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4 posts from June 2016


"Where's The Value In MACRA?" (June 24th)

Students of the Medicare program are well aware in late April, CMS dropped its proposed Medicare Access and CHIP Reauthorization Act (MACRA) rule.  Specifically, the rule addresses MACRA Title I.   At 424 Federal Register pages the rule will make considerable changes to how CMS will, beginning in 2019, annually update Medicare Part or physician payments.  For all the Strum and Drang surrounding MACRA and regulatory implementation thereof, the proposed rule represents conventional thinking.  Despite the considerable rhetoric about moving Medicare payments from volume to value, remarkably, value goes undiscussed, i.e., value as the relationship between care outcomes and spending.  If we're serious about "bending the Medicare cost curve" and/or expecting providers to accept downside financial risk via ACOs and other models or CMS demonstrations, we'll not get there by continuing to ignore measuring for value.  

If you're interested please feel free: http://thehealthcareblog.com/blog/2016/06/23/wheres-the-value-in-macra/


Recent Efforts to Improve Quality Measurement: A Conversation with Dr. Helen Burstin (June 15th)

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Measuring health care quality and outcomes effectively and efficiently remains a daunting task.  Quality measures are largely seen as too process versus outcome focused, substantially irrelevant to patients and insufficiently aligned between and among payers.  Measuring care or care quality, ironically, can and does detract from actual care delivery, can have no relationship to spending efficiency and on its own is costly.  A recent article published in Health Affairs found physician practices spent over $15 billion in 2014 in reporting quality measures.  Concerning the Medicare program's quality measurement activities, MedPAC in a 2014 report to the Congress went so far as to state, "Medicare's current quality measurement approach as gone off the rails." 

During this 23 minute conversation Dr. Burstin briefly describes the work of the National Quality Forum (NQF), the work done by the CMS-led Core Measure Collaborative, quality measurement under the CMS proposed MACRA (Medicare Access and CHIP Reauthorization Act) rule, risk adjusting measures for socio-demographic factors, the role of PREMS and PROMS or patient reported experience and outcome measures and correlating care quality and spending or measuring for healthcare value.  

Dr. Helen Burstin is the Chief Scientific Officer at the NQF.  Prior to serving in her current position, Dr. Burstin was NQF's Senior Burstin PhotoVice President for Performance Measurement.  Prior to NQF Dr. Burstin was the Director of the Center for Primary Care at the DHHS Agency for Healthcare Research and Quality (AHRQ).  Prior to AHRQ, Dr. Burstin was an Assistant Professor at Harvard Medical School and the Director of Quality Measurement at the Brigham and Woman's Hospital in Boston.  Dr. Burstin has published more than 80 articles and book chapters on quality, safety and disparities.  She was recently selected as a 2015-2016 Baldridge Executive Fellow.  She currently is also is a Professorial Lecturer in the Department of Health and Policy and a Clinical Associate Professor of Medicine at George Washington University and serves as a preceptor in internal medicine.

For information concerning NQF go to: http://www.qualityforum.org/Home.aspx




How CMS Proposes to Annually Update Medicare Physician Reimbursement Under MACRA: A Conversation with Mara McDermott (June 14th)

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In an extremely busy year for Medicare delivery and payment reform,  regulatory implementation of the 2015 Medicare Access and CHIP Reauthorization Act (MACRA) stands out.   This past April CMS published the agency's 960-page proposed rule to implement the law.  The proposed rule, that will go final this fall, will change the way Medicare physician payments (Medicare Part B) are annually updated beginning in payment year 2019.   Payment updates, either at the individual provider or at the group level, will be calculated either by the Merit-based Incentive Payment System (MIPS), a composite score based on four, differently weighted, component scores, or via provider participation in what CMS defines as an "advanced" Alternative Payment Model (APM) pathway, e.g., Track 2 and 3 ACOS and Patient Centered Medical Homes that meet certain financial risk criteria.

During this 22-minute discussion Ms. Mara McDermott evaluates how CMS proposes to define APM nominal risk, how the agency has defined the MIPS composite score, the effect MACRA will have on small practices, how Medicare Advantage plans and physicians can be included in MACRA, and several inter-related issues.   (While the introduction to this discussion provides some brief explanatory information, our conversation assumes the listener has some familiarity with Title I of the MACRA law.)    

Mara McDermott is the Vice President of CAPG (formerly the California Association of Physician Groups) where she leads the Mara McDermott_smorganization's federal legislative and regulatory activities in Washington, D.C.  Prior to joining CAPG, Mara was Counsel in the health industry practice of Akin Gump Strauss Hauer and Field.  Mara received her JD with high honors and her MPH from George Washington University School of Law in 2007.  She received her BA in 2003 from the University of California, Davis.

The CMS MACRA proposed rule is at: https://www.federalregister.gov/articles/2016/05/09/2016-10032/medicare-program-merit-based-incentive-payment-system-mips-and-alternative-payment-model-apm

 Information concerning CAPG is at: http://www.capg.org/



"About Hastert’s “Known Acts:” The Indifference Is as Disturbing as the Crime" (June 6th)


This past April 27th former US House Speaker, Denise Hastert, was convicted of violating federal banking laws resulting from his efforts to buy the silence of a high school student he sexually molested several decades ago while Hastert was employed as the school's wrestling coach.  Since Hastert's sentencing no Congressional leader nor the White House has bothered to condemn Hastert's "known acts" much less recognize the adverse life time health effects survivors' suffer, nor has the health care media, nor leading health care associations.  This behavior is the status quo.   If your interested in the Hastert case and non-response to it, here is the link to: "About Hastert's "Known Acts:" The Indifference is as Disturbing as the Crime."   


See also this related January 2013 Health Affairs blog post: http://healthaffairs.org/blog/2013/01/30/not-even-discussed-in-private-rooms-childhood-sexual-abuse-and-abuse-survivors/

My podcast interview with Diane Champe, noted in the above THCB blog post, is dated December 7, 2012.