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A Deep Dive on the MACRA NPRM

May 5, 2016• 16

By JOHN HALAMKA

Screen Shot 2016-05-05 at 4.20.36 PM As promised last week, I’ve read and taken detailed notes on the entire 962 page MACRA NPRM so that you will not have to.

Although this post is long, it is better than the 20 hours of reading I had to do!Here is everything you need to know from an IT perspective about the MACRA NPRM.

1. What is the MACRA NPRM trying to achieve with regard to healthcare IT?

The MACRA NPRM proposes to consolidate components of three existing programs, the Physician Quality Reporting System (PQRS), the Physician Value-based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program for eligible professionals (EPs), creating a single set of reporting requirements. The rule would sunset payment adjustments under the current PQRS, VM, and the Medicare EHR Incentive Program for eligible professionals.

Blog Notes

May 5, 2016

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Protecting the Health of Americans by Improving the Use of Antibiotics

May 4, 2016• 6

By TOM FRIEDEN, MD

Tom Frieden optimized Few appreciate the threat of antibiotic resistance to human medicine more than readers of this blog. You know antibiotics as lifesaving “miracle” drugs that treat sepsis, save victims of burns and trauma, and are crucial to survival of patients receiving transplants and cancer treatment. At the same time, you understand the devastating consequences when these drugs don’t work anymore—when infections become resistant.

The overuse of antibiotics breeds antibiotic-resistant infections that threaten patients, hospitals, and our entire health care system. Resistant infections mean more and longer hospitalizations, increased hospital costs, and higher mortality. As clinicians, it is our job to help our colleagues in the medical community and the American public better understand the risk posed by inappropriate use of antibiotics. Patients and the community benefit from more appropriate antibiotic use, which reduces risks for the individual patient as well as the entire community.

A new, first-of-its-kind analysis of antibiotic use in US doctor’s offices and emergency departments, published in the Journal of the American Medical Association (JAMA), highlights how common inappropriate antibiotic prescribing is. CDC, in collaboration with The PEW Charitable Trusts and other public health and medical experts, found at least a third of antibiotics are given when the patient does not need them. This overuse, largely due to overprescribing for relatively minor illnesses including common colds, sore throats, and ear infections – for which antibiotics are not effective – amounts to 47 million excess antibiotic prescriptions each year.

Fact Checking the Health Reform Debate

May 4, 2016• 1

By PAUL KECKLEY

Paul Keckley Opinions about the U.S. health system vary widely based largely on our individual experiences as users from time to time. And most Americans don’t think of it as a system at all. Rather, it’s a collection of doctors, hospitals, insurers, drug and device manufacturers and others that operate in a complicated, disconnected, expensive industry that’s increasingly difficult to navigate and afford.

Little wonder that opinions about health reform and the Affordable Care Act divide our nation: half see it as over-reach by the federal government that threatens a system best left alone, and half see it as a remedy for systemic flaws. Both argue their positions fervently, and neither is inclined to consider the view of the other. And in both camps, there are widely held misconceptions that run counter to what’s actually known.

For those who oppose health reform and the ACA and are predisposed toward its undoing, the biggest misconceptions are…Continue reading…

ACO 552: The Advanced Class

May 4, 2016• 28

By ANISH KOKA, MD

flying cadeucii Lisa Bari, a Master of Public Health candidate at Harvard, attempts to take me to ACO school in her response to a piece I wrote. I welcome the discussion. Game on!

Lisa’s initial point, and the one she ends on, seems to say my argument falls apart because I somehow don’t understand the difference between a commercial ACO and a Medicare ACO. I beg to differ. She states that CMS cannot be held responsible for a commercial non-governmental agreement between a private insurer and a group of health care providers.

I guess you do need to go to Harvard to decipher this stuff. Is the implication that the only ACO model the architect of the ACOs are responsible for is the initial Pioneer model? It makes no sense. To recap: CMS was instructed to create ACO’s. There are 2 programs to do this. The Pioneer model, and Medicare shared savings program (MSSP). As I understand it, the large regional ACO next to me is set up as part of the MSSP. Someone makes a payment to these ACOs when there are cost savings, right? By the end of her first paragraph, one almost has the impression that ACO’s are a renegade program that emerged from thin air between insurers and health care providers. Yes, a commercial insurer decides to make an agreement with an ACO and they set a $4 rate. I guess I am to assume if the govt/CMS did it directly it would be much more. And I do realize that ACO’s are for PCPs, and not designed for specialists. The only reason I think I have any ‘contract’ at all is because I have a PCP I work with. My point with regards to the ACO payment was that I have no clue where that $4 is going – but that compensation for care coordination at that level is inadequate, and would require quite the mix of healthy:sick to make that work. Is there another number you can give me so I can take an opinion on the matter – or should I just continue to trust our fearless leaders?

