HHS releases new data and tools to increase transparency on hospital utilization and other trends

Data can help improve care coordination and health outcomes for Medicare beneficiaries

With more than 2,000 entrepreneurs, investors, data scientists, researchers, policy experts, government employees and more in attendance, the Department of Health and Human Services (HHS) is releasing new data and launching new initiatives at the annual Health Datapalooza conference in Washington, D.C.

Today, the Centers for Medicare Medicaid Services (CMS) is releasing its first annual update to the Medicare hospital charge data, or information comparing the average amount a hospital bills for services that may be provided in connection with a similar inpatient stay or outpatient visit. CMS is also releasing a suite of other data products and tools aimed to increase transparency about Medicare payments. The data trove on CMS’s website now includes inpatient and outpatient hospital charge data for 2012, and new interactive dashboards for the CMS Chronic Conditions Data Warehouse and geographic variation data. Also today, the Food and Drug Administration (FDA) will launch a new open data initiative. And before the end of the conference, the Office of the National Coordinator for Health Information Technology (ONC) will announce the winners of two data challenges.

“The release of these data sets furthers the administration’s efforts to increase transparency and support data-driven decision making which is essential for health care transformation,” said HHS Secretary Kathleen Sebelius.

“These public data resources provide a better understanding of Medicare utilization, the burden of chronic conditions among beneficiaries and the implications for our health care system and how this varies by where beneficiaries are located,” said Bryan Sivak, HHS chief technology officer. “This information can be used to improve care coordination and health outcomes for Medicare beneficiaries nationwide, and we are looking forward to seeing what the community will do with these releases. Additionally, the openFDA initiative being launched today will for the first time enable a new generation of consumer facing and research applications to embed relevant and timely data in machine-readable, API-based formats."

2012 Inpatient and Outpatient Hospital Charge Data

The data posted today on the CMS website provide the first annual update of the hospital inpatient and outpatient data released by the agency last spring. The data include information comparing the average charges for services that may be provided in connection with the 100 most common Medicare inpatient stays at over 3,000 hospitals in all 50 states and Washington, D.C. Hospitals determine what they will charge for items and services provided to patients and these “charges” are the amount the hospital generally bills for those items or services.

With two years of data now available, researchers can begin to look at trends in hospital charges. For example, average charges for medical back problems increased nine percent from $23,000 to $25,000, but the total number of discharges decreased by nearly 7,000 from 2011 to 2012.

In April, ONC launched a challenge – the Code-a-Palooza challenge – calling on developers to create tools that will help patients use the Medicare data to make health care choices. Fifty-six innovators submitted proposals and 10 finalists are presenting their applications during Datapalooza. The winning products will be announced before the end of the conference.

Chronic Conditions Warehouse and Dashboard

CMS recently released new and updated information on chronic conditions among Medicare fee-for-service beneficiaries, including:

• Geographic data summarized to national, state, county, and hospital referral regions levels for the years 2008-2012;
• Data for examining disparities among specific Medicare populations, such as beneficiaries with disabilities, dual-eligible beneficiaries, and race/ethnic groups;
• Data on prevalence, utilization of select Medicare services, and Medicare spending;
• Interactive dashboards that provide customizable information about Medicare beneficiaries with chronic conditions at state, county, and hospital referral regions levels for 2012; and
• Chartbooks and maps.

These public data resources support the HHS Initiative on Multiple Chronic Conditions by providing researchers and policymakers a better understanding of the burden of chronic conditions among beneficiaries and the implications for our health care system.

Geographic Variation Dashboard

The Geographic Variation Dashboards present Medicare fee-for-service per-capita spending at the state and county levels in interactive formats. CMS calculated the spending figures in these dashboards using standardized dollars that remove the effects of the geographic adjustments that Medicare makes for many of its payment rates. The dashboards include total standardized per capita spending, as well as standardized per capita spending by type of service. Users can select the indicator and year they want to display. Users can also compare data for a given state or county to the national average. All of the information presented in the dashboards is also available for download from the Geographic Variation Public Use File.

Research Cohort Estimate Tool

CMS also released a new tool that will help researchers and other stakeholders estimate the number of Medicare beneficiaries with certain demographic profiles or health conditions. This tool can assist a variety of stakeholders interested in specific figures on Medicare enrollment. Researchers can also use this tool to estimate the size of their proposed research cohort and the cost of requesting CMS data to support their study.

Digital Privacy Notice Challenge

ONC, with the HHS Office of Civil Rights, will be awarding the winner of the Digital Privacy Notice Challenge during the conference. The winning products will help consumers get notices of privacy practices from their health care providers or health plans directly in their personal health records or from their providers’ patient portals.

OpenFDA

The FDA’s new initiative, openFDA, is designed to facilitate easier access to large, important public health datasets collected by the agency. OpenFDA will make FDA’s publicly available data accessible in a structured, computer readable format that will make it possible for technology specialists, such as mobile application creators, web developers, data visualization artists and researchers to quickly search, query, or pull massive amounts of information on an as needed basis. The initiative is the result of extensive research to identify FDA’s publicly available datasets that are often in demand, but traditionally difficult to use. Based on this research, openFDA is beginning with a pilot program involving millions of reports of drug adverse events and medication errors submitted to the FDA from 2004 to 2013. The pilot will later be expanded to include the FDA’s databases on product recalls and product labeling.

