal assumes that readmissions are avoidable.
Although some readmissions are clearly related to inefficient and unsafe care delivery that is amenable to intervention, many (if not most) are related to patient condition, poor compliance, and suboptimal post–acute care options in the community. Because of these complex clinical and socioeconomic factors, our understanding of how to effectively reduce readmissions remains limited, is generally resource intensive, and is not well compensated in the current payment structure.
These issues will present real challenges to hospitals in trying to meaningfully meet the goals laid out by CMS. For now, embracing approaches such as Project BOOST (Better Outcomes for Older Adults Through Safer Transitions) or Project RED (Re-Engineered Discharge), fostering greater patient engagement in the care transition process, and partnering more closely with our community clinic providers will begin making a positive impact.
However, only through a better understanding of the posthospital syndrome (N. Engl. J. Med. 2013;368:100-2) and meaningful payment reform will we gain the necessary additional tools to make a truly meaningful impact.
Dr. Robert Pendleton is chief medical quality officer for University of Utah Health Care, Salt Lake City.
Medicare continues to drive hospitals toward greater transparency and financial accountability, with the goal being the delivery of higher-value care to our patients. This is a noble pursuit. As a health care system we must embrace the need to do better for our patients – greater effectiveness, safer care, and more efficient care.
To date, measures of success have largely been based upon process of care measures, such as the core measures for pneumonia, heart failure, and surgical patients. Hospitals (and hospitalists) will now begin to see a rapid movement toward accountability for outcomes and not just performance in processes of care. The inclusion of standardized and risk-adjusted hospital-acquired conditions such as central-line bloodstream infections and patient safety indicators (PSIs) are important examples.
Readmission rates are also included in these measured and reported outcomes. At first glance, penalizing hospitals for 30-day readmissions seems like an appropriate and laudable goal. However, this goal assumes that readmissions are avoidable.
Although some readmissions are clearly related to inefficient and unsafe care delivery that is amenable to intervention, many (if not most) are related to patient condition, poor compliance, and suboptimal post–acute care options in the community. Because of these complex clinical and socioeconomic factors, our understanding of how to effectively reduce readmissions remains limited, is generally resource intensive, and is not well compensated in the current payment structure.
These issues will present real challenges to hospitals in trying to meaningfully meet the goals laid out by CMS. For now, embracing approaches such as Project BOOST (Better Outcomes for Older Adults Through Safer Transitions) or Project RED (Re-Engineered Discharge), fostering greater patient engagement in the care transition process, and partnering more closely with our community clinic providers will begin making a positive impact.
However, only through a better understanding of the posthospital syndrome (N. Engl. J. Med. 2013;368:100-2) and meaningful payment reform will we gain the necessary additional tools to make a truly meaningful impact.
Dr. Robert Pendleton is chief medical quality officer for University of Utah Health Care, Salt Lake City.
The penalties are going up in Medicare’s hospital readmission reduction program.
Starting on Oct. 1, hospitals could face up to a 2% cut in Medicare payments if their 30-day readmission rates for acute myocardial infarction, heart failure, and pneumonia are too high. The program started on Oct. 1, 2012, with a 1% cap on penalties.
The penalty increase was outlined in Medicare’s proposed fiscal year 2014 inpatient prospective payment system rule, which was released April 26.
The Medicare proposal also outlines the government’s plans to expand the readmission reduction program to include two new readmission measures.
Starting on Oct. 1, 2014, the program would also include readmissions associated with an acute exacerbation of chronic obstructive pulmonary disease, as well as readmissions for elective total hip or knee arthroplasty.
The inclusion of COPD for fiscal year 2015 was expected since that condition was specifically highlighted by Congress in the Affordable Care Act (ACA), which created the readmission reduction program. However, lawmakers had also recommended adding coronary artery bypass graft (CABG) surgery, percutaneous coronary intervention (PCI), and other vascular conditions, which are not included in the Centers for Medicare and Medicaid Services (CMS) proposal.
The reasons for the switch were largely due to cost and volume, according to the proposal rule.
In 2005, annual hospital charges totaled $3.95 billion for primary total hip arthroplasty and $7.42 billion for total knee arthroplasty. When combined, the two procedures represent the largest procedures cost in the Medicare budget.
At the same time, inpatient admissions for PCI and other vascular conditions have been declining, according to Medicare officials, as more of those services are being shifted to hospital outpatient departments.