ACO 101: Koka Completely Misses The Mark on Medicare ACOs

May 3, 2016• 9

By LISA BARI

flying cadeucii Recently, Anish Koka, MD, a Cardiologist from Pennsylvania, posted his anti-Accountable Care Organization (ACO) manifesto here on The Health Care Blog. [1] Koka argues that ACOs don’t work and are doomed to fail because they were designed by non-practicing physician policymakers and academics in ivory towers. He appears to be basing his judgment on a commercial ACO contract that only pays him $4 per month extra for care coordination and requires that he meet specific quality measures. He is also conflating his experience in a commercial ACO with Medicare ACOs, and interprets the initial results of one Medicare ACO program to mean that all ACOs are a failure. Finally, he relays an anecdote of caring for one of his patients, Mrs. K, a patient with chronic illness who doesn’t want to take her medication.

In his post, Dr. Koka calls out “well-meaning, hard-working folks that own a Harvard Crimson sweater…[whose] intent is to fundamentally change how health care is provided.” As luck would have it, I do own a Harvard Crimson sweater, and I’d like to respond.

Measuring Hillary

May 2, 2016• 10

By STEVEN FINDLAY

Screen Shot 2016-05-02 at 8.18.04 AM Hillary Clinton is now the presumptive Democratic nominee and the odds-on favorite to be our next president.

For healthcare, that could be a very good thing, not just compared to a Trump (or Cruz) presidency but for the following reasons:

(1) Hillary knows and cares deeply about healthcare.

Even if you don’t support or like her, she’s been a tireless advocate for reform and coverage expansion for decades. She worked, for example, in the 1980s with the Children’s Defense Fund and other groups to enhance coverage for children.

As first lady, of course, Bill put her in charge, in 1991, of developing a health reform plan. Though the process had its flaws, she was steeped in the subject for over a year and learned it inside and out.

Famously, the legislation failed in 1993-94 due to staunch Republican opposition (and, yes, a bungled legislative strategy by the White House). A widespread impression still exists that Hillary slunk back from the issue after the Clinton reform failed. Not true. Continue reading…

The Angry Physician

May 1, 2016• 34

By ANISH KOKA, MD

Screen Shot 2016-05-01 at 8.34.08 AM

I think I speak for most physicians when I say that we did not choose to go into medicine to shape health care policy. Medicine is a calling, and I treated it as such. I immersed myself with taking care of patients, and keeping up with the ever changing knowledge landscape that is medicine. I left the policy making to the folks I voted for the last 8 years. These were the adults, the intellectuals – they would take care of the task of taking out the bad elements of our healthcare system and leaving the good. I truly believed. I eagerly began the ehr/meaningful use saga believing this would result in better care for patients.

It took me two years to realize the meaninglessness of meaningful use. I still can’t believe how long it took me to realize that creating a workflow in my office to print out and deliver clinical summaries to patients didn’t do anything other than fill the trashbin. I still held out hope. I thought – this was a first draft, improvements would come. What came instead were positively giddy announcements of the success of the meaningful use roll out. The administration was actually doubling down. There was no acknowledgment for the mess that had been created – onward and forward on the same road we must continue to march. Except the road would no longer be paved and we would be walking uphill.

You Won’t Believe What Medicare Just Did on Patient Engagement!

May 1, 2016• 8

By MICHAEL MILLENSON

Screen Shot 2016-05-01 at 11.01.48 AM

Sure, I’ve always wanted to write a clickbait headline that sounds like a promo for the bastard child of Buzzfeed and the Federal Register. But, seriously: you will not believe what Medicare just did about patient engagement in a draft new rule dramatically changing how doctors are paid.

And, depending upon the reaction of the patient community, you definitely won’t believe what happens next.

Engaging Responsibly In the Health Care Debate

Apr 30, 2016• 18

By JIM PURCELL

flying cadeucii With no apology offered, I will be venturing into a very subjective realm, namely, a characterization of today’s healthcare dialogue and what, in my opinion, might be an improvement.

I would suggest we have fallen into the trap that was partly enhanced by email and blogs, namely, that we can say outrageous things impolitely and without consequence. With email we tend to be much blunter and impolite than we would be face to face. On blogs, we can be positively toxic. It’s like driving in a car with a tinted windshield that no one can see through. You are anonymous and therefore can act less responsibly.

Another vignette. I grew up in a very small upstate New York town where everyone knew everyone else. You used your car horn to beep “hi” or to warn, and not in anger, ever. When you waved at someone, it was with all five fingers. And so on. I think you get my point.

The healthcare debate always has stoked emotions like almost no other. It is intensely personal, and the stakes are high. We’re all involved and engaged.

As I’ve written in the past, I first earned my stripes as a lawyer representing my local Blue Cross plan in rate hearings. These rate hearings always started with “public comment.” The comment ranged from pure outrage to controlled anger to discontent coupled with suggestions. What did we pay the most attention to? Of course, the latter.