For more information about CMS data products, please visit http://www.cms.gov/Research-Statistics-Data-and-Systems/Research-Statistics-Data-and-Systems.html.

For more information about today’s FDA announcement visit:

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/UCM399335 or http://open.fda.gov/

CMS Advises Delay in ICD-10 Front-End Testing Until October

Providers, suppliers, billing companies and clearinghouses can submit ICD-10 acknowledgement test claims anytime up to the new planned October 1, 2015 ICD-10 implementation date. However, the Centers for Medicare and Medicaid Services is advising stakeholders to delay this front-end testing until after October 6, 2014, when Medicare is scheduled to update its systems.

A May 30 announcement from Niall Brennan, acting director of the CMS Offices of Enterprise Management, recommended that submitters contact their local Medicare Administrative Contractor for additional information about ICD-10 acknowledgment testing, which will allow providers, suppliers, billing companies and clearinghouses the opportunity to determine whether CMS will be able to accept their claims with ICD-10 codes.

In March, Brennan said that CMS successfully conducted a week of ICD-10 testing for more than 127,000 claims that were submitted with ICD-10 codes to the Medicare Fee-for-service claims systems and which received electronic acknowledgements confirming that their claims were accepted. He reported that about 2,600 participating providers, suppliers, billing companies and clearinghouses participated in the test week--representing about five percent of all submitters--and that this testing did not identify any issues with the Medicare FFS claims systems. 

Brennan also informed stakeholders that CMS will be conducting end-to-end ICD-10 testing in 2015. "Details about this testing will be released soon," he said. In May, CMS canceled limited end-to-end testing that had been scheduled for late July, when CMS planned to give a small sample group of providers the opportunity to participate in end-to-end testing with Medicare Administrative Contractors and the Common Electronic Data Interchange contractor.

The Department of Health and Human Services expects to release an interim final rule in the near future that will include a new compliance date requiring the use of ICD-10 beginning October 1, 2015. The rule will require HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015. Last week, CMS announced that the partial code freeze for ICD-9-CM and ICD-10 will continue through October 1, 2015.

http://www.healthdatamanagement.com/news/CMS-Advises-Delay-in-ICD-10-Front-End-Testing-Until-October-48169-1.html

(CMS–10340) Collection of Encounter Data From Medicare Advantage Organizations, Section 1876 Cost HMOS/CMPS, Section 1833 Health Care Prepayment Plans (HCPPS), and Pace Organizations

SUPPLEMENTARY INFORMATION:

Contents:

This notice sets out a summary of the use and burden associated with the following information collections. More detailed information can be found in each collection’s supporting statement and associated materials (see ADDRESSES).

CMS–10340 Collection of Encounter Data From Medicare Advantage Organizations, Section 1876 Cost HMOS/CMPS, Section 1833 Health Care Prepayment Plans (HCPPS), and Pace Organizations

CMS–10380 Reporting Requirements for Grants to States for Rate Review Cycle I, Cycle II, Cycle III, and Cycle IV and Effective Rate Review Program Under the Paperwork Reduction Act (PRA) (44 U.S.C. 3501–3520), federal agencies must obtain approval from the Office of Management and Budget (OMB) for each collection of information they conduct or sponsor.

The term ‘‘collection of information’’ is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and includes agency requests or requirements that members of the public submit reports, keep records, or provide information to a third party.

Section 3506(c)(2)(A) of the PRA requires federal agencies to publish a 60-day notice in the Federal Register concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of information, before submitting the collection to OMB for approval. To comply with this requirement, CMS is publishing this notice.

Information Collection

1. Type of Information Collection

Request:

Extension of a currently approved collection; Title of Information Collection: Collection of Encounter Data from Medicare Advantage Organizations, Section 1876 Cost HMOS/CMPS, Section 1833 Health Care Prepayment Plans (HCPPS), and Pace Organizations;

Use:

CMS collects encounter data or data on each item or service delivered to enrollees of Medicare Advantage (MA) plans offered by MA organizations. MA organizations currently obtain this data from providers. CMS collects this information using standard transaction forms and code sets.

CMS will use the data for determining risk adjustment factors for payment, updating the risk adjustment model, calculating Medicare DSH percentages, Medicare coverage purposes, and quality review and improvement activities.

The data is also used to verify the accuracy and validity of the costs claimed on cost reports.

For PACE organizations, encounter data would serve the same purpose it does related to the MA program and would be submitted in a similar manner.

Form Number: CMS–10340 (OCN: 0938– 1152); Frequency: Weekly; Affected Public: Private sector (business or other for-profits); Number of Respondents: 683; Total Annual Responses: 516,493,635; Total Annual Hours: 34,433 (For policy questions regarding this collection contact Michael Massimini at 410–786–1566).