The fiscal 2014 payment proposal also includes a revised methodology for calculating hospital readmission rates in an effort to do a better job of accounting for certain planned readmissions.
The change is a mixed bag for hospitals, according to the Premier healthcare alliance. While the revised methodology will likely result in a more accurate payment calculation, it fails to take into consideration socioeconomic and community factors.
"Hospitals that serve high percentages of lower-income patients will be disproportionately penalized for circumstances outside their control," Blair Childs, senior vice president of public affairs at Premier, said in a statement.
"This places additional financial burdens on already stressed local health care systems in these communities."
The Medicare program is also moving forward with the Hospital-Acquired Condition Reduction Program, which was also created by the ACA.
The new program, which begins on Oct. 1, 2014, levies a 1% penalty on hospitals that rank in the lowest-performing quartile for eight hospital-acquired conditions. The proposed rule includes the quality measures, scoring methodology, and correction process that are planned for the program.
During the first year, officials plan to use quality measures that are calculated using claims data or are part of the Inpatient Quality Reporting program.
The eight measures are divided into two domains. Hospitals will receive a score for each measure, which will then be used to calculate a domain score. The two domains will be weighted equally to get a total score under the program, according to CMS.
The measures in the first of the two domains are pressure ulcer rate; volume of foreign object left in the body; iatrogenic pneumothorax rate; postoperative physiologic and metabolic derangement rate; postoperative pulmonary embolism or deep vein thrombosis rate; and accidental puncture and laceration rate.
CMS is also considering the use of a composite patient safety indicator measure set as an alternative to the first domain.
The second domain being used to get a total score under the new program includes two health care–associated infection measures: central line–associated bloodstream infection and catheter-associated urinary tract infection.
CMS plans to account for risk factors such as age, gender, and comorbidities when calculating the measure rates.
There are no surprises in the conditions chosen for the new program, said Erik Johnson, senior vice president at Avalere Health. However, the fact that CMS officials chose to include eight measures at the start of the program indicates how serious they are about hospital-acquired conditions, he said.
Mr. Johnson predicted that hospitals will take these quality programs seriously as well.
Through the combination of the hospital-acquired condition program, the readmission reduction program, value-based purchasing, and a few other programs, hospitals now have at least 7% of their Medicare payments at risk based on performance on quality measures, he said.
"It’s already starting to move behaviors," he added.
"Hospitals are by and large making a good-faith effort to get better at all of those things. But there are going to be winners and losers, and the losers may end up losing big on a lot of this stuff," according to Mr. Johnson
CMS will accept public comments on the proposal until June 25 at www.regulations.gov. The agency is scheduled to release its final rule by Aug. 1.
The penalties are going up in Medicare’s hospital readmission reduction program.
Starting on Oct. 1, hospitals could face up to a 2% cut in Medicare payments if their 30-day readmission rates for acute myocardial infarction, heart failure, and pneumonia are too high. The program started on Oct. 1, 2012, with a 1% cap on penalties.
The penalty increase was outlined in Medicare’s proposed fiscal year 2014 inpatient prospective payment system rule, which was released April 26.
The Medicare proposal also outlines the government’s plans to expand the readmission reduction program to include two new readmission measures.
Starting on Oct. 1, 2014, the program would also include readmissions associated with an acute exacerbation of chronic obstructive pulmonary disease, as well as readmissions for elective total hip or knee arthroplasty.
The inclusion of COPD for fiscal year 2015 was expected since that condition was specifically highlighted by Congress in the Affordable Care Act (ACA), which created the readmission reduction program. However, lawmakers had also recommended adding coronary artery bypass graft (CABG) surgery, percutaneous coronary intervention (PCI), and other vascular conditions, which are not included in the Centers for Medicare and Medicaid Services (CMS) proposal.
The reasons for the switch were largely due to cost and volume, according to the proposal rule.
In 2005, annual hospital charges totaled $3.95 billion for primary total hip arthroplasty and $7.42 billion for total knee arthroplasty. When combined, the two procedures represent the largest procedures cost in the Medicare budget.
At the same time, inpatient admissions for PCI and other vascular conditions have been declining, according to Medicare officials, as more of those services are being shifted to hospital outpatient departments.
The fiscal 2014 payment proposal also includes a revised methodology for calculating hospital readmission rates in an effort to do a better job of accounting for certain planned readmissions.
