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Volume, not quality, still determines most doctor pay
The vast majority of payments to U.S. physicians continues to be based only on the volume of services the doctors provide rather than the quality of those services, according to a nonprofit employer coalition that released its first annual national payment reform scorecard. The national scorecard by the Catalyst for Payment Reform, a coalition of large corporations and other health care purchasers, offers a preliminary snapshot of how the concept of value-oriented payments is progressing in the U.S. In conducting a voluntary survey of 57 health plans that represented about 67% of the commercial group market, or 104 million covered lives, the report found that only 6% of all outpatient primary care and specialist payments, and 11% of all inpatient hospital payments, were based on value. Most of the health care dollars paid to health care professionals “remain in traditional fee for service, paying providers for every test and procedure they perform regardless of necessity or out [Read more]
Quality effort yields big drop in death rate at hospitals
Working together to share best practices, analyze data and implement care improvements, 333 hospitals participating in a quality collaborative have cut their risk-adjusted mortality rate by 36% since 2007, said a report issued in March by the project's organizers. The Quality, Efficiency, Safety, Transparency initiative — dubbed QUEST for short — was launched in 2007 with 157 hospitals by Premier Inc., a Charlotte, N.C.-based purchasing and quality improvement alliance of more than 2,800 U.S. hospitals. Premier officials said the hospitals have averted nearly 92,000 deaths since 2007 by dramatically cutting mortality related to sepsis, respiratory conditions, cardiac conditions and shock. The estimates were made by comparing expected mortality rates based on prior-year results with actual deaths adjusted for patients' illness severity. Many other hospitals have lowered their death rates in recent years, but a comparison found that QUEST hospitals outperformed other facilit [Read more]
AMA pushes for better insurance exchange networks
Standards ensuring that consumers have access to sufficient networks of health care professionals on federally operated health insurance exchanges need to be tightened, the American Medical Association wrote in a March 15 letter to the Obama administration. In his correspondence to acting Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner, AMA Executive Vice President and CEO James L. Madara, MD, specified what information qualified health plans on these marketplaces should be providing. Insurance regulators and consumers need to be able to make informed decisions on whether a plan’s network has an adequate supply of primary care and specialty physicians, he stated. Dr. Madara was responding to guidance CMS issued March 1 to insurance companies that will be offering qualified health plans in federally facilitated or partnership health insurance exchanges. These are the companies CMS will be working with, as both the federal and partnership models involve a [Read more]
More trained clinicians, research urged for mentally ill
Mental health professionals and other participants at a recent congressional forum said a dearth of trained physicians and the presence of too many regulatory barriers are some of the main factors preventing severely mentally ill children from getting the medical help they need. The March 5 bipartisan forum was convened by Rep. Tim Murphy (R, Pa.), who chairs the House Energy and Commerce oversight and investigations subcommittee, to discuss what federal resources might be needed to prevent another incident such as the mass killings at Sandy Hook Elementary School in Newtown, Conn. The forum focused on severely mentally ill individuals who could be prone to violence but who often don’t receive the timely treatments available to those with other medical emergencies. “Why do we treat the head differently from the rest of the body?” asked Pete Earley, an author and the parent of a son with mental illness, during the forum. These disparities often mean that mentally ill patient [Read more]
IOM gives thumbs-down to Medicare regional value-based pay
Instituting a geographically based value index in Medicare that would change payment rates for physicians and other health professionals based on how much program spending is incurred by different regions could lead to serious adverse effects on the system, according to preliminary research by the Institute of Medicine. In 2009, Congress requested that the IOM investigate evidence of wide disparities in Medicare spending among different regions of the U.S. that appear to have little correlation to patients’ health outcomes — evidence that many experts say indicates wasteful program spending in some parts of the country. Lawmakers asked the IOM specifically to consider whether adopting a regional value index, which would alter pay rates based on a given region’s composite cost and quality measures, could help encourage higher-value care. In an interim report released by an IOM committee on March 25, the research organization said making such regional pay adjustments would no [Read more]
Medicare spending disparities not reflected in cancer survival rates
A study concluding that there was no clear association between the survival rates of advanced cancer patients and the amount that Medicare spent on their care suggests that more doctors should be looking to health care delivery models that focus on palliative, patient-centered care rather than aggressive interventions, health care observers said. “Improvements in outcomes for patients with advanced cancer have been limited,” stated the study, which was published online in the Journal of the National Cancer Institute on March 12. New therapies for those with advanced cancer often are very expensive but extend the patient's life by only weeks or months. Other studies looking at regional differences in medical spending have not always found improved outcomes when spending is higher. To assess a possible correlation between medical spending and survival rates, Gabriel Brooks, MD, a medical oncology fellow with the Dana-Farber Cancer Institute, and fellow researchers examined both [Read more]
Urgency intensifies on call to repeal Medicare SGR
Congress’ official Medicare advisers have joined the growing chorus of policy experts who say the program may never again be in as favorable a position to overhaul the formula that helps determine physician pay as it is now. The annual March report to Congress from the Medicare Payment Advisory Commission renewed a proposed policy, first outlined in October 2011, to repeal the Medicare sustainable growth rate and replace it with a decade of set annual payment updates for physicians. In testimony to the House Ways and Means health subcommittee on March 15, the day the newest report was issued, MedPAC Chair Glenn Hackbarth outlined what is at stake for lawmakers on the Medicare payment issue if they go another year without taking the commission’s advice. “The need to repeal the SGR is urgent,” Hackbarth said. “Deferring repeal of the SGR will not leave the Congress with a better set of choices, as the array of new payment models is unlikely to change, and SGR fatigue is i [Read more]
Medicaid nonexpansion states could leave millions uninsured
More than 5 million of the poorest individuals may not be able to obtain health insurance under the Affordable Care Act, resulting in higher uncompensated care costs for health care systems, an analysis has concluded. Starting in 2014, states have the option of expanding eligibility for their Medicaid programs to 133% of poverty (an effective rate of 138% when certain income is discounted from consideration). In states that don't expand Medicaid, most individuals from 100% to 400% of poverty would be eligible to apply for federal premium tax credits to buy coverage from the health insurance exchange that will operate in their states. But for those below the poverty line, no subsidized insurance options may exist in non-expansion states. “In states that choose not to expand, there are some 5.3 million individuals who fall above their state's Medicaid eligibility level but below 100% of the federal poverty level and thus aren't eligible” for the federal exchange subsidies, acco [Read more]
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