Thursday, June 30, 2016

CMS’ Open Payments Program Posts 2015 Financial Data


CMS News


FOR IMMEDIATE RELEASE
June 30, 2016

Contact: CMS Media Relations
(202) 690-6145 | CMS Media Inquiries
 

CMS’ Open Payments Program Posts 2015 Financial Data

Health care industry manufacturers reported $7.52 billion in payments and ownership and investment interests to physicians and teaching hospitals in 2015

Today, the Centers for Medicare & Medicaid Services (CMS) published 2015 Open Payments data, along with newly submitted and updated payment records for the 2013 and 2014 reporting periods, at https://openpaymentsdata.cms.gov/.  The Open Payments program (sometimes called the “Sunshine Act”) requires that transfers of value by manufacturers of drugs, devices, biologicals, and medical supplies that are paid to physicians and teaching hospitals will be published on a public website.

For Open Payments program year 2015, health care industry manufacturers reported $7.52 billion in payments and ownership and investment interests to physicians and teaching hospitals.  This amount is comprised of 11.90 million total records attributable to 618,931 physicians and 1,116 teaching hospitals.  

Payments in the three major reporting categories are: 

·         $2.60 billion in general (i.e., non-research related) payments

·         $3.89 billion in research payments

·         $1.03 billion of ownership or investment interests held by physicians or their             immediate family members

Over the course of the Open Payments program since 2014, we have published 28.22 million records, accounting for $16.77 billion in payments and ownership and investment interests.

The Open Payments 2015 program year data set is the second full year of data available on the CMS Open Payments website. The availability of consecutive, full-year data allows the public the opportunity to explore trends in the health care industry manufacturers’ payments to physicians and teaching hospitals for items and services such as food and beverage, travel, education, honoraria, and research.  We are also able to analyze payments related to covered drugs, devices, biologicals, and supplies.  For example, CMS has determined that for program year 2015, 2.26 percent (637,131 records) of all financial transactions between physicians and pharmaceutical companies was related to opioid medications.  

“Transparency is empowering physicians to be purposeful about their financial relationships with companies, and there is a notable shift towards charitable contributions and away from other interactions such as honoraria and gifts,” said Dr. Shantanu Agrawal, a CMS deputy administrator and director of the Center for Program Integrity.

The amount and distribution of payments and ownership and investment interest categories remained consistent between the 2014 and 2015 reporting periods. 

For more information, please visit: https://openpaymentsdata.cms.gov/


In-case you missed the Technical Background Media held on 6/27/16, here’s the Encore/Playback #: (855) 859-2056 ID#  414 33 056. A digital recording of the press conference is now available for replay through July 12, 2016.

According to a recent government report, here is a breakdown ...

... of the expected source of payment for emergency department visits made by U.S. adults aged 18 to 64 in 2012:

  • 33% - private insurance
  • 21% - Medicaid
  • 20% - no insurance
  • 9% - Medicare
  • 5% - worker's compensation
  • 11% - unknown/blank

Source: "Expected Source of Payment at Emergency Department Visits for Adults Aged 18–64 for the United States and in the Five Most Populous States, 2012," National Center for Health Statistics/Centers for Disease Control and Prevention, NCHS Data Brief No. 253, June 2016, http://www.cdc.gov/nchs/products/databriefs/db253.htm

1 in 3 Americans Experienced a Prescription Drug Price Hike


Consumer Reports recently released an analysis on consumer healthcare spending trends. Here are some key findings from the report:

·         1 in 3 Americans said they experienced a prescription drug price hike in the past year.

·         47% of those who experienced a price increase did not comply with the Rx to save money.

·         One quarter of those who experienced a drug price increase used their credit card more often.

·         18% of Americans put off a doctor's visit because of cost.

·         8 in 10 doctors said they were concerned about their patients' ability to afford their treatments.

·         25% of patients said they had a conversation with their practitioner about the cost of their treatment.