The change is a mixed bag for hospitals, according to the Premier healthcare alliance. While the revised methodology will likely result in a more accurate payment calculation, it fails to take into consideration socioeconomic and community factors.
"Hospitals that serve high percentages of lower-income patients will be disproportionately penalized for circumstances outside their control," Blair Childs, senior vice president of public affairs at Premier, said in a statement.
"This places additional financial burdens on already stressed local health care systems in these communities."
The Medicare program is also moving forward with the Hospital-Acquired Condition Reduction Program, which was also created by the ACA.
The new program, which begins on Oct. 1, 2014, levies a 1% penalty on hospitals that rank in the lowest-performing quartile for eight hospital-acquired conditions. The proposed rule includes the quality measures, scoring methodology, and correction process that are planned for the program.
During the first year, officials plan to use quality measures that are calculated using claims data or are part of the Inpatient Quality Reporting program.
The eight measures are divided into two domains. Hospitals will receive a score for each measure, which will then be used to calculate a domain score. The two domains will be weighted equally to get a total score under the program, according to CMS.
The measures in the first of the two domains are pressure ulcer rate; volume of foreign object left in the body; iatrogenic pneumothorax rate; postoperative physiologic and metabolic derangement rate; postoperative pulmonary embolism or deep vein thrombosis rate; and accidental puncture and laceration rate.
CMS is also considering the use of a composite patient safety indicator measure set as an alternative to the first domain.
The second domain being used to get a total score under the new program includes two health care–associated infection measures: central line–associated bloodstream infection and catheter-associated urinary tract infection.
CMS plans to account for risk factors such as age, gender, and comorbidities when calculating the measure rates.
There are no surprises in the conditions chosen for the new program, said Erik Johnson, senior vice president at Avalere Health. However, the fact that CMS officials chose to include eight measures at the start of the program indicates how serious they are about hospital-acquired conditions, he said.
Mr. Johnson predicted that hospitals will take these quality programs seriously as well.
Through the combination of the hospital-acquired condition program, the readmission reduction program, value-based purchasing, and a few other programs, hospitals now have at least 7% of their Medicare payments at risk based on performance on quality measures, he said.
"It’s already starting to move behaviors," he added.
"Hospitals are by and large making a good-faith effort to get better at all of those things. But there are going to be winners and losers, and the losers may end up losing big on a lot of this stuff," according to Mr. Johnson
CMS will accept public comments on the proposal until June 25 at www.regulations.gov. The agency is scheduled to release its final rule by Aug. 1.
Hospitalists Should Refrain from Texting Patient Information
Refrain from Texting about Your Patients
Can I text my partners patient information?
–Stephen Henry, San Luis Obispo, Calif.
Dr. Hospitalist responds:
Can you? Sure. Do you? Probably. Should you? No.
Texting any patient information falls under the category of ePHI (Electronic Protected Health Information) as part of HIPAA. Technically, such patient-specific information must be protected at all times. Once you send a text, at least three copies are known to exist: one on each of the devices, plus one copy on the network it went through, adding for each network it has to cross. Sure, your phone may be password-protected, but is your partner’s? What about the carrier? How protected is their data?
HIPAA goes into excruciating technical detail about all the safeguards that must be present. You are more than welcome to read it (www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule) to see if you meet all the standards. Or you can take my word for it: You don’t.
So you can see why most health organizations expressly prohibit the texting of patient information. If you rang up your local health-care or hospital lawyer, I’m sure they would tell you to never text patient information. Is that reasonable advice? In 2013, I doubt it.
So what’s the practical advice to follow? For starters, password-protect your phone, if you haven’t already. Nothing worse than losing your phone and having patient information on it. A lot of the OCR (Office for Civil Rights, a branch of Health and Human Services) fines for HIPAA violations stem from folks misplacing unencrypted devices with patient information on them.
Just as important, don’t text anything that you wouldn’t want to see blown up on a lawyer’s display board in court. I’ve seen some really egregious examples of communication between doctors that have no business being preserved electronically. Texting “Mr. X in Room 2101 is a meth-using, narcotic-seeking, half-naked, lunatic troll” is an absolutely stupid thing to do. For that matter, so are remarks that seem less offensive: “And his son is completely unreasonable.” Save your commentary and stick to the facts, because you just generated three copies forever.
