CMS intends to modify requirements for Meaningful Use

By Patrick Conway, MD

Today, we at the Centers for Medicare & Medicaid Services (CMS) are pleased to announce our intent to engage in rulemaking to update the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs beginning in 2015. These intended changes would help to reduce the reporting burden on providers, while supporting the long term goals of the program.

Since the first year of the EHR Incentive Programs in 2011, the United States has seen unprecedented growth in the adoption and meaningful use of EHRs. To date, more than 400,000 eligible providers have joined the ranks of hospitals and professionals that have adopted or are meaningfully using EHRs. This means that millions of patients across the nation are benefiting from the potential of better coordinated care among professionals, more accurate prescribing, and improved communication.

The new rule, expected this spring, would be intended to be responsive to provider concerns about software implementation, information exchange readiness, and other related concerns in 2015. It would also be intended to propose changes reflective of developments in the industry and progress toward program goals achieved since the program began in 2011.

We are considering proposals to:

  • Realign hospital EHR reporting periods to the calendar year to allow eligible hospitals more time to incorporate 2014 Edition software into their workflows and to better align with other CMS quality programs.
  • Modify other aspects of the program to match long-term goals, reduce complexity, and lessen providers’ reporting burdens.
  • Shorten the EHR reporting period in 2015 to 90 days to accommodate these changes.

To clarify, we are working on multiple tracks right now to realign the program to reflect the progress toward program goals and be responsive to stakeholder input. Today’s announcement that we intend to pursue the changes to meaningful use beginning in 2015 through rulemaking, is separate from the forthcoming Stage 3 proposed rule that is expected to be released by early March. CMS intends to limit the scope of the Stage 3 proposed rule to the requirements and criteria for meaningful use in 2017 and subsequent years. 

These changes reflect the Department of Health and Human Services’ commitment to creating a health information technology infrastructure that elevates patient-centered care, improves health outcomes and supports the providers who care for patients. We continuously strive to work in partnership with providers to improve affordability, access, and quality.

For more information about the EHR Incentive Programs, please visit HTTP://www.cms.gov/EHRIncentivePrograms.

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Moving forward on primary care transformation

By Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and Chief Medical Officer 

Today, we at the Centers for Medicare & Medicaid Services (CMS) are excited to announce the promising findings from two large-scale tests of advanced primary care: the Comprehensive Primary Care (CPC) initiative and the Multi-payer Advanced Primary Care Practice (MAPCP) Demonstration. The CPC initiative, in its first year, decreased hospital admissions by 2% and emergency department visits by 3%, contributing to the reduction of expenditures nearly enough to offset care management fees paid by CMS. The MAPCP Demonstration generated an estimated $4.2 million in savings through the use of advanced primary care initiatives.

These two programs are part of broader efforts to deliver better care, spend dollars more wisely, and have healthier people and communities.

Comprehensive Primary Care initiative

With authority from the Affordable Care Act, the CPC initiative is a unique multi-payer partnership between Medicare, Medicaid private health care payers, and primary care practices in four states (Arkansas, Colorado, New Jersey and Oregon) and three regions (New York’s Capital District and Hudson Valley, Ohio and Kentucky’s Cincinnati-Dayton region, and Oklahoma’s Greater Tulsa region). This initiative includes providing care management for those at greatest risk; improving health care access; tracking patient experience; coordinating care with hospitals and specialists; and using health information technology to support population health. Practices receive non-visit based care management fees from the participating payers, and the opportunity to share in savings.

In the first year, 492 practices participated, serving about 345,000 Medicare beneficiaries and more than 2.5 million patients overall. Results from this first year suggest that CPC has generated nearly enough savings in Medicare health care expenditures to offset care management fees paid by CMS.

  • The primary sources of the savings were reduced rates of hospital admissions and emergency department visits.
  • The bulk of the savings was generated by patients in the highest-risk quartile, but favorable results were also seen in other patients.
  • Over 90 percent of practices successfully met all first-year transformation requirements.
  • The expenditure impact estimates differ across the seven regions.
  • Additional time and data are needed to assess impact on care quality.

Results should be interpreted cautiously as effects are emerging earlier than anticipated, and additional research is needed to assess how the initiative affects cost and quality of care, beyond the first year. Because the effects of the CPC program are likely to be larger in subsequent years, these early results are consistent with the possibility that the model will eventually break-even or generate savings.