Source: Consumer Reports, June 21, 2016

Plan year 2016 Federally-facilitated Marketplace (FFM) registration and training for agents and brokers will close on the Marketplace Learning Management System (MLMS) on July 15 at 11:59 AM Eastern Time


Plan year 2016 Federally-facilitated Marketplace (FFM) registration and training for agents and brokers will close on the Marketplace Learning Management System (MLMS) on July 15 at 11:59 AM Eastern Time (ET) as we prepare to launch the registration and training for plan year 2017. Information on the FFM registration and training for plan year 2017 is coming soon. 

To be sure your profile is updated in the MLMS before the last day, do not sign up for a new plan year 2016 FFM training curriculum after July 1. After this date, the MLMS is only available for updates to your profile’s training completion status. If you plan to complete any of the other plan year 2016 FFM registration requirements (e.g., identity proofing, sign the applicable Agreement(s)), or print copies of your Registration Completion Certificate(s), we encourage you to do so by July 14. Please note that completion of a plan year 2016 training curriculum, or signing the plan year 2016 FFM Agreements, does not count towards plan year 2017 FFM registration for agents and brokers. 

To print your plan year 2016 FFM Registration Completion Certificate(s), sign in to the CMS Enterprise Portal with your FFM User ID and password. On the “My Status” page, the “Complete Agent Broker Training” entry will show “Complete” in the “Status” column if you have completed training. Select the “Print Certificate(s)” link and follow the prompts. While you should retain copies of your Registration Completion Certificate(s), CMS has directed issuers and web-brokers to use the CMS Agent and Broker FFM Registration Completion List to confirm you have completed all FFM registration requirements, including required training. 

Please visit the Agents and Brokers Resources webpage to view “Myths and Facts about the Closing of the MLMS” This document provides valuable information to assist you with the transition from plan year 2016 to plan year 2017. 

Also, please note the MLMS will be undergoing scheduled maintenance from 12:00 PM ET on June 29 to 11:59 PM ET on June 30. Due to this maintenance, the MLMS cannot be launched during this time; and any course or curriculum completed during this time will not be recorded. Please log out of the system before the maintenance window begins to ensure your training progress is recorded. The MLMS will be accessible after the Portal maintenance period. We apologize for the inconvenience. 

Contact Us: 

·         For information about the FFM agent and broker program, contact the Producer and Assister Help Desk via email at FFMProducer-AssisterHelpDesk@cms.hhs.govor call the Agent and Broker Call Center at 1-855-267-1515 and select option “1.”

Direct questions about a client’s Individual Marketplace plan to the Marketplace Call Center at 1-800-318-2596. Direct questions about SHOP Marketplace coverage to the SHOP Call Center at 1-800-706-7893. 

19% ...

... was the average increase in total cancer treatment costs (up to $58,000 per patient) from 2013 to 2014, according to a new report by IMS Health.

"The national nature of [Anthem's and Cigna's] overlapping assets —


— large group and administrative services only — means the bar for proving that there are no issues on the national or local level is probably set higher" compared with Aetna Inc.'s proposed acquisition of Humana Inc.

— Christine Arnold, an equities analyst with Cowen & Co., wrote in a June 16 note to investors.

Wednesday, June 29, 2016

According to a recent survey by Consumer Reports,

... almost one-third of Americans said they had experienced a drug price hike in the past year.

Source: "Consumer Reports Finds: Nearly One-Third of Americans Experiencing Price Hikes for Meds; Pricey Pills Impacting Retirement Plans, Family Life, Overall Health," Consumer Reports Press Release, June 21, 2016, http://pressroom.consumerreports.org/pressroom/2016/06/consumer-reports-finds-nearly-one-third-of-americans-experiencing-price-hikes-for-meds-pricey-pills-impacting-retirement-pl.html

Tuesday, June 28, 2016

Americans spent $30.2 billion out-of-pocket on complementary healthcare approaches ...

... such as herbal supplements, meditation, chiropractic, and yoga, according to a 2012 nationwide survey. This amount represents 9.2 % of all out-of-pocket spending on health care and 1.1% of total health care spending nationally.