If you receive an insensitive text, don’t reply. Simply call the sending physician to discuss any issues. Even being on a “secure” texting network won’t protect you from errors of commission.
If I were to text about a patient (purely hypothetically, mind you), I would limit the information as much as possible. Keep it simple and generic (what HIPAA likes to call “de-identified information”)—for example, “Room 428 is ready for discharge.”
Please, hold the subjective commentary. There is no good reason to have an extended text exchange about a patient; you are creating an electronic trail that has no good reason to exist and never really goes away. It’s just the same as writing in the chart, except that it has the illusion of privacy. And that’s all it is: an illusion.
At the end of the day, I’d probably worry more about the discoverable aspect of your text messages in a lawsuit than the possibility of a HIPAA fine, but neither one sounds like much fun to me.
Refrain from Texting about Your Patients
Can I text my partners patient information?
–Stephen Henry, San Luis Obispo, Calif.
Dr. Hospitalist responds:
Can you? Sure. Do you? Probably. Should you? No.
Texting any patient information falls under the category of ePHI (Electronic Protected Health Information) as part of HIPAA. Technically, such patient-specific information must be protected at all times. Once you send a text, at least three copies are known to exist: one on each of the devices, plus one copy on the network it went through, adding for each network it has to cross. Sure, your phone may be password-protected, but is your partner’s? What about the carrier? How protected is their data?
HIPAA goes into excruciating technical detail about all the safeguards that must be present. You are more than welcome to read it (www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule) to see if you meet all the standards. Or you can take my word for it: You don’t.
So you can see why most health organizations expressly prohibit the texting of patient information. If you rang up your local health-care or hospital lawyer, I’m sure they would tell you to never text patient information. Is that reasonable advice? In 2013, I doubt it.
So what’s the practical advice to follow? For starters, password-protect your phone, if you haven’t already. Nothing worse than losing your phone and having patient information on it. A lot of the OCR (Office for Civil Rights, a branch of Health and Human Services) fines for HIPAA violations stem from folks misplacing unencrypted devices with patient information on them.
Just as important, don’t text anything that you wouldn’t want to see blown up on a lawyer’s display board in court. I’ve seen some really egregious examples of communication between doctors that have no business being preserved electronically. Texting “Mr. X in Room 2101 is a meth-using, narcotic-seeking, half-naked, lunatic troll” is an absolutely stupid thing to do. For that matter, so are remarks that seem less offensive: “And his son is completely unreasonable.” Save your commentary and stick to the facts, because you just generated three copies forever.
If you receive an insensitive text, don’t reply. Simply call the sending physician to discuss any issues. Even being on a “secure” texting network won’t protect you from errors of commission.
If I were to text about a patient (purely hypothetically, mind you), I would limit the information as much as possible. Keep it simple and generic (what HIPAA likes to call “de-identified information”)—for example, “Room 428 is ready for discharge.”
Please, hold the subjective commentary. There is no good reason to have an extended text exchange about a patient; you are creating an electronic trail that has no good reason to exist and never really goes away. It’s just the same as writing in the chart, except that it has the illusion of privacy. And that’s all it is: an illusion.
At the end of the day, I’d probably worry more about the discoverable aspect of your text messages in a lawsuit than the possibility of a HIPAA fine, but neither one sounds like much fun to me.
Refrain from Texting about Your Patients
Can I text my partners patient information?
–Stephen Henry, San Luis Obispo, Calif.
Dr. Hospitalist responds:
Can you? Sure. Do you? Probably. Should you? No.
Texting any patient information falls under the category of ePHI (Electronic Protected Health Information) as part of HIPAA. Technically, such patient-specific information must be protected at all times. Once you send a text, at least three copies are known to exist: one on each of the devices, plus one copy on the network it went through, adding for each network it has to cross. Sure, your phone may be password-protected, but is your partner’s? What about the carrier? How protected is their data?
HIPAA goes into excruciating technical detail about all the safeguards that must be present. You are more than welcome to read it (www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule) to see if you meet all the standards. Or you can take my word for it: You don’t.
So you can see why most health organizations expressly prohibit the texting of patient information. If you rang up your local health-care or hospital lawyer, I’m sure they would tell you to never text patient information. Is that reasonable advice? In 2013, I doubt it.
So what’s the practical advice to follow? For starters, password-protect your phone, if you haven’t already. Nothing worse than losing your phone and having patient information on it. A lot of the OCR (Office for Civil Rights, a branch of Health and Human Services) fines for HIPAA violations stem from folks misplacing unencrypted devices with patient information on them.