2. Type of Information Collection

Request: Revision of a currently approved collection; Title of Information Collection: Reporting Requirements for Grants to States for Rate Review Cycle I, Cycle II, Cycle III, and Cycle IV and Effective Rate Review Program; Use: Under the section 1003 of the Affordable Care Act (ACA) (section 2794 of the Public Health Service Act), the Secretary, in conjunction with the states and territories, is required to establish a process for the annual review, beginning with the 2010 plan year, of unreasonable increases in premiums for health insurance coverage.

Section 2794(c) requires the Secretary to establish the Rate Review Grant Program to assist states to implement this provision. In addition, section 2794(c) requires the Rate Review Grant Program to assist states in the establishment and enhancement of ‘‘Data Centers’’ that collect, analyze, and disseminate health care pricing data to the public.

Concurrent with this information collection request, HHS released Cycle IV of the Rate Review Grants, ‘‘Grants to States to Support Health Insurance Rate Review and Increase Transparency in the Pricing of Medical Services.’’ 

The purpose of Cycle IV of the Rate Review Grant Program is to continue the rate review successes of Cycles I, II, and III, as well as to provide greater support to Data Centers, thereby enhancing medical pricing transparency. States and territories that apply for funds are required to complete the grant application. 

States and territories that are awarded funds under this funding opportunity are required to provide the Secretary with rate review data, four quarterly reports, and one annual report per year until the end of the grant period detailing the state’s progression towards a more comprehensive and effective rate review process. A final report is due at the end of the grant period.

This information collection is required for effective monitoring of grantees and to fulfill statutory requirements under section 2794(b)(1)(A) of the ACA that requires grantees, as a condition of receiving a grant authorized under section 2794(c), to report to the Secretary information about premium increases.

On May 23, 2011, CMS published a final rule with comment period (76 FR 29964) to implement the annual review of unreasonable increases in premiums for health insurance coverage called for by section 2794. Under the regulation, if CMS determines that a state has an Effective Rate Review Program in a given market, using the criteria set forth in the rule, CMS will adopt that state’s determinations regarding whether rate increases in that market are unreasonable, provided that the state reports its final determinations to CMS and explains the bases of its determinations.

 The final rule titled ‘‘Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review’’ (78 FR 13406, February 27, 2013) amends the standards under the Effective Rate Review Program. Currently, CMS relies on publicly available information and annual calls with individual states to obtain the information needed to evaluate whether a state has begun to or continues to satisfy the Effective Rate Review Program criteria. CMS is proposing to instead collect the information in writing from all states that would like to request effective status.

Form Number: CMS–10380 (OCN: 0938–1121); Frequency: Annually and On occasion; Affected Public: Public Sector and State and Territory Governments; Number of Respondents: 50; Total Annual Responses: 553; Total Annual Hours: 20,951. (For policy questions regarding this collection contact Susie Lorden at 301–492–4162.)

Dated: May 28, 2014. Martique  Jones, Deputy Director, Regulations Development Group, Office of Strategic Operations and Regulatory Affairs.

http://www.regulations.gov/#!documentDetail;D=CMS-2014-0073-0001

NHS staff working together to improve care

Staff are working together to improve care

MORE than 7,650 NHS Wales staff have completed the first level of the national learning programme Improving Quality Together, according to new figures.

The scheme, which provides staff, contractors, managers and board members with skills that will help them improve the care delivered to patients, has been completed at the first level by 7,654 people in the past 15 months.

There are three levels to the programme, launched in March 2013, and it is led by 1,000 Lives Improvement, which is part of Public Health Wales.

Staff complete the bronze level through a series of online modules, with the silver level providing an opportunity to develop and implement improvement projects. The gold level is establishing a network of improvement coaches and there is additional training for board members.

Dr Alan Willson, director of 1,000 Lives Improvement, said: "Improving Quality Together is providing staff with the knowledge and expertise to continue improving our services, so that they are the safest and most efficient they can be.

"We are already seeing the benefits of staff speaking a common language of improvement as they work towards the same goals - improved patient experience and outcomes."

"We are delighted that so many NHS Wales staff have completed at least the bronze level of Improving Quality Together and are looking forward to even more colleagues signing up to the learning programme."

In Aneurin Bevan University Health Board, cleaner operating theatres have lead to safer care under the scheme.

Nurse Helen Dinham used the skills she learnt to reduce surgical site infections, by improving the standard practice of cleaning in orthopaedic theatres in the health board.

Improving Quality Together helped her team address the obstacles that were preventing the correct level of cleaning taking place, such as standardising equipment and amended policies.

The outcome of the project was 100% compliance with the cleaning requirements, meaning infection risks were reduced and patients would recover more quickly.

She said: "Reaching our target was very good for staff morale and has reassured patients that the quality of care and the standard of cleanliness in orthopaedic theatres is excellent."

In ABMU Health Board, they looked at improving patient flow and communication on hospital wards.

Reducing delays in a patient's journey and improving communication on hospital wards are just two of the key benefits gained from Jo Rowland's silver project in the Princess of Wales Hospital, Bridgend.

The assistant head of physiotherapy used her Improving Quality Together training to implement daily ward rounds to discuss each patient and find out the next step needed.

Reporting back findings on a daily basis has increased efficiency and resulted in reduced lengths of stay in hospital and improved patient flow through the wards.

