Medicare
GAO report suggests HHS address contractor performance and plan for needed measures
Posted on January 30, 2012
The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) directed the Department of Health and Human Services (HHS) to enter into a 4-year contract with an entity to perform various activities related to health care quality measurement. In January 2009, HHS awarded a contract to the National Quality Forum (NQF), a nonprofit organization that endorses health care quality measures—that is, recognizes certain ones as national standards. In 2010, the Affordable Care Act (ACA) established additional duties for NQF. This is the second of two reports MIPPA required GAO to submit on NQF’s contract with HHS. In this report—which covers NQF’s performance under the contract from January 14, 2010, through August 31, 2011—GAO examines (1) the status of projects under NQF’s required contract activities and (2) the extent to which HHS used or planned to use the measures it has received from NQF under the contract to meet its quality measurement needs, as of August 2011. GAO interviewed NQF and HHS officials, reviewed relevant laws, and reviewed HHS and NQF documents.
GAO recommends HHS: (1) use all monitoring tools required under the contract to help address NQF’s performance, (2) complete testing of retooled measures, and (3) comprehensively plan for its quality measurement needs. HHS neither agreed nor disagreed with these recommendations. NQF concurred with many of the findings in the report and provided additional context.
The Center for Medicare and Medicaid Innovation: A Year’s Progress
Posted on January 26, 2012
Improving the quality of care delivery and reducing explosive growth in healthcare costs is a cornerstone of The Patient Protection and Affordable Care Act (ACA). It reflects the shared understanding that the current silo-based approaches to care delivery that focus on settings of care (e.g., physician office, hospital) rather than care delivery across multiple providers and setting (e.g., episodic) are not working. Costs are increasing at an unsustainable pace, and evidence from leading researchers collectively points to serious deficiencies in health care quality and the disconnect between high spending and health care quality.
To foster the development of more collaborative and…
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Independent Payment Advisory Board (IPAB)
Posted on January 13, 2012
Section 3403 of the Affordable Care Act (ACA) established the Independent Payment Advisory Board (IPAB), a 15-member panel of appointed experts that will recommend cost-saving measures for Medicare. In the face of controversy about its structure and powers, legislation has been introduced in the 112th Congress to repeal its establishment.
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ACAP releases article on dual eligibles
Posted on January 12, 2012
Jane Hyatt Thorpe and Katherine Jett Hayes recently released an article funded by the Association for Communication Affiliated Plans (ACAP), “A New State Plan Option to Integrate Care and Financing for Persons Dually Eligible for Medicare and Medicaid,” which reviews barriers to clinical and financial integration in services for dual eligibles prior to passage of the ACA, identifies models used by states to integrate care through contract and waiver authorities available to CMS prior to passage of the ACA, describes two new demonstrations proposed by CMS through the Medicare-Medicaid Coordination Office and Innovation Center, and introduces a state plan option as a new model for consideration by federal and state policymakers. This new model draws on experience from existing programs and waivers to provide a permanent state plan option for a fully integrated, capitated care model that could be made available to states prior to the completion of the demonstration process begun by the Medicare-Medicaid Coordination Office and Innovation Center.
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ACA Demonstration to provide home care for Medicare patients
Posted on December 20, 2011
The Centers for Medicare & Medicaid Services (CMS) announced today a new Demonstration under the Affordable Care Act (ACA) that will enable up to 10,000 Medicare beneficiaries with chronic conditions to receive most of their necessary care at home. The new Independence at Home Demonstration, a provision of the ACA, significantly expands the scope of in-home care that Medicare patients are eligible to receive. If they choose to opt into the Demonstration, beneficiaries with have access to a wide range of primary care services. Participation is optional. The Demonstration will reward providers with an incentive payment if they offer high-quality care care and reduce Medicare expenditures. CMS will implement quality measures to ensure beneficiaries experience high quality care under the new Demonstration.