Just as important, don’t text anything that you wouldn’t want to see blown up on a lawyer’s display board in court. I’ve seen some really egregious examples of communication between doctors that have no business being preserved electronically. Texting “Mr. X in Room 2101 is a meth-using, narcotic-seeking, half-naked, lunatic troll” is an absolutely stupid thing to do. For that matter, so are remarks that seem less offensive: “And his son is completely unreasonable.” Save your commentary and stick to the facts, because you just generated three copies forever.
If you receive an insensitive text, don’t reply. Simply call the sending physician to discuss any issues. Even being on a “secure” texting network won’t protect you from errors of commission.
If I were to text about a patient (purely hypothetically, mind you), I would limit the information as much as possible. Keep it simple and generic (what HIPAA likes to call “de-identified information”)—for example, “Room 428 is ready for discharge.”
Please, hold the subjective commentary. There is no good reason to have an extended text exchange about a patient; you are creating an electronic trail that has no good reason to exist and never really goes away. It’s just the same as writing in the chart, except that it has the illusion of privacy. And that’s all it is: an illusion.
At the end of the day, I’d probably worry more about the discoverable aspect of your text messages in a lawsuit than the possibility of a HIPAA fine, but neither one sounds like much fun to me.
Obama budget proposal gives more power to IPAB
President Obama is proposing to cut more than $370 billion from the Medicare program over the next decade, a move aimed at reducing the federal deficit and putting the program on firmer financial footing.
The president’s fiscal year 2014 budget proposal, sent to Congress April 10, includes cuts for physicians, drug companies, hospitals, and long-term facilities, as well as increased cost-sharing for some Medicare beneficiaries.
The part of the budget with the potential to have the biggest impact on doctors is the increased authority for the Independent Payment Advisory Board (IPAB). The 15-member board was created under the Affordable Care Act (ACA) and is charged with recommending to Congress how to reduce spending growth in Medicare. Under current law, IPAB would make recommendations only if the projected Medicare per capita growth rate exceeded the gross domestic product (GDP) plus 1%. In the president’s budget proposal, that target would be triggered early, when Medicare spending was projected to exceed GDP plus 0.5%.
This change is projected to save the federal government $4.1 billion over the next decade.
The bulk of the Medicare savings will come from proposals to cut payments to drug companies, long-term care facilities, and increases in cost sharing by beneficiaries.
For instance, the administration estimates it will save about $123 billion over 10 years by allowing the Medicare Part D program to pay the lower Medicaid rate for prescription drugs for its low-income beneficiaries.
A change involving post–acute care providers would save $79 billion. The administration wants to reduce the market basket updates for inpatient rehabilitation facilities, long-term care hospitals, skilled nursing facilities, and home health agencies by 1.1% starting in 2014 and running through 2023.
Beneficiaries also would contribute more for their Medicare premiums under the Obama budget proposal. Starting in 2017, certain Medicare beneficiaries will pay more for their Part B and D premiums, which is expected to generate $50 billion in savings over 10 years.
The budget also includes about $22.1 billion in cuts to Medicaid over 10 years.
The budget also includes a little good news for physicians: It assumes that the Congress will eliminate the Sustainable Growth Rate (SGR) formula used in setting Medicare physician payments.
The American Medical Association praised the administration for its commitment to move toward new ways to pay for health care.
"The President’s proposals align with many of the principles developed by the AMA and 110 other physician organizations on transitioning Medicare to include an array of accountable payment models," Dr. Jeremy A. Lazarus, AMA president, said in a statement. "It is critical for physicians to have a period of stability and the flexibility to choose options that will help them lower costs and improve the quality of care for their patients. We are encouraged that the president and members of Congress are focused this year on eliminating this failed formula and strengthening Medicare for patients now and in the future."
The cost-cutting proposals aren’t new; President Obama included some of them in last year’s budget proposal. He also called for cuts to Medicare when negotiating for a deficit reduction deal with House Speaker John Boehner (R-Ohio) late last year.
President Obama said his proposed budget would lower the federal deficit in a "balanced way," allowing more targeted cuts to replace the across-the-board budget cuts set out in the sequester, which took effect in March. Overall, the Obama administration estimates that the new budget would achieve $1.8 trillion in deficit reduction over the next 10 years.