It has also provided a consistent approach, which has improved communication between staff, patients and their families.

Meanwhile, Cardiff and Vale University Health Board has improved access to dental services for patients in prison Head of primary care service delivery Rhian Blake used her silver training to improve access to dental services for patients at Her Majesty's Prison in Cardiff. In the past 18 months the profile of the prison population had changed significantly, with more individuals on remand and shorter sentences.

As a result, many patients had incomplete dental treatment, or didn't receive the required treatment in a timely fashion.

Rhian used the programme's methodology to analyse the problem and find solutions, which included the immediate allocation of appointments when needed, and a quicker triage process. The changes led to a reduction in complaints and fewer missed appointments.

http://www.walesonline.co.uk/news/health/nhs-staff-working-together-improve-7203178

5 Strategies to Up Your Game During the ICD-10 Delay

Is your organization struggling to adapt to the new ICD-10 deadline?

Have you already exceeded your training budget? 

Do you have a plan that will protect your revenue and mitigate risk during the next 16 months?

If not, click the image below to find out what you need to do to ensure a successful transition!

ICD-10 and How the Delay Will Affect Your Practice

What can you do to take advantage of the ICD-10 delay? Learn 5 strategies to up your game!

Visit mHealthGames for additional free resources!

Dying with a team of support

Palliative care teams help help terminally ill patients live as good a life as possible until the end.

Rebecca Roberts had never heard of palliative care two years ago when her boyfriend, "Papa" Joe Funes, begain suffering multiple organ failure. But by the end of Papa Joe's life, she was devoted to the medical process.

Dr. Matthew Katics, director of palliative medicine services at Salinas Valley Memorial Hospital, defines palliative care as a specialty that provides patients total care while they are enduring an often fatal illness. By definition, palliative care can treat non-terminal patients, but the lion's share of care is done during the patients final weeks or months of life.

"Total care cuts to the heart of palliative care," Katics said. "We move away from treating a disease and toward treating a person. Palliative care is not synonymous with hospice."

Palliative care is often confused with hospice, but they are not the same. Hospice allows terminally ill patients to return home to spend their final days in familiar surroundings and made comfortable. The goal of palliative medicine is to improve the quality of life for the patient, terminal or not. Palliative care is a multi-pronged approach, using physicians, psychosocial workers to treat mood, nurses skilled in this type of care, and members of the clergy and other spiritual leaders.

"Palliative care is a medical specialty directed at those with life-limiting chronic disease," said Dr. John Hausdorff, medical director of the palliative care team at the Community Hospital of the Monterey Peninsula. "It focuses on providing relief from the symptoms, pain, and distress of illness, whatever the diagnosis."

Katics used an example of a patient entering the hospital for a hip replacement. The patient has suffered excruciating pain for many years and is now addicted to opiates. After the surgery, a palliative care team – the doctor, nurses and a psychosocial care worker – will help the patient explore alternative treatments for long-term pain management to get them to the point of functional recovery.

Or a patient could come into the hospital with difficulty breathing and suffering from chronic obstructive pulmonary diseases. The emergency room stabalized the patient's breathing, but what about when he goes home? Then what? The palliative care team will review his medicines, talk with him, and even evaluate him for any mood disorders. COPD is a fatal disease that can take years to kill.

Palliative care nurses at Salinas Valley Memorial Hospital ask questions of Dr. Matthew Katics, who heads up the SVMH palliative medicine team. (Photo: Dennis L. Taylor/The Salinas Californian )

"We want you living as good as you can, feeling as good as you can, for the time you have," Katics said.

Papa Joe begins a journey

It was the summer of 1994 when Roberts received a call informing her that her boyfriend was en route in an ambulance from King City to Salinas with a massive head injury. When she arrived at SVMH, she didn't recognize him, she said. His head was massively swollen and his skin was the color of slate.

Thursday afternoon Roberts and Katics sat under the shade in a patio at the hospital, catching each other up on their lives since Papa Joe died two years ago.

That 1994 summer, Papa Joe was found on the ground at the base of a grandstand in a park in King City. One side of his head was horribly malformed from an impact – from what, exactly, was never established. It could have been the result of an altercation with what Roberts calls "Joe's acquaintances." But a neurosurgeon told Roberts that the pattern and severity of the injury was not consistent with a blow from a club or cane. The damage was far greater.

Nearly 20 years later, a good many in King City harbor far more nefarious believes – that Papa Joe might have been beaten, then climbed to the top of the stands to lick his wounds. It was there that Joe, who had minor run-ins with King City Police before, was tossed off the grandstand where he sustained the violent injuries to his head. Other, less dramatic, scenarios feed the rumor mill in the farming and ranching community in the deep southern part of Monterey County.

Initially no police report was written up, but when SVMH required one to proceed with treatment, Roberts said the response was, "You mean that son of a bitch is still alive?" A broadly worded report was written, where it remains an open case because it is now a homicide.

Meanwhile Joe remained in a coma, and doctors were telling Roberts he didn't have a chance of survival. But with Roberts fighting every effort to disconnect him from life support, Papa Joe continued to live. First minor moves, a hand squeeze, then one day he opened his eyes and tried to talk. A doctor came in removed the breathing tube and Joe talked with a raspy, tired voice. He also answered all the doctor's questions, who then determined he was alert and oriented. He went home, extremely disabled.

