CMS Hospital Value-Based Purchasing Program Results for Fiscal Year 2019: In its shift to more value-based payments, CMS continues to reduce DRG payments and add potential bonuses by using measures from a Total Performance Scorecard. The metrics come equally from four areas: Clinical Care, Safety, Person and Community Engagement, and Efficiency and Cost Reduction. CMS estimates “that the total amount available for value-based incentive payments in FY 2019 will be approximately $1.9 billion.”
Read more from VMS about these payments
About public health:
Colorectal Cancer ControlWhere Have We Been and Where Should We Go Next?: Screening for colorectal cancer (CRC) has been proven to save lives. The problem is getting the tests to patients and having them use the tests. The most common screen measures fecal blood (FBT). A meta analysis published in JAMA Internal Medicine sheds light on what needs to be done to increase screening rates. In an accompanying editorial, the conclusion is:
”We can now safely say that, in general, no more studies are needed to demonstrate that outreach with FBT and patient navigation* increase CRC screening. Instead, we need research in other areas of the CRC control continuum, including how best to implement evidence-based strategies and adaptations needed for different settings and populations, how to ensure follow-up after a positive CRC test result, what interventions increase adherence to ongoing CRC screening, and ultimately, what association CRC control programs have with CRC incidence, mortality, and health equity.”
* “Patient navigation is a barriers-focused intervention whereby a trained individual guides a patient through a complex health care system, addressing sociocultural, educational, and logistical barriers with the main goal of minimizing loss to follow-up.”
Now that we have workable strategies, they ned to be implemented.
2018 Update on Medical Overuse: Many services are overused or inappropriately used- leading not only to increased costs but followup with potentialy harmful interventions. This fifth annual review of the topic of overuse should be studied by healthcare policy, insurance and health system professionals to make sure patients receive exactly the care they deserve.
Read the article
About clinical studies:
Evaluating Progression-Free Survival as a Surrogate Outcome for Health-Related Quality of Life in Oncology: When evaluating an out of intervention, what measures are appropriate to gauge success? Sometimes we use actual endpoints, such as death rates. At other times we use surrogate endpoints, such as reduction of blood pressure or cholesterol. But the effect on surrogate endpoints does to always translate to actual endpoint results. In this literature review, the authors found that the “progression-free interval” after cancer treatment does not correlate well with measures of health-related quality of life. They argue that the latter measure is important and needs to be incorporated in discussions of the effectiveness of cancer treatments.
Insurer-backed coalition forms to push efforts to stem 'surprise bills': If patients obtain care outside their insurance’s network of contracted providers, they can receive a bill that is multiples of what would have been paid. Since the care was not authorized, the patient often bears most of the cost. Nine major healthcare organizations have formed a coalition to combat such “surprise bills.” Their recommendations call on more federal intervention to implement protections. A few questions should be addressed first. What is the patient’s responsibility for knowing how their health plan works? What is the provider’s responsibility to know patient benefits? In cases of emergency care, providers cannot refuse care because of the patient’s insurance or lack of it (see EMTALA rules).
All would agree that the situation where patients absolutely need protection is during emergencies when they cannot reasonably ask all involved about their contracted status.
Precedent exists for this protection- from the start of Medicare risk plans (now called Medicare Advantage) health plans were able to pay hospitals using DRGs and physicians using the RBRVS (nationally determined fees modified for geography) if non contracted providers were involved in emergency care. While private insurance is regulated by states, perhaps the federal ACA can be amended to correct this deplorable practice.
Read more about this coalition
About healthcare trends:
Top health industry issues of 2019: PwC just issued its 13th annual report on projections in healthcare for the following year. Reappearing on this list is rising consumer demands for service quality like they expect in other sectors.
Read the report