Source: "Americans Spent $30.2 Billion Out-Of-Pocket On Complementary Health Approaches," National Center for Complementary and Integrative Health Press Release, June 22, 2016, https://nccih.nih.gov/news/press/cost-spending-06222016 

Join us for the CMS National Training Program


 
 

Join us for the CMS National Training Program

Learning Series Webinar

July 14, 2016

1:00 – 2:30 pm ET

 

This webinar will provide information to help you with the following:

  • Define the Medicare health and drug plan Reward and Incentive (RI) Program requirements
  • Clarify how they differ from plan enrollment marketing activities

 

According to a national survey of large employers:


  • 28.9% of employers have conducted an evaluation and decided not to move active employees to a private health insurance exchange
  • Of those employers who conducted an evaluation of exchanges for active employees, 84.6% listed “unproven cost savings” as the primary reason why they did not move
  •  However, 42% of employers have no plans to evaluate private exchanges

Source: "Pacific Resources' Survey Shows Large Employers Not Confident in Private Health Exchanges as a Viable Alternative for Providing Healthcare Benefits to Active Employees, Pacific Resources Press Release, May 24, 2016, http://www.pacresbenefits.com/press-releases/private-health-exchanges-survey-results

The Top 5 Unhealthy Cities In America/ Based On Their Premature Death Rate (Per 100,000 People)


1. Beckley, WV/ 553.4

 

2. Gadsden, AL/ 546.4

 

3. Anniston-Oxford-Jacksonville, AL/ 520.7

 

4. Florence, SC/ 513.5

 

5. Macon, GA/ 507.5

 

 

Source: 24/7 Wall st.

1 in 5 Americans Paid For Complementary Health Approaches in 2012


The CDC recently released a National Health Statistics Report on complementary health expenditures in 2012. Here are some key findings from the report:

·         20% of Americans had 1 or more expenditures for complementary health approaches in 2012.

·         55.2 million adults (23.5%) had at least one expenditure for some complementary health approach.

·         4.1 million children (7.1%) had at least one expenditure for some complementary health approach.

·         $30.2 billion was spent out-of-pocket on complementary health approaches in 2012.

·         Adults spent $14.1 billion for visits to complementary practitioners amd $12 billion for supplements.

·         4.2% of children and 13.7% of adults purchased natural product supplements in 2012.

Source: CDC, June 22, 2016

CMS has posted a number of new resources to the Agents and Brokers Resources webpage.


CMS has posted a number of new resources to the Agents and Brokers Resources webpage. Some of the resources below provide information about CMS’ preparations for plan year 2017. The other resources provide information to guide you in helping consumers maintain their current health coverage.

New Marketplace Learning Management System (MLMS) Go Dark Resources Posted

Myths and Facts about the Closing of the MLMS Resource 

Learn about:

  • Key dates related to the MLMS closing for plan year 2016
  • How its closing will affect your ability to complete FFM registration for plan year 2016, if you have not done so already, or access materials related to your completed plan year 2016 registration.

“Quick Reference Guide: Avoiding the Creation of a Duplicate CMS Enterprise Portal Account” Resource 

Learn about:

  • What to do if you are not sure if you have already created a CMS Enterprise Portal account
  • Steps to take if you have forgotten your CMS Enterprise Portal Account FFM User ID or password 

New Webinar Slides Posted

Slides from the “IRS Data Recheck of Failure to File and Reconcile 2014 APTC Population” webinar held on June 2 

  • Learn about the new failure to file and reconcile process the FFMs are implementing in the summer of 2016 that may impact consumers you work with.

Contact Us: 

·         For information about the FFM agent and broker program, contact the Producer and Assister Help Desk via email at FFMProducer-AssisterHelpDesk@cms.hhs.govor call the Agent and Broker Call Center at 1-855-267-1515 and select option “1.”
Direct questions about a client’s Individual Marketplace plan to the Marketplace Call Center at 1-800-318-2596. Direct questions about SHOP Marketplace coverage to the SHOP Call Center at 1-800-706-7893. 

24 million ...


... people would lose insurance coverage if the Affordable Care Act were repealed following the 2016 elections, with the brunt of those individuals dropped from the Medicaid program, according to a new report issued by the Urban Institute for the Robert Wood Johnson Foundation

"I think this is a reasonable policy response ...