A fall re-injured the original head trauma, and the result was stroke-like symptoms. Back in the hospital he began to retain water and his kidneys began to fail. Joe was now being treated by the palliative care team and they stabilized him. That was when Roberts met Katics for the first time. Her experience with doctors was not good. In the early days she had face-to-face confrontations with a doctor who was determined to unplug his live support. Katics and his team were different.

"He's one of a kind," Roberts said. "After all those years of posturing and the sighs aimed at me, all my distrust melted away."

Katics' approach to Papa Joe

Often the gravely ill patient is the only one doctors must contend with. When families are in the mix, each member sometimes has wildly different views of the best care for their sick loved one. The facts that all must keep in mind as they approach their last days is that medical science is allowing people to live longer, but not better. Diseases that would have killed a generation ago can be contained for years. But what does the patient want?

"Is giving them more days better or just prolonging the suffering?" Katics asked. "People are complex and they have a desire to know."

Dr. Matthew Katics explains directions to palliative care nurses Thursday at Salinas Valley Memorial Hospital. (Photo: Dennis L. Taylor/The Salinas Californian )

When there is family involved, there are emotions and confusion. There are many paths a patient can elect to follow, but Katics and his team ensure none of the decisions are made in ignorance.

"Each path is OK as long as you are doing it with your eyes open," he said. "Part of my job is to get to clarity for the patient and family."

The sooner a patient teams with a palliative care unit the better the outcome, whatever that may be. The ideal time would be at the point of diagnosis of a serious disease, said Christine Short, director of Nursing Support Services and coordinator of the palliative medicine service at CHOMP.

"If palliative care starts at an early stage, such as upon a serious diagnosis, a thoughtful conversation can occur with the patient about what matters most and is most important to them," she said. "Our priority is to respect patients' wishes and interests, and to make sure they understand their situation well enough to make informed decisions."

In one case at CHOMP, a woman with long-term gastrointestinal issues had several surgeries and had difficulty managing ongoing pain and nausea. After dealing with the immediate medical issues, the palliative care team met with her and her husband.

The team asked her to think about the future – what interventions she wanted and who would speak for her if she couldn't. A social worker – part of any palliative care team – stepped in and helped the couple with an advanced healthcare directive, which provides instructions to medical teams for future care. Both SVMH and CHOMP palliative care teams strongly advise everyone to pick up an advanced directive from their primary physician, fill it out, have their doctor keep a copy, have the hospital file another copy, and keep a copy for you.

"Giving the couple the advanced directive prompted them to talk with their friends to arrive at clear directions to any future physician caring for them," CHOMP's Hausdorff said.

Papa Joe's goodbye

When Roberts decided there was nothing more doctors could do for her love, she made the decision to take him home. But she was surprised that there was one more thing Katics could do for them. Joe's breathing was distressed and he needed a breathing bag in the ambulance on the way home. But paramedics weren't allowed to use an ambu bag, as they are called, per ambulance company policy.

"So Dr. Katics jumped in the back of the ambulance and bagged Joe all the way home," Roberts said. "And then at home, he helped me set up all the supplies I would need to care for Joe."

His two daughters, his mother, and his grand-kids sat around his bed. He looked at Roberts with raised eyebrows in that "I'm sorry" expression, closed his eyes and died.

On Thursday, Roberts and Katics sat on the patio, at times holding hands as they talked about Joe.

Dr. Matthew Katics soothes Rebecca Roberts as they talk about “Papa” Joe’s ordeal before he died. (Photo: Dennis L. Taylor/The Salinas Californian )

Fighting back tears, Roberts told Katics that she loved Papa Joe. "We were talking and had a whole plan to move away, start a new life, and then two days later, boom, that happened."

Katics took that in for a moment, squeezed her hand and softly told her: You advocated for him, and you fought the fight that was right for him."

http://www.thecalifornian.com/story/news/local/2014/05/31/dying-team-support/9793265/

NPAF Issues Call to Action for Cancer Research

With mounting evidence that cancer research and biomedical discovery are slowing even as a 45% increase in cancer cases is projected by 2030, the National Patient Advocate Foundation (NPAF) – a national non-profit organization providing the patient’s voice in improving access to quality cancer care – just released a blueprint to accelerate the delivery of promising new treatments to patients and launched a new grassroots movement called Project Innovation to drive action. 

 

Issued as a call to action, the new white paper – Securing the Future of Innovation in Cancer Treatment – is the result of consultation with biomedical researchers, medical innovators, patient advocates, clinicians and policymakers and offers a roadmap for addressing the pervasive obstacles slowing the pace of cancer discovery. Among the barriers cited are a nearly 20% drop in government-funded basic research since 2010 and a steady decline in venture capital investment in biotechnology since 2007. 