Multi-payer Advanced Primary Care Practice Demonstration

The MAPCP Demonstration is multi-payer initiative in which Medicare is participating with Medicaid and private health care payers in eight advanced primary care initiatives in Maine, Michigan, Minnesota, New York, North Carolina, Pennsylvania, Rhode Island, and Vermont. Unlike CPC, the states convene the participants and administer the initiatives rather than CMS. Under this demonstration, participating practices and other auxiliary supports (e.g., community health teams) receive monthly care management fees from the participating payers and additional support (e.g., data feedback, learning collaboratives, practice coaching).

More than 3,800 providers, 700 practices, and 400,000 Medicare beneficiaries participated in the first year. During the first year, the demonstration produced an estimated $4.2 million in savings. Also, the rate of growth in Medicare FFS health care expenditures was reduced in Vermont and Michigan, driven largely by reduced growth in inpatient expenditures. There is less evidence that the state initiatives were able to reduce hospitalization, readmission and emergency department visit rates. Additional findings in this evaluation period include:

  • The MAPCP payments provided needed support to help practices transform the way they deliver and coordinate care, including use of nurse care managers or care coordinators, restructuring of staff, improvements in patient flow, adoption of health information technology, and more frequent staff meetings.
  • Medicare was able to integrate seamlessly with the structure and organization of the eight state initiatives. Medicare’s participation sent a strong signal about the importance of primary care and the potential of these programs, helping to affirm payer and provider commitments.
  • Although collecting and using data was a recurring challenge, health information systems facilitated the transformation process.

These first-year results illustrate the potential for steady improvements in the participating practices’ advanced primary care capabilities. CMS anticipates continued improvements as the participating practices deepen and refine their methods of delivering advanced primary care so that patients can continue to receive improved quality and coordination of care.

Additional

 

 

ACOs Moving Ahead

By Sean Cavanaugh, Deputy Administrator and Director, Center for Medicare

Today, we at CMS are excited to announce that 89 new Accountable Care Organizations (ACOs) will be joining the Medicare Shared Savings Program (Shared Savings Program). With today’s announcement, we will have a total of 405 ACOs participating in the Shared Savings Program next year, serving more than 7.2 million beneficiaries. When combined with the Innovation Center’s 19 Pioneer ACOs, we will have a total of 424 ACOs serving over 7.8 million beneficiaries.    

ACOs are one part of this Administration’s vision for improving the coordination and integration of care received by Medicare beneficiaries. ACOs are groups of doctors, hospitals, and other health care providers that work together to give Medicare beneficiaries in Original Medicare (fee-for-service) high quality, coordinated care. ACOs can share in any savings they generate for Medicare, if they meet specified quality targets.

Since ACOs first began participating in the program in early 2012, thousands of health care providers have signed on to participate in the program, working together to provide better care to Medicare’s seniors and people with disabilities. In 2014 alone, existing Shared Savings Program ACOs added almost 17,000 healthcare providers, and the 89 new ACOs will bring approximately 23,000 additional physicians and other providers into the ACO program starting January 1. The growth of this program for providing health care has been continued and consistent since its inception, and we are encouraged by that interest.

We are starting to see promising results. This fall, we released the early findings from the ACOs who started the program in 2012. Shared Savings Program ACOs improved on 30 of the 33 quality measures in the first 2 years, including patients’ ratings of clinicians’ communication, beneficiaries’ rating of their doctors, and screening for high blood pressure. They also outperformed group practices reporting quality on 17 out of 22 measures. We are also seeing promising results on cost savings with combined total program savings of $417 million for the Shared Savings Program and the Pioneer ACO Model.

While we are encouraged by what we have seen so far, we also understand there are opportunities to improve the program to make it stronger. Earlier this month, we published a proposed rule to update the guidelines for the program. We are looking forward to receiving comments from ACOs, beneficiaries, and their advocates, providers, and other stakeholders interested in seeing the ACOs succeed long-term.

ACOs are also just one way that CMS is working to reduce the rate of growth in Medicare spending while improving care. Medicare spending per beneficiary was essentially flat in nominal dollars in fiscal year 2014, and from 2010 to 2014, Medicare spending per beneficiary grew at a rate that was 2 percentage points per year less than growth in GDP per capita. While the recent slow cost growth has multiple causes, our reforms in the Medicare and Medicaid programs are meaningful contributors to these gains and are improving quality as well. Preliminary data for 2013, for example, indicates improvements in patient safety resulted in 50,000 fewer deaths, 1.3 million fewer patient harms, and $12 billion in avoided health care spending. Recent research implies that many of these reforms may be generating savings in the private sector as well.

Ultimately, today’s announcement is about delivering better care, spending dollars more wisely, and having healthier people and communities. ACOs drive progress in the way care is provided by improving the coordination and integration of health care, and improving the health of patients with a priority placed on prevention and wellness. We look forward to continuing this partnership with doctors, hospitals, and other health care providers in increasing value and care coordination across the health system.