... [rules proposed by HHS on June 8 to limit short-term health plan products] — recognizing that short-term plans have some value but should be used only for short-term coverage. The way those plans are underwritten do pose a real threat to the exchanges, but they also fill a gap in the marketplace. This is a classic insurance spiral: consumers are going to look for these types of work-around plans as long as the rates continue to go up dramatically (or choice is increasingly limited) in the exchanges — and the more they opt out of the exchanges, the faster the premiums will rise. The exchanges need those healthy people in order to provide some predictability into their premiums, but if public policy fails to constrain the attractiveness in short-term plans, it'll be difficult. Limiting duration and renewability are two good steps to balance the risk pools in the exchanges. I'm not sure it will be enough."

— Erik Johnson, vice president for value-based care at Optum, Inc., a unit of UnitedHealth Group, told AIS's Health Plan Week.

Pushback on Part B Payment Model Continues, but Battle May Be Futile


Reprinted from SPECIALTY PHARMACY NEWS, a monthly newsletter designed to help health plans, specialty pharmacies, pharma companies, providers and employers contain costs and improve outcomes related to high-cost specialty products.

By Angela Maas, Managing Editor

June 2016 Volume 13 Issue 6

The battle over CMS’s proposed Medicare Part B Drug Payment Model continues, but at least one analyst thinks implementation is likely in the fall.

Phase I of the proposed Part B Drug Payment Model (81 Fed. Reg. 13230, March 11, 2016) would test changing the add-on payment to the average sales price (ASP) of a drug (SPN 3/16, p. 1). Currently these drugs are reimbursed at ASP +6%, but the proposal would change the add-on payment to 2.5%, plus a $16.80 per-drug per-day flat fee payment. This test would begin later this year, no earlier than 60 days after the final rule is published. The second phase of the proposed payment model would begin “on or after” Jan. 1, 2017. It would test one or more value-based purchasing strategies, such as indication-based pricing or reference pricing.

CMS is proposing running the model for five years, with both phases in operation for three years.

In a May 17 note, Evercore ISI analyst Terry Haines maintained that the changes “are 80 per cent likely to be adopted by CMS in July 2016 and implemented in fall 2016 despite rising industry and congressional pressure to delay or stop it.…CMS remains on track to adopt Phase I after public comments were received and has not backed off its timetable, although some small modification is not out of the question,” such as making the geographical scope smaller, extending the time the model will run or both, he said.

“We think CMS is unlikely to significantly change its timetable because the agency wants to get Phase I in place in this presidential administration and CMS believes Congress will not be able to stop it,” wrote Haines. With President Obama certain to veto a bill to stop the changes, assuming it would even pass the Senate, “the year-end government spending bills,” which would come months after the first phase of the model has started, are the most likely way to stop it, said the analyst. “That leaves congressional opponents with a strategy of attaching a Part B stoppage to some other ‘must-pass’ bill that Obama would sign. Before July, when CMS today intends to finalize its Part B Phase I rules, there are no obvious ‘must-pass’ bills, so if CMS keeps to its timetable it can get Phase I in place.”

“Further implementation,” he asserted, “will be up to a new president.” If that is Hillary Clinton (D), she “will keep the Part B changes going forward.” If it’s Donald Trump (R), he could “possibly stop it in its tracks, change it, or undo it,…but he supports government negotiation for Part D so even though his position on Part B is not known his opposition cannot be assumed.”

The analyst note was released the same day as the House Energy and Commerce Committee’s hearing on the model, titled “The Obama Administration’s Medicare Drug Experiment: The Patient and Doctor Perspective.” Most who gave either spoken or written testimony called for CMS to withdraw the model or at the very least make changes to it.

In early June, House Energy and Commerce Committee Member John Shimkus (R-Ill.), House Ways and Means Committee Member and Budget Committee Chairman Tom Price, M.D. (R-Ga.), and House Ways and Means Committee Member Charles Boustany Jr., M.D. (R-La.), spoke out against CMS after the agency responded to a letter they submitted calling for the withdrawal of the model that was co-signed by 239 congressional members. CMS simply thanked the representatives “for sharing your thoughts” on the model, described the model, said the agency had “included your comments as part of the public record” and added that it “will carefully consider the public comments” as it develops a final rule.