 

Also impeding progress are logistical, bureaucratic, institutional and regulatory obstacles that add years to scientific discovery and drug development, such as added steps and inefficiencies in the clinical trials process, duplicative and conflicting standards, auditing mandates, increasing regulatory requirements and delays in review decisions. As a result, it takes nine or more years from discovery to approval for a new cancer therapy compared to an average time of two years for HIV drugs. Further, because drug development is an uncertain process, a 2010 Tufts University study puts the cost of developing one innovative cancer drug at upwards of $1 billion. 

 

“This report represents a wakeup call for all Americans and is intended to spark a national movement to make cancer innovation a national priority,” said Nancy Davenport-Ennis, NPAF’s founder and chairman. “Cancer kills 1,600 Americans every day and this number will only increase in the years ahead unless we commit as a nation to hasten the pace of medical discovery. It is time to put cancer innovation on the national agenda and press for solutions that will save lives instead of continuing a one-sided conversation on the cost of treatment.”

 

Project Innovation to spearhead a national dialogue on cancer innovation

 

To turn these findings into practice, NPAF will spearhead Project Innovation, a social activation effort to involve patients, their family members and local citizens in speaking out about the importance of accelerating cancer innovation. Utilizing the online hub – www.projectinnovation.org – digital advertising and multiple information channels, Project Innovation will tap the energy and ideas of cancer patients, advocates, healthcare professionals, biomedical researchers, medical innovators, payers, policymakers and 21st century thinkers on ways to move cancer discovery forward. Plans call for hosting regional town halls, workshops and advocacy forums across the country; scheduling meetings with federal and state legislators and regulators; and arming interested citizens and patient advocate volunteers nationwide to advocate for cancer innovation in their communities. 

 

Project Innovation is a collaboration of leaders from national cancer advocacy organizations, providers, biomedical research institutions, the business community and industry to put cancer innovation on the policy agenda. 

 

Three pillars of innovation

 

Through Project Innovation, NPAF’s agenda-setting report will be distributed widely to patient advocates, healthcare professionals, biomedical researchers, medical innovators, payers, and policymakers with the goal of elevating cancer innovation as a national priority and advancing policy solutions addressing three pillars of innovation. Specifically, NPAF’s action agenda calls for action in the following areas: 

 

1. Expand the science of innovation by reducing logistical obstacles
2. Improve the value of innovation by bolstering funding opportunities
3. Enhance the delivery of innovation through improved communication and coordination between providers and patients

http://www.dddmag.com/news/2014/05/npaf-issues-call-action-cancer-research

Chesterton Health and Emergency Center offers shorter wait times, high patient satisfaction

The Chesterton Health and Emergency Center offers average wait times of 15 minutes or less and has maintained a patient satisfaction rate in the 99 percentile since it opened in 2012, according to medical director, David Hunnius, DO.

The center, which is open 24/7 and is the area’s only freestanding emergency facility, also assures patients will receive primary care from board-certified emergency medicine physicians.

“There’s no type of emergency we can’t handle; this is a full-service department, staffed by experienced, board-certified physicians. We offer everything a hospital-based emergency department does,” said Hunnius, who, since 2009, also has been medical director of Franciscan St. Anthony Health – Michigan City, parent of the Chesterton center.

“We provide compassionate, highly skilled medical care, which results in very satisfied patients, as evidenced by our patient satisfaction scores,” Hunnius said. Travis Thatcher-Curtis, Franciscan St. Anthony Health Emergency Department manager, who also oversees the Chesterton center, said the 15-minute average figure is not a gimmick, but is based on 2013 tracking board data. Assessing patients sooner results in faster diagnoses, treatment and ultimately, satisfaction, he added.

“Besides the high patient satisfaction scores recorded since we opened, the Chesterton ED was also a 2013 Press Ganey Guardian of Excellence Award winner, which is presented to organizations that achieve satisfaction scores in the 95 percentile or greater over a designated period of time. Our patients are receiving the definitive level of care they need in a timely manner and are receiving it from a care team with a high level of competency with regards to emergency medicine.”

Thatcher-Curtis said being able to more quickly complete the treatment process “gives patients back time in their day because of the efficiency with which we can provide services.”

The center also includes an onsite laboratory, high-field open MRI, 64-slice CT, ultrasound, mammography and general x-ray services, along with primary care and specialty physician practices.

http://www.nwitimes.com/promo/health-guide/chesterton-health-and-emergency-center-offers-shorter-wait-times-high/article_f4ecf378-e852-11e3-8079-001a4bcf887a.html

HHS finalizes most proposed provision changes to ACA exchanges for 2015

HHS recently released the final Exchange and Insurance Market Standards for 2015 and Beyond rule, affecting several provisions within the Affordable Care Act.

The rule finalizes most provisions as proposed, including policies relating to health insurance discontinuation and renewal, quality reporting and enrollee satisfaction surveys, the Small Business Health Options Program (SHOP), and adjustments to risk corridors and the medical loss ratio (MLR) requirements in light of transitional policies and technical issues associated with 2014 open enrollment. The rule also finalizes stronger standards for Navigators and other consumer assistance entities.