But the budget is already getting a cool reception from Republicans on Capitol Hill. House Budget Committee Chairman Paul Ryan (R-Wisc.) said that after eliminating the sequester, there is only about $119 billion in deficit reduction over the next decade in the president’s proposed budget.
"I’m disappointed by the president’s proposal because it merely ratifies the status quo," Rep. Ryan said in a statement. "It doesn’t break new ground; it goes over old ground."
Both the House and the Senate have already passed their own budget proposals for fiscal year 2014.
In addition to the Medicare and Medicaid cuts, the President’s budget offers some targeted increases.
For instance, the Centers for Medicare and Medicaid Services is seeking about $1.5 billion in new funding to help support operations and outreach related to the ACA’s health insurance exchanges. The funds would support the federally operated exchanges and offer assistance to states that are running their own exchanges. The exchanges will open for enrollment on Oct. 1, 2013, the first day of fiscal year 2014. Coverage under the exchanges is set to begin on Jan. 1, 2014.
Health and Human Services Secretary Kathleen Sebelius said she is hopeful that Congress will come through with the money to help launch the new program. "We intend to implement the law," she said during a press conference April 10.
The budget also includes funding for mental health. The proposal invests $130 million to add 5,000 mental health professionals to the behavioral health workforce. The money will also fund Project AWARE (Advancing Wellness and Resilience in Education), which trains teachers to detect and respond to mental illness in their students.
The Centers for Disease Control and Prevention would get an additional $30 million to track gun violence and research ways to prevent it under the budget proposal sent to Congress.
The American Psychiatric Association supported the administration’s effort to identify at-risk individuals early through Project AWARE. But the APA said in a statement that it was concerned that the effort to expand the supply of mental health professionals seems to stop at nonphysician providers.
"We recognize the growing need for mental health providers; however, providing a small amount of training to lesser-qualified health professionals at the expense of utilizing veteran medical psychiatrists will only serve to exacerbate the problem we are trying to solve," the APA wrote. "As a nation, we should ensure that patients have access to the full range of services, from physician care to hospital care to outpatient clinics and long-term follow-up."
The National Institutes of Health would receive a $471 million funding increase over its fiscal year 2012 funding, bringing its total budget to $31.1 billion. That includes about $40 billion toward an effort to map the human brain. The agency will also invest $80 million to speed up drug development and the testing of new therapies for Alzheimer’s disease.
President Obama is proposing to cut more than $370 billion from the Medicare program over the next decade, a move aimed at reducing the federal deficit and putting the program on firmer financial footing.
The president’s fiscal year 2014 budget proposal, sent to Congress April 10, includes cuts for physicians, drug companies, hospitals, and long-term facilities, as well as increased cost-sharing for some Medicare beneficiaries.
The part of the budget with the potential to have the biggest impact on doctors is the increased authority for the Independent Payment Advisory Board (IPAB). The 15-member board was created under the Affordable Care Act (ACA) and is charged with recommending to Congress how to reduce spending growth in Medicare. Under current law, IPAB would make recommendations only if the projected Medicare per capita growth rate exceeded the gross domestic product (GDP) plus 1%. In the president’s budget proposal, that target would be triggered early, when Medicare spending was projected to exceed GDP plus 0.5%.
This change is projected to save the federal government $4.1 billion over the next decade.
The bulk of the Medicare savings will come from proposals to cut payments to drug companies, long-term care facilities, and increases in cost sharing by beneficiaries.
For instance, the administration estimates it will save about $123 billion over 10 years by allowing the Medicare Part D program to pay the lower Medicaid rate for prescription drugs for its low-income beneficiaries.
A change involving post–acute care providers would save $79 billion. The administration wants to reduce the market basket updates for inpatient rehabilitation facilities, long-term care hospitals, skilled nursing facilities, and home health agencies by 1.1% starting in 2014 and running through 2023.
Beneficiaries also would contribute more for their Medicare premiums under the Obama budget proposal. Starting in 2017, certain Medicare beneficiaries will pay more for their Part B and D premiums, which is expected to generate $50 billion in savings over 10 years.
The budget also includes about $22.1 billion in cuts to Medicaid over 10 years.
The budget also includes a little good news for physicians: It assumes that the Congress will eliminate the Sustainable Growth Rate (SGR) formula used in setting Medicare physician payments.