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Sen. Wyden (D-OR) joins Rep. Ryan (R-WI) on Medicare Plan
Posted on December 18, 2011
Democratic Sen. Ron Wyden of Oregon teamed up with Republican Rep. Paul Ryan of Wisconsin on a Medicare overhaul plan that would provide beneficiaries with a fixed amount to buy private coverage or pay for a traditional fee-for-service plan. Different from the Ryan plan introduced earlier this year, the Ryan-Wyden proposal would not do away with Medicare, but instead would leave it is an option for beneficiaries to purchase with their vouchers. However, this plan would not ensure that the voucher would make Medicare affordable, nor would it preclude private insurance policies from designing benefit plans to exclusively attract healthy beneficiaries.
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House passes bill with 2-year SGR fix
Posted on December 16, 2011
Introduced by Republican leadership only days earlier, the U.S. House of Representatives has passed a legislative package, some of which is paid for by reducing funding of certain components of the Affordable Care Act (ACA). The legislation provides funding for the controversial Keystone XL pipeline, preempts certain rules issued by the Environmental Protection Agency, extends unemployment insurance, and prevents a reduction in physician payments under Medicare (the “SGR fix”), among other provisions. The legislation is paid for, at least in part, by increasing the amount of ineligible premium sharing tax-credit money that can be recoped by the IRS under the ACA, and by cutting the Public Health and Prevention trust fund by $8 billion.
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CMS announces new deadlines for Advance Payment Model
Posted on November 30, 2011
The Advance Payment Accountable Care Organization (ACO) Model is an initiative developed by the Centers for Medicare and Medicaid (CMS) Innovation Center designed for organizations participating as ACOs in the Medicare Shared Savings Program (Shared Savings Program). Through the Advance Payment Model, selected participants in the Shared Savings Program will receive advance payments that will be recouped from the shared savings they earn. CMS released a notice today announcing the new application deadline for participation in the Advance Payment Model for certain ACOs. Applications for the performance period beginning on April 1, 2012 will be accepted from January 3, 2012 through February 1, 2012. The period during which applications will be accepted for the performance period beginning on July 1, 2012 will remain identical to the period for the Medicare Shared Savings Program.
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Update: Medicare Shared Savings Program for Accountable Care Organizations
Posted on November 8, 2011
While a primary aim of the Affordable Care Act (ACA) was to increase access to affordable health insurance coverage, a critical, although less publicized, component of the law is a series of provisions designed to improve health care quality and efficiency and to advance the concept of “value-based purchasing.” The Agency for Health Care Research and Quality (AHRQ) defines the concept of value-based purchasing as holding “providers of health care accountable for both the cost and quality of care.” AHRQ notes that “value-based purchasing brings together information on the quality of health care, including patient outcomes and health status, with data on the dollar outlays going towards health. It focuses on managing the use of the health care system to reduce inappropriate care and to identify and reward the best-performing providers. This strategy can be contrasted with more limited efforts to negotiate price discounts, which reduce costs but do little to ensure that quality of care is improved.”
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Hospital Readmissions Reduction Program
Posted on November 1, 2011
Hospitals in the United States readmit an average of 20% of Medicare patients within thirty days of their initial discharge. These readmissions cost the Medicare program an estimated 12 billion dollars each year and may be an indicator of poor quality of care where the readmission was potentially preventable. In its June 2007 Report to Congress, the Medicare Payment Advisory Commission (MedPAC) classified many hospital readmissions as potentially preventable. Based on these recommendations, Congress included the Hospital Readmissions Reduction Program (HRRP or Program) in the Affordable Care Act. CMS issued the final rule implementing the HRRP on August 18, 2011, although CMS will continue to clarify additional details of the program through future rulemaking.
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- Constitutional Challenges Update: Florida et al. v United States Department of Health and Human Services posted on January 4, 2012
- The Center for Medicare and Medicaid Innovation: A Year’s Progress posted on January 26, 2012
- Chronic Disease Management posted on February 23, 2011
- Hospital Readmissions Reduction Program posted on November 1, 2011
- Update to Consumer Operated and Oriented Plan (CO-OP) Program: Final Rule posted on January 18, 2012
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