Consistent with the proposed rule, issuers will see some benefit from the changes to the MLR provisions and premium stabilization programs to recognize the uncertainty created by the transitional policies and technical issues of 2014. In addition, state regulators were granted slightly more flexibility to request a delay in employee choice for 2015, which should help stabilize risk pools in the small group market and encourage more issuers to participate in the SHOP. However, issuers will face greater burden from the finalized requirement for plans to provide a 24-hour expedited exceptions process for coverage of non-formulary drugs under exigent circumstances.

The requirement for plans to expedite the process to cover a non-formulary drug under certain circumstances will help ensure that consumers have timely access to certain prescription drugs.

HHS intends to release technical guidance on some of these provisions, including the process by which it will make sequestered funds from the reinsurance and risk adjustment programs available to issuers in FY 2016. HHS has already released technical guidance on the proposed methodology for calculating quality ratings, which HHS intends to finalize shortly. Next year, HHS intends to release guidance on Enrollee Satisfaction Survey (ESS) vendors and details regarding the display of rating information and ESS results in marketing materials.

Read/download the final Exchange and Insurance Market Standards for 2015

http://ifawebnews.com/2014/05/30/hhs-finalizes-most-proposed-provision-changes-to-aca-exchanges-for-2015/

ACO Results: What We Know So Far

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May 30th, 2014 

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  by Matthew Petersen and 
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  David Muhlestein

Editor’s note: For more on this topic, stay tuned for the upcoming June issue of Health Affairs, which features a series of articles on accountable care organizations. 

Accountable care is a relatively recent addition to the health care vernacular, but its roots can be traced to the decades-long effort to coordinate medical care. In the United States, health care has evolved into a fragmented pay-for-volume system which has both driven up cost and decreased quality. Coordination of care is meant to reverse this trend.

Through such solutions as Health Management Organizations (HMOs), Integrated Delivery Networks (IDNs) and now Accountable Care Organizations (ACOs), policymakers, providers and payers have sought to consolidate and coordinate patient care. Contemporary care coordination efforts focus on accountable care which increases provider accountability for the cost and quality of care.

The driving principle behind the formation of ACOs is the Institute for Healthcare Improvement’s triple aim: improving the patient experience of care, improving the health of populations, and reducing the per capita cost of health care. One of the broadest applications of this concept is the creation of Medicare ACOs under the Patient Protection and Affordable Care Act. This includes the Pioneer ACO Program and the Medicare Shared Savings Program.

More recently, states have also pursued ACO contracts to cover Medicaid populations. In the private sector, providers have forged ACO contracts with commercial payers. At the close of 2010, only 41 preliminary Accountable Care Organizations existed. The number of ACOs more than tripled to 138 a year after the passage of the PPACA. By 2012 the number nearly tripled again, and by the end of 2013 more than 600 ACOs were operating across the U.S.

In the past year, CMS has begun releasing both financial and quality results from Pioneer and Medicare Shared Savings Program (MSSP) ACOs. Some commercial ACOs have released selected results as well. While results are preliminary and incomplete, both CMS and commercial ACO results warrant a cautious but optimistic outlook on ACOs and their ability to accomplish the triple aim.

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Sample Group

The Leavitt Partners Center for Accountable Care Intelligence conducted an analysis of ACO results to determine the cost and quality implications of the ACO model on the U.S. health care system. Information was gleaned from primary and secondary research, including the Leavitt Partners ACO Database of over 620 ACOs. Information about Pioneer and MSSP ACO results was gathered from CMS, and includes press releases, announcements, and data sets.

Data was supplemented with information gathered through interviews and surveys carried out with the leadership of more than a hundred ACOs nationwide. Commercial ACO results were gathered primarily through publically available data such as press releases by affiliated providers or payers and supplemented by interviews with ACO leadership. A breakdown of how many ACOs were represented in our study can be found in Table 1.

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Findings

Although ACOs share common goals, they vary widely in terms of organization and level of development. Results will be discussed separately for Pioneer, MSSP, Medicaid and Commercial ACOs. Where available, both financial and quality results will be discussed and analyzed.

Pioneer ACOs

Thirty-two organizations began the Pioneer ACO program in 2012. Of these organizations, 23 remain in the ACO Pioneer program. Nine ACOs left the pioneer program, with seven of those transitioning to the MSSP ACO program and two leaving completely.

“We really did learn a lot as a Pioneer ACO,” said the VP of one of the departing ACOs. “However, we’d be better off putting our energy into the health plan we already have… We didn’t have the confidence, based on historical trends, that we could beat the trend. We would have been in a loss position and writing a check to Medicare.”

The Pioneer program generated $147 million in total savings with approximately $76 million in savings returned to ACOs. Of the original 32 Pioneer ACOs, 12 shared in savings while 19 did not share in savings or losses. Only one ACO shared in losses. Addressing these mixed results, the CEO of one Pioneer ACO that neither shared savings nor losses stated, “Our objectives were not to do well in a particular financial cycle. We believe the payoff is going to be accumulated clinical transformation.”

Figure 1

Pioneer ACOs were held to a set of 33 ACO quality metrics, which are also common to the MSSP program. These metrics span four quality domains: patient experience, care coordination, patient safety, preventive health and at-risk populations. ACOs were held responsible only for the reporting of these metrics, not for any quality improvement.