In response, the representatives decried CMS’s “lack of a substantive response…to the detailed concerns raised by a bipartisan majority of the House of Representatives,” labelling it “disappointing” and “disrespectful” to patients and their families, who “deserve a thoughtful response from CMS” before the model goes forward. “CMS’s brief and uninformative response is dismissive of the risks posed to our nation’s sickest patients, including those with cancer, rheumatoid arthritis, rare diseases, and neurological disorders who could be adversely impacted by the proposal,” they wrote, calling for Congress to pass legislation, H.R. 5122, that would stop the model from being implemented.

View the congressional letter at http://tinyurl.com/hpw8zvw and CMS’s response at http://tinyurl.com/jysabn7.
https://aishealth.com/archive/nspn0616-06?utm_source=Real%20Magnet&utm_medium=Email&utm_campaign=98945830

Monday, June 27, 2016

CMS Announces Proposed Payment Changes for Medicare Home Health Agencies for 2017


CMS News


FOR IMMEDIATE RELEASE
June 27, 2016

Contact: CMS Media Relations
(202) 690-6145 | CMS Media Inquiries
 

CMS Announces Proposed Payment Changes for Medicare Home Health Agencies for 2017 (CMS-1648-P)


Today, the Centers for Medicare & Medicaid Services (CMS) announced proposed changes to the Medicare home health prospective payment system (HH PPS) for calendar year (CY) 2017 that would foster greater efficiency, flexibility, payment accuracy, and improved quality. Approximately 3.4 million beneficiaries received home health services from approximately 11,400 home health agencies, costing Medicare approximately $17.8 billion in 2015.

In the rule, CMS projects that Medicare payments to home health agencies in CY 2017 would be reduced by 1.0 percent, or $180 million based on the proposed policies. The proposed decrease reflects the effects of the 2.3 percent home health payment update percentage ($420 million increase); the rebasing adjustments to the national, standardized 60-day episode payment rate, the national per-visit payment rates, and the non-routine medical supplies (NRS) conversion factor ($420 million decrease); the effects of the -0.97 percent adjustment to the national, standardized 60-day episode payment rate to account for nominal case-mix growth for an impact of -0.9 percent ($160 million decrease); and the effects of the proposed increase to the fixed-dollar loss (FDL) ratio used in determining outlier payments from 0.45 to 0.56 for an estimate impact of -0.1 percent ($20 million decrease).  

To be eligible for the home health benefit, beneficiaries must need intermittent skilled nursing or therapy services and must be homebound and under the care of a physician. Covered home health services include skilled nursing, home health aide, physical therapy, speech-language pathology, occupational therapy, medical social services, and medical supplies. Home Health Agencies (HHAs) are paid a national, standardized 60-day episode payment for all covered home health services, adjusted for case-mix and area wage differences.

The HH PPS proposed rule is one of several rules for calendar year 2017 that reflect a broader Administration-wide strategy to create a health care system that results in better care, smarter spending, and healthier people. Provisions in these rules are helping to move our health-care system to one that values quality over quantity and focuses on reforms such as achieving better health outcomes, preventing disease, helping patients return home, helping manage and improve chronic diseases, and fostering a more-efficient and coordinated health care system.

Payment Policy Provisions

Rebasing the 60-day Episode Rate

The Affordable Care Act directs CMS to apply an adjustment to the national, standardized 60-day episode rate and other applicable amounts to reflect factors such as changes in the number of visits in an episode, the mix of services in an episode, the level of intensity of services in an episode, the average cost of providing care per episode, and other relevant factors. CMS must phase-in any adjustment over a four-year period, in equal increments, not to exceed 3.5 percent of the amount (or amounts) as of the date of the enactment of the Affordable Care Act (CY 2010).

In this proposed rule, CMS would complete the final year of the four-year phase-in of the rebasing adjustments to the HH PPS payment rates. As finalized in the CY 2014 final rule, the CY 2017 rebasing adjustment to the national, standardized 60-day payment rate is -$80.95.  The overall impact due to the rebasing adjustments is estimated to be a -2.3 percent decrease in HH PPS payments for CY 2017. As noted above and further below, this is offset by the home health payment update percentage, which would increase overall HH PPS payments in CY 2017 by 2.3 percent. 

Updates to Reflect Case-Mix Growth

CMS will implement a 0.97 percent reduction to the national, standardized 60-day episode rate in CY 2017 to account for nominal case-mix growth from 2012 to 2014 (prior to rebasing). CY 2017 will be the second year of the three-year phase-in of the reduction to account for nominal case-mix growth. The -0.97 percent adjustment to the national, standardized 60-day episode payment rate to account for nominal case-mix growth results in an estimated decrease in HH PPS payments for CY 2017 of -0.9 percent.

Negative Pressure Wound Therapy (NPWT)

The Consolidated Appropriations Act of 2016 requires a separate payment to be made to HHAs for disposable NPWT devices when furnished on or after January 1, 2017 to an individual who receives home health services for which payment is made under the Medicare home health benefit. As described in the Consolidated Appropriations Act of 2016, the separate payment amount for an applicable disposable device will be set equal to the amount of the payment that would otherwise be made under the Medicare Hospital Outpatient Prospective Payment System (OPPS).

Change in Methodology and the Fixed-Dollar Loss (FDL) Ratio Used to Calculate Outlier Payments

CMS is proposing to change the methodology used to calculate outlier payments, moving from a cost per visit approach to a cost per unit approach (1 unit = 15 minutes).  This approach would more accurately calculate the cost of an outlier episode of care and thus would better align outlier payments with episode cost than the cost per visit approach.  In addition, CMS is proposing to increase the FDL ratio from 0.45 to 0.56 in order to ensure outlier payments do not exceed 2.5 percent of total payments for CY 2017, as required by the Social Security Act (for an estimated   -0.1 percent decrease in HH PPS payments for CY 2017).

Other Updates

CMS is also proposing to update the HH PPS payment rates by the home health payment update percentage of 2.3 percent, as required by the Social Security Act.

Home Health Quality Reporting Program (HH QRP) Updat

Section 2(a) of the Improving Medicare Post-Acute Care Transformation Act of 2014 (the IMPACT Act)  requires HHAs, Skilled Nursing Facilities (SNFs), Inpatient Rehabilitation Facilities (IRFs), and Long-Term Care Hospitals (LTCHs) to: submit standardized patient assessment data, data on quality measures and data on resource use and other measures. The data must be standardized and interoperable so as to allow for the exchange of such data among PAC providers.  It also modifies PAC assessment instruments to provide for the submission and comparison of such standardized patient assessment data. These requirements are intended to enable interoperability as well as improve quality and discharge planning, among other purposes.

CMS is proposing to adopt for the CY 2018 payment determination four measures to meet the requirements of the IMPACT Act. Three of these measures are resource-based and calculated using Medicare claims.  The fourth measure is assessment-based and is calculated using Outcome and Assessment Information Set (OASIS) data.  The proposed measures are as follows:

  • All-condition risk-adjusted potentially preventable hospital readmission rates,
  • Total estimated Medicare spending per beneficiary,
  • Discharge to the community, and
  • Medication reconciliation.

The Home Health Conditions of Participations (CoPs) require HHAs to submit OASIS assessments as a condition of payment and also for quality measurement purposes. HHAs that do not submit quality measure data to CMS will see a two percent reduction in their annual payment update (APU). Last year CMS finalized its proposal to require all HHAs to submit both admission and discharge OASIS assessments for a minimum of 90 percent of all patients with episodes of care occurring during the reporting period.  CMS is incrementally increasing this compliance threshold over a three-year period beginning with the reporting period for CY 2017. 

In 2015, CMS undertook a comprehensive reevaluation of all 81 HH quality measures, some of which are used only in the Home Health Quality Initiative (HHQI), and others which are also used in the HH QRP.  The goal of this reevaluation was to streamline the measure set, consistent with MMS guidance and in response to stakeholder feedback.  This reevaluation included a review of the current scientific basis for each measure, clinical relevance, usability for quality improvement, and evaluation of measure properties, including reportability, and variability. 