The American Medical Association praised the administration for its commitment to move toward new ways to pay for health care.
"The President’s proposals align with many of the principles developed by the AMA and 110 other physician organizations on transitioning Medicare to include an array of accountable payment models," Dr. Jeremy A. Lazarus, AMA president, said in a statement. "It is critical for physicians to have a period of stability and the flexibility to choose options that will help them lower costs and improve the quality of care for their patients. We are encouraged that the president and members of Congress are focused this year on eliminating this failed formula and strengthening Medicare for patients now and in the future."
The cost-cutting proposals aren’t new; President Obama included some of them in last year’s budget proposal. He also called for cuts to Medicare when negotiating for a deficit reduction deal with House Speaker John Boehner (R-Ohio) late last year.
President Obama said his proposed budget would lower the federal deficit in a "balanced way," allowing more targeted cuts to replace the across-the-board budget cuts set out in the sequester, which took effect in March. Overall, the Obama administration estimates that the new budget would achieve $1.8 trillion in deficit reduction over the next 10 years.
But the budget is already getting a cool reception from Republicans on Capitol Hill. House Budget Committee Chairman Paul Ryan (R-Wisc.) said that after eliminating the sequester, there is only about $119 billion in deficit reduction over the next decade in the president’s proposed budget.
"I’m disappointed by the president’s proposal because it merely ratifies the status quo," Rep. Ryan said in a statement. "It doesn’t break new ground; it goes over old ground."
Both the House and the Senate have already passed their own budget proposals for fiscal year 2014.
In addition to the Medicare and Medicaid cuts, the President’s budget offers some targeted increases.
For instance, the Centers for Medicare and Medicaid Services is seeking about $1.5 billion in new funding to help support operations and outreach related to the ACA’s health insurance exchanges. The funds would support the federally operated exchanges and offer assistance to states that are running their own exchanges. The exchanges will open for enrollment on Oct. 1, 2013, the first day of fiscal year 2014. Coverage under the exchanges is set to begin on Jan. 1, 2014.
Health and Human Services Secretary Kathleen Sebelius said she is hopeful that Congress will come through with the money to help launch the new program. "We intend to implement the law," she said during a press conference April 10.
The budget also includes funding for mental health. The proposal invests $130 million to add 5,000 mental health professionals to the behavioral health workforce. The money will also fund Project AWARE (Advancing Wellness and Resilience in Education), which trains teachers to detect and respond to mental illness in their students.
The Centers for Disease Control and Prevention would get an additional $30 million to track gun violence and research ways to prevent it under the budget proposal sent to Congress.
The American Psychiatric Association supported the administration’s effort to identify at-risk individuals early through Project AWARE. But the APA said in a statement that it was concerned that the effort to expand the supply of mental health professionals seems to stop at nonphysician providers.
"We recognize the growing need for mental health providers; however, providing a small amount of training to lesser-qualified health professionals at the expense of utilizing veteran medical psychiatrists will only serve to exacerbate the problem we are trying to solve," the APA wrote. "As a nation, we should ensure that patients have access to the full range of services, from physician care to hospital care to outpatient clinics and long-term follow-up."
The National Institutes of Health would receive a $471 million funding increase over its fiscal year 2012 funding, bringing its total budget to $31.1 billion. That includes about $40 billion toward an effort to map the human brain. The agency will also invest $80 million to speed up drug development and the testing of new therapies for Alzheimer’s disease.
President Obama is proposing to cut more than $370 billion from the Medicare program over the next decade, a move aimed at reducing the federal deficit and putting the program on firmer financial footing.
The president’s fiscal year 2014 budget proposal, sent to Congress April 10, includes cuts for physicians, drug companies, hospitals, and long-term facilities, as well as increased cost-sharing for some Medicare beneficiaries.
The part of the budget with the potential to have the biggest impact on doctors is the increased authority for the Independent Payment Advisory Board (IPAB). The 15-member board was created under the Affordable Care Act (ACA) and is charged with recommending to Congress how to reduce spending growth in Medicare. Under current law, IPAB would make recommendations only if the projected Medicare per capita growth rate exceeded the gross domestic product (GDP) plus 1%. In the president’s budget proposal, that target would be triggered early, when Medicare spending was projected to exceed GDP plus 0.5%.
This change is projected to save the federal government $4.1 billion over the next decade.