All Pioneer ACOs successfully reported quality metrics to CMS and showed improvement where comparable data was available. In interviews with Leavitt Partners, Pioneer ACO leaders outlined a few tools they used to improve the quality of clinical care including best practices, evidence-based medicine, and electronic health records.

MSSP ACOs

The MSSP ACO program is broader than the Pioneer program with less stringent rules for participation. CMS has released preliminary results on the first two cohorts of MSSP ACOs, which include 114 ACOs that started in 2012. Of the 114 MSSP ACOs, 54 kept costs below budget benchmarks and 29 of those saved more than 2 percent, thus qualifying for shared savings (see figure 2). These 29 ACOs received $126 million in savings and generated $128 million in total CMS trust fund savings. The other 60 MSSP ACOs experienced spending above their set benchmark.

Figure 2

One of the principle differences in the MSSP program is the ability to choose between an upside-risk-only contract (sharing in savings; no risk for losses) or an upside/downside-risk contract (sharing in savings while being at risk for losses). ACOs accepting both upside and downside risk would receive a larger share of any shared savings due to their willingness to risk shared losses. Only four ACOs elected to take downside risk and two of those shared in losses.

The CEO of one ACO that incurred shared losses remained positive when reporting to MedPAC stating, “I’m actually quite optimistic about ACOs as a real catalyst to change the paradigm of care delivery… I’d like to wait and give these ACOs a chance to perform. You know, we haven’t gotten a lot of negative feedback from the marketplace or from our members.”

MSSP ACOs were held to the same aforementioned set of 33 ACO quality metrics. Again, MSSP ACOs were required only to report quality metrics. Failure to do so resulted in forfeiting a portion potential shared savings. All but five MSSP ACOs successfully reported their quality metrics.

Medicaid ACOs

Medicaid ACOs are still in their infancy and have only been adopted by a few states, including Oregon, Iowa, Vermont and Colorado. The maturity of these programs varies widely and little information is available in the way of results. Perhaps the best test case can be found in Oregon where Medicaid ACOs have been designed to cover the entire geography of the state. Detailed financial results released by the Oregon Health Authority (OHA) show that Medicaid ACOs were able to decrease cost of care for 19 out of the 21 financial measures tracked. Areas of cost increases were focused around outpatient primary care. While the overall savings were marginal, the OHA is, “encouraged by the first nine months of progress data.”

In their February 2014 report, OHA highlighted results of their 17 quality metrics. A focus on utilization resulted in a 13 percent decrease in emergency department visits and an 8 percent decrease in all-cause readmission while hospitalization for chronic conditions was cut by a third. Other areas of improvement include technology (EHR adoption has doubled in Oregon), primary care, and preventive care. Colorado’s Medicaid ACO program has also highlighted positive preliminary results including $44 million in gross savings in its second year. Few other state programs have publically released their quality or financial metrics. It remains to be seen if shared savings will offset investment costs.

Commercial ACOs

Perhaps the most diverse group of ACOs are those with commercial contracts. Like Medicare ACOs, commercial payers with ACO contracts strive for the “triple aim” goals of improved patient experience, improved quality of care, and decreased cost of care. However, they are not necessarily held to the same financial requirements, quality metrics, or reporting timeline used by the Center for Medicare and Medicaid Services (CMS). Publically available commercial results tend to highlight mostly positive aspects of a particular ACO.

Results are more difficult to compare than Medicaid ACOs due to their lack of uniformity in measurement and reporting. According to the Leavitt Partners ACO Database, there are 287 ACOs with commercial contracts, only 12 of which have reported financial results of some sort. Eleven of the 12 commercial ACOs report having saved money. Very few of these have reported a dollar figure for savings, but costs were reported to have decreased by between 2 and 12 percent.

Successes include one New England ACO that reported a medical cost trend 1.2 percentage points better than its market overall, as well as a large Northeast ACO which shared approximately $2 million in their contract with United Healthcare. Savings aside, the cost of ACO investment was made clear by one Northwestern ACO that reports spending about $1 million on infrastructure and only earning $125,000 in savings in the first year.

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In addition to negotiating their own financial arrangements with providers, commercial payers with ACO contracts also determine their own quality metrics. Some metrics are similar to those set by CMS while others are unique to a specific payer.

Table 2 provides insight into the quality metrics of some of the leading players in ACO commercial contracts. Commercial ACOs have been tight lipped about their quality metrics; quality metrics found in table 2 were garnered from publically available sources and are not a comprehensive list. Commercial contracts focus on preventive care management of chronic illnesses and access to care. Fifteen commercial ACOs reported quality results, although only about 50 percent of those provided quantifiable data.

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Winners and Losers

More important than providing a pulse on the ACO movement, the true value of these results lies in their ability to influence those organizations considering entering into the world of accountable care. These results represent a variety of sources including large health care systems, smaller physician groups, private payers, government contracts, etc. This makes them applicable to a wide variety of providers cautiously considering accountable care.

The results here go beyond answering the question “is it working?” They show winners and losers in the ACO game and highlight successful strategies as well as potential pitfalls.

http://healthaffairs.org/blog/2014/05/30/aco-results-what-we-know-so-far/