For a list of the 89 new ACOs announced today, visit: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/News.html ?

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CMS releases data on quality to help patients choose providers

Updates provide quality metrics for hospitals and physicians
By Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and Chief Medical Officer

The Centers for Medicare & Medicaid Services (CMS) today released data on the quality of care provided by physician group practices, Accountable Care Organizations (ACOs) and hospitals. These data are available on Physician Compare, Hospital Compare and Data.Medicare.gov.

The performance information released this month will give patients and families additional information they can use to inform their selection of a hospital or physician practice. Health care professionals differ in the quality and safety of care they provide and these websites empower consumers with information to help with health care decisions, encourage providers to strive for higher levels of quality, and drive overall health system improvement.

The data released today includes:

  • Information on Hospital Value-Based Purchasing Program 2015 payment adjustments The Hospital Value-Based Purchasing Program provides a useful snapshot of how hospitals are performing on important quality indicators of patient care, quality, efficiency, and well-being. It is one of many Affordable Care Act programs Medicare is implementing to pay for quality instead of quantity. The program ties a portion of payments to hospitals’ performance on certain quality measures such as death within 30 days after a heart attack and patient experience of care.
     
    The portion of FY 2015 Medicare payments available to fund the value-based incentive payments increases from 1.25 to 1.5 percent of the base operating DRG payment amounts to all participating hospitals. The total amount available for value-based incentive payments in FY 2015 will be approximately $1.4 billion.

    Data from the third year of the program indicates that hospitals are improving care and outcomes for Medicare beneficiaries. More hospitals this year will experience a positive change in their payments (1,714) compared to the number of hospitals that will experience a negative change (1,375) – a reversal of last year  This change indicates that many hospitals are improving the quality of care delivered to patients.
     
    More information on the Hospital Value-Based Purchasing program payment adjustments can be found here: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2015-IPPS-Final-Rule-Home-Page-Items/FY2015-Final-Rule-Tables.html.

  • Updated performance results on diabetes and cardiovascular care by some physician group practices and ACOs

    CMS has posted the publicly reported 2013 Physician Quality Reporting System (PQRS) Group Practice Reporting Option measures for the 139 group practices and 214 Shared Savings Program Accountable Care Organizations (ACOs) and 23 Pioneer ACOs.

  • Hospital performance results on Hospital-Acquired Conditions (HACs) such as central line-associated bloodstream infections, catheter associated urinary tract infections, pressure ulcers and accidental punctures or lacerations
    HACs are a group of reasonably preventable conditions that patients did not have upon admission to a hospital, but developed during the hospital stay. The HAC Reduction Program uses public reporting and financial incentives to encourage hospitals that treat Medicare beneficiaries to reduce HACs and improve patient safety.
     
    To determine hospital performance under the HAC Reduction Program, CMS computes a Total HAC Score for each hospital. The higher a hospital’s Total HAC Score, the less well the hospital performed under the HAC Reduction Program. Beginning in FY 2015, the law requires a payment reduction of one percent for those hospitals that rank in the top quartile of Total HAC Scores.
     
    More information on the HACs Reduction program and HAC scores can be found here: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/HAC-Reduction-Program.html.

CMS is committed to providing useful and current quality performance data. The Compare sites empower consumers with information to help with health care decisions, encourage providers to strive for higher levels of quality, and drive overall health system improvement. While consumers and patients are the main audience for the Compare sites, stakeholders can visit Data.Medicare.gov and use the same data that power the Compare websites in easy-to-use formats.
 
CMS is committed to transparency of data about quality and cost of care provided by physicians, hospitals and other health care professionals. This transparency is critical to transforming the health care delivery system to achieve the three aims of better care for patients, better health for communities and spending dollars wisely.

 

Home Health Compare Site to Offer New Tools for Consumers

By Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and Chief Medical Officer

Consumers have many options when choosing a health care provider. Providers vary in the quality of the care they give, and everyone wants to choose the provider who will be best for themselves or their loved ones. Yet frequently the choice must be made quickly and without the time for consumers to locate and review a wide range of information sources.

The Centers for Medicare & Medicaid Services (CMS) has established the Compare sites on Medicare.gov as the official CMS source for information about the quality of health care providers so that consumers have a single, easy-to-access source of information to support their decision-making.

Yet sometimes even the information on the Compare sites can seem like “too much of a good thing” – too much information, too many measures to consider. Therefore, CMS has been adding new tools to the Compare sites in order to make the information there easier to use.  These include “star” ratings, similar to the ratings that consumers can review on websites for other products and services, which summarize the detailed information on health care provider quality that the sites already offer and make it more accessible to consumers.