The bulk of the Medicare savings will come from proposals to cut payments to drug companies, long-term care facilities, and increases in cost sharing by beneficiaries.
For instance, the administration estimates it will save about $123 billion over 10 years by allowing the Medicare Part D program to pay the lower Medicaid rate for prescription drugs for its low-income beneficiaries.
A change involving post–acute care providers would save $79 billion. The administration wants to reduce the market basket updates for inpatient rehabilitation facilities, long-term care hospitals, skilled nursing facilities, and home health agencies by 1.1% starting in 2014 and running through 2023.
Beneficiaries also would contribute more for their Medicare premiums under the Obama budget proposal. Starting in 2017, certain Medicare beneficiaries will pay more for their Part B and D premiums, which is expected to generate $50 billion in savings over 10 years.
The budget also includes about $22.1 billion in cuts to Medicaid over 10 years.
The budget also includes a little good news for physicians: It assumes that the Congress will eliminate the Sustainable Growth Rate (SGR) formula used in setting Medicare physician payments.
The American Medical Association praised the administration for its commitment to move toward new ways to pay for health care.
"The President’s proposals align with many of the principles developed by the AMA and 110 other physician organizations on transitioning Medicare to include an array of accountable payment models," Dr. Jeremy A. Lazarus, AMA president, said in a statement. "It is critical for physicians to have a period of stability and the flexibility to choose options that will help them lower costs and improve the quality of care for their patients. We are encouraged that the president and members of Congress are focused this year on eliminating this failed formula and strengthening Medicare for patients now and in the future."
The cost-cutting proposals aren’t new; President Obama included some of them in last year’s budget proposal. He also called for cuts to Medicare when negotiating for a deficit reduction deal with House Speaker John Boehner (R-Ohio) late last year.
President Obama said his proposed budget would lower the federal deficit in a "balanced way," allowing more targeted cuts to replace the across-the-board budget cuts set out in the sequester, which took effect in March. Overall, the Obama administration estimates that the new budget would achieve $1.8 trillion in deficit reduction over the next 10 years.
But the budget is already getting a cool reception from Republicans on Capitol Hill. House Budget Committee Chairman Paul Ryan (R-Wisc.) said that after eliminating the sequester, there is only about $119 billion in deficit reduction over the next decade in the president’s proposed budget.
"I’m disappointed by the president’s proposal because it merely ratifies the status quo," Rep. Ryan said in a statement. "It doesn’t break new ground; it goes over old ground."
Both the House and the Senate have already passed their own budget proposals for fiscal year 2014.
In addition to the Medicare and Medicaid cuts, the President’s budget offers some targeted increases.
For instance, the Centers for Medicare and Medicaid Services is seeking about $1.5 billion in new funding to help support operations and outreach related to the ACA’s health insurance exchanges. The funds would support the federally operated exchanges and offer assistance to states that are running their own exchanges. The exchanges will open for enrollment on Oct. 1, 2013, the first day of fiscal year 2014. Coverage under the exchanges is set to begin on Jan. 1, 2014.
Health and Human Services Secretary Kathleen Sebelius said she is hopeful that Congress will come through with the money to help launch the new program. "We intend to implement the law," she said during a press conference April 10.
The budget also includes funding for mental health. The proposal invests $130 million to add 5,000 mental health professionals to the behavioral health workforce. The money will also fund Project AWARE (Advancing Wellness and Resilience in Education), which trains teachers to detect and respond to mental illness in their students.
The Centers for Disease Control and Prevention would get an additional $30 million to track gun violence and research ways to prevent it under the budget proposal sent to Congress.
The American Psychiatric Association supported the administration’s effort to identify at-risk individuals early through Project AWARE. But the APA said in a statement that it was concerned that the effort to expand the supply of mental health professionals seems to stop at nonphysician providers.
"We recognize the growing need for mental health providers; however, providing a small amount of training to lesser-qualified health professionals at the expense of utilizing veteran medical psychiatrists will only serve to exacerbate the problem we are trying to solve," the APA wrote. "As a nation, we should ensure that patients have access to the full range of services, from physician care to hospital care to outpatient clinics and long-term follow-up."
The National Institutes of Health would receive a $471 million funding increase over its fiscal year 2012 funding, bringing its total budget to $31.1 billion. That includes about $40 billion toward an effort to map the human brain. The agency will also invest $80 million to speed up drug development and the testing of new therapies for Alzheimer’s disease.