Which Medicare initiatives use quality measures?

In December, CMS listed its quality measures that it is considering for incorporation into some of their value-based payment programs and quality reporting programs. However, which Medicare quality reporting and payment initiatives use quality measures?  A full list is below. Ambulatory Surgical Center Quality Reporting Program (ASCQR) End-Stage Renal Disease Quality Incentive Program (ESRD QIