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4 posts from December 2017

12/26/2017

"Fixing MACRA Means Fixing The APM Pathway" (December 26th)

Per my last interview, here is my most recent essay, titled, "Fixing MACRA Means Fixing the APM Pathway," posted by The Health Care Blog (THCB) on December 18th:http://thehealthcareblog.com/blog/2017/12/18/fixing-macra-should-mean-fixing-the-apm-pathway/.  As you'll see I, along with my co-author, Dr. Scott Hines, argue MedPAC's interest in reinventing MIPS misses the forest for the trees. 

Happy Holidays.  

12/19/2017

Kristen O'Brien Discusses the Final 2018 MACRA Rule (December 18th)

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This past November 16 CMS published the agency's final 2018 MACRA (Medicare Access and CHIP Reauthorization Act) rule (at 661 federal register pages).  MACRA, authorized in 2015, formulates how approximately 1.5 million Medicare Part B physicians and other eligible clinicians are reimbursed.  Annual MACRA proposed and final rule making is closely monitored since the law's MIPS (Merit-Based Incentive Payment System) and Advanced Payment Model (APM) pathway are the two formulas CMS uses to annually update Fee for Service Medicare Spending (Part A and Part B) and how eligible clinicians under Medicare Advantage (Part C) can participate in MACRA's payment updates or rewards.    

During this 24 minute conversation Ms. O'Brien discusses the MIPS two threshold exclusions, MIPS quality and cost components, the composite performance score (CPS), the Advanced APM (AAPM) pathway, the anticipated 2018 Medicare Advantage (MA) AAPM demonstration and criticisms of MACRA implementation, specifically MedPAC's.  

Ms. Kristen O'Brien serves as Counsel at the law firm, Olsson, Frank and Weeda (OFW), in their Health Industry and Regulatory O'Brien Practice.  Prior to OFW, she served as Senior Legislative Counsel with the American Medical Association and prior still worked in private practice.   Ms. O'Brien's experience also includes serving as professional staff for the Senate Finance Committee under Former Committee Chair, Senator Max Baucus (D-MT), where she worked on health and environmental issues as well as financial reform.  Ms. O'Brien received her J.D. cum laude from Georgetown University Law Center and her undergraduate from Cornell University that included study at the London School of Economics.

The 2018 final MACRA rule is at: https://www.federalregister.gov/documents/2017/11/16/2017-24067/medicare-program-cy-2018-updates-to-the-quality-payment-program-and-quality-payment-program-extreme.

 

 

12/12/2017

Clay Richards Discusses Medicare's Bundled Payments for Care Improvement (BPCI) Demonstration (December 11th)

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CMS has been experimenting with Medicare bundled payment arrangements, where the provider is reimbursed a total fee (either prospectively or reconciled retrospectively), for three decades.  Under ACA authority CMS' Center for Medicare and Medicaid Innovation (CMMI) has launched several five-year bundled payment demonstrations, most notably BPCI that began in 2013.  The BPCI demo allows providers to voluntary accept a bundled payment for any one of 48 Diagnosis Related Groups (DRGs), for example a heart attack, under three care models.  Model Two is the most popular.  It begins with an anchor acute hospital stay followed by 30 to 90 days of post acute care.  The most common Model Two bundle is for hip or knee replacement surgery.  Recently, the Lewin Group completed its third evaluation of the BPCI.  Regardless of the demonstration's performance to date, has it moreover reduced spending and/or improved care quality and outcomes, it is anticipated CMS will renew the BPCI demo in the very near future since the current demo times out this September. 

During this 25-minute discussion Mr. Clay Richards discusses naviHealth's BPCI's efforts, the company's BPCI financial and quality results to date, Lewin Group's most recent BPCI evaluation and how the demonstration can be improved under a reauthorized BPCI demonstration.  

Mr. Clay Richards is CEO of naviHealth, a post-actue care transition company and one of the nation's largest BPCI Clay richardsconvenors.  The company, founded in 2012, partners with approximately 50 hospitals in 25 states, collectively they account for over 40,000 BPCI care episodes  annually.  Prior to joining naviHealth, Mr. Richards served as Senior Vice President of Healthways, Inc.  Mr. Richards' community service includes serving on the Martha O'Bryan Center Board, the Oak Hill School Board and on the Vanderbilt Owen Graduate School of Management Board of Visitors.  Mr. Richards was graduated from Washington and Lee University and from the University of Mississippi School of Law.

Information on naviHealth is at: https://www.navihealth.com/.

Information on the BPCI demo and the Lewin Group's evaluation can be found at: https://innovation.cms.gov/initiatives/bundled-payments/.  

12/07/2017

Myra Christopher Discusses Under Treated Chronic Pain and the PAINS Project (December 6th)

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Despite the fact an estimated 100 million Americans suffer from chronic pain costing approximately $640 billion annually in medical expenses and lost productivity, the disease remains widely under treated.  This is all the more true for ethnic and racial minorities independent of age, gender, education, wealth and pain intensity.  Despite recent efforts by the Institute of Medicine, the DHHS, i.e., its 2016 "National Pain Strategy," and new payment models designed to improve care quality, for example, Accountable Care Organizations and Patient Centered Medical Homes, under treatment persists.  Addressing the problem has become all the more difficult over approximately the past decade due to the opioid epidemic that has blurred, if not erased, the line between effective treatment and drug abuse.  We face the nearly impossible situation where Americans are simultaneously under treated and over medicated.     

During this 29-minute conversation Ms. Christopher discusses why chronic pain continues to be under treated, to what extent, if any, chronic pain measurement and data collection has improved, the work of the Center for Practical Bioethics' PAINS Project and the extent to which the opioid epidemic is undermining chronic pain treatment. 

Ms. Myra Christopher is currently the Director of the PAINS Project and as well the Kathleen M. Foley Chair at the Center for ChristopherPractical Bioethics.   She served as President and CEO of the Center from its inception in 1985 through 2011.  From 1998 through 2003 she served as National Program Officer at the Robert Wood Johnson Foundation's National Program Office for State-Based Initiatives to Improve End-of-Life Care.   She has consulted with numerous organizations including the Joint Commission on the Accreditation of Healthcare Organizations, at CMS in developing the Community State Partnerships to Improve End-of-Life Care initiative, participated in drafting the IOM's 2011 "Relieving Pain in America" report discussed during this interview, as a reviewer on the IOM's 2014 report, "Dying in America" and the DHHS committee that produced the  "National Pain Strategy." She has also consulted with the CDC, AARP and other organizations to promote pain and palliative care as public health issues.  She is s a founding member of the Coalition to Transform Advanced Illness (CTAC), has served on numerous boards including the Duke University Institute for Care ad the End of Life and has received as well numerous awards including the American Society for Bioethics + Humanities Lifetime Achievement Award in Bioethics.   

For more information on the PAINS Project go to: http://painsproject.org/

The IOM's "Relieving Pain In America" is at: https://www.ncbi.nlm.nih.gov/pubmed/22553896.

The DHHS' "National Pain Strategy" is at: https://www.hhs.gov/ash/about-ash/news/2016/national-pain-strategy-outlines-actions-improving-pain-care/index.html.