We plan to add star ratings to Home Health Compare as early as the summer of 2015. None of the current information on the site will be removed; rather, the star ratings are intended to be an additional tool to support consumers’ health care decision-making. Over the coming months, we will be sharing the details of our proposed method for calculating the star ratings and soliciting input from consumers, home health providers, and other stakeholders, so that we can make the Home Health Compare star ratings as reliable and useful as possible.

We are excited to be expanding our support for home health care consumers, and we hope that the data will lead to continuing improvement in the quality and efficiency of the services that are provided to our beneficiaries.

New Open Payments Search Tool Launches Today: Access a simple to use search interface

By Dr. Shantanu Agrawal, CMS Deputy Administrator and Director of Center for Program Integrity

Open Payments is a congressionally mandated, national disclosure program that promotes transparency and accountability in health care. But what does “transparency” mean to you as a patient, and why is it important? The program gives you the opportunity to know if your doctors have a financial relationship with companies that make or supply medications, medical supplies or devices, and the biological products used in your care. The bottom line is that knowing about these relationships will let you be a more involved and informed health care consumer.

On September 30, 2014, we posted the first set of data about these financial relationships at cms.gov/openpayments. To make it easier to search the Open Payments data, we’ve released a beta search tool that allows you to search your doctor by name. As we work to make searching easier, we are asking for your feedback to improve website. Additional enhancements will be made available in coming weeks, including displays of summary data, data charts, graphs, as well as more detailed data. These innovative improvements will add value to both consumers and researchers using the Open Payments data.

With the addition of this new search tool, we are also providing more detailed information on the data released, including updating the data about the company that made the payment, giving researchers and consumers more granular information. This update was made in the “Applicable Manufacturer or Applicable GPO Making Payment Name” column and will provide the company that provided the payment.

Please visit cms.gov/openpayments to view the data and use the new search tool, and take the next step in becoming a more involved and informed health care consumer.

 

IMPROVED QUALITY OF MEDICARE PLANS AND STEADY PREMIUMS ARE GREAT NEWS AS OPEN ENROLLMENT SET TO BEGIN ON OCT. 15

By Marilyn Tavenner, CMS Administrator

As we approach the beginning of Medicare open enrollment on October 15, the Centers for Medicare & Medicaid Services (CMS) wants everyone to know that for most seniors who have Original Medicare, the 2015 Part B premiums will remain unchanged for a second consecutive year. This means more of seniors’ retirement income—and any increase in Social Security benefits—stays in their pockets.

In addition, quality continues to improve both in Medicare Advantage and the Part D Prescription Drug Program, as more people with Medicare get access to higher quality plans. About 60 percent of people who have a Medicare Advantage Plan are currently enrolled in plans with four or more stars for 2015, compared to an estimated 17 percent back in 2009 (Medicare Advantage enrollment is projected to reach an all-time high in 2015, with more than 16 million beneficiaries). Likewise, about 53 percent of Part D enrollees are currently enrolled in stand-alone prescription drug plans with four or more stars for 2015, compared to just 16 percent in 2009.

CMS calculates plan star ratings for Medicare health and drug plans on a scale of 1 to 5—with 5 being the best—based on quality and performance. These ratings are designed to help beneficiaries, their families, and caregivers compare plans. Overall, the number of Medicare Advantage Plans and prescription drug plans earning four or more stars for 2015 increased by 6 and 36 percent, respectively, compared with 2014.

Improved quality in Medicare health and prescription drug plans is just one of the many positive changes we’ve seen since the Affordable Care Act was signed into law.

Thanks to slower than expected growth in health care, premiums and deductibles in 2015 for the approximately 49 million Americans enrolled in Original Medicare will remain unchanged at $104.90 and $147, respectively. For the fourth year in a row, Medicare premium costs are meeting or beating expectations. According to Health & Human Services, premiums will be at least $125 lower over the course of a year then what the Congressional Budget Office (CBO) estimated for 2015 back in 2009.

This news comes as historically slow growth in health care costs continues. Health care prices are rising at their lowest rates in nearly 50 years, Medicare spending per beneficiary is currently falling, and—according to a major annual survey released last month—employer premiums for family coverage grew just 3.0 percent in 2014, tied with 2010 for the lowest percentage increase on record back to 1999.

We’re continuing to work hard to make sure this good news continues. The lower costs and better care is good news for the Trust Funds, great news for taxpayers, and even better news for people with Medicare.

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