CMS’ measure development and maintenance contractor convened a Technical Expert Panel (TEP) on August 21, 2015, to review and advise on the reevaluation results. Information regarding the TEP’s feedback is available at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Downloads/Health-Quality-Reporting-Program-HHQRP-TEP-.zip. As a result of the comprehensive reevaluation, CMS identified 28 HHQI measures that were either “topped out” and/or determined to be of limited clinical and quality improvement value by TEP members.  Therefore, these measures will no longer be included in the HHQI.  A list of these measures, along with our reasons for no longer including them in the HHQI, can be found at the following link https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/HHQIQualityMeasures.html

Home Health Value-Based Purchasing Model

In the final CY 2016 Home Health Prospective Payment System final rule, CMS finalized its proposal to implement the Home Health Value-Based Purchasing (HHVBP) Model in nine states representing each geographic area in the nation. All Medicare-certified home health agencies (HHAs) that provide services in Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee, and Washington are competing on value in the HHVBP Model, where payment adjustments will be based on each HHA’s total performance score on a set of measures already reported via OASIS and HHCAHPS for all patients serviced by the HHA, or determined by claims data, plus three new measures where points are achieved for reporting data.

The HHAs in these nine states will have their payments adjusted (upward or downward) in the following manner:  a maximum payment adjustment of three percent in CY 2018; a maximum payment adjustment of five percent in CY 2019; a maximum payment adjustment of six percent in CY 2020; a maximum payment adjustment of seven percent in CY 2021; and, a maximum payment adjustment of eight percent in CY 2022. 

Under the CY 2017 Home Health Prospective Payment System proposed rule, in addition to providing an update on the progress towards developing public reporting of performance under the HHVBP Model, CMS proposes the following changes and improvements related to the HHVBP Model:

  • Calculate benchmarks and achievement thresholds at the state level rather than the level of the size-cohort and revise the definition for “benchmark” to state that benchmark refers to the mean of the top decile of Medicare-certified HHA performance on the specified quality measure during the baseline period calculated for each state;
  • A minimum requirement of eight HHAs in a size-cohort;
  • Increase the timeframe for submitting New Measure data from seven calendar days to fifteen calendar days following the end of each reporting period to account for weekends and holidays;
  • Remove four measures (Care Management: Types and Sources of Assistance, Prior Functioning ADL/IADL, Influenza Vaccine Data Collection Period, and Reason Pneumococcal Vaccine Not Received) from the set of applicable measures;
  • Adjust the reporting period and submission date for the Influenza Vaccination Coverage for Home Health Personnel measure from a quarterly submission to an annual submission; and
  • Add an appeals process that includes the existing recalculation process and adds a reconsideration process.

For additional information about the Home Health Prospective Payment System, visit https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS/index.html.

For additional information about the Home Health Value-Based Purchasing Model, visit https://innovation.cms.gov/initiatives/home-health-value-based-purchasing-model.  

The proposed rule can be viewed at https://www.federalregister.gov/public-inspection.

The 10 Least Healthy Cities In America - By Adult Obesity Rate


1. Hammond, LA - 40.3%

 

2. Pine Bluff, AR - 38.3%

 

3 .Jonesboro, AR - 37.2%

 

4. Fort Smith, AR-OK - 36.5%

 

5. Florence, SC - 36.3%

 

6. Huntington-Ashland, WV-KY-OH - 36.1%  

 

7. Alexandria, LA - 36.1%

 

8. Mobile, AL - 36.1%

 

9. Albany, GA - 35.9%

 

10.Monroe, LA - 35.3%

 

 

Source: 24/7 Wall st.

Diabetes Spending Reached $16,021 Per Capita in 2014


The Health Cost Institute recently released a study on healthcare spending for diabetes patients. Here are some key findings from the report:

·         Spending on people with diabetes reached $16,021 per capita in 2014, an $897 increase from 2013.

·         Health care spending for people with diabetes rose 6% compared to 3.2% for people without diabetes.

·         The number of ER visits among people with diabetes rose 8.1% annually from 2012-2014.

·         People with diabetes had 7x more filled days of cardiovascular drugs than those without diabetes.

·         Young adults (19-25) with diabetes had 4x more hospital admissions for mental health and substance use.

·         In 2014, insureds with diabetes spent $1,944 out of pocket compared to $752 for those without diabetes.

Source: Health Cost Institute, June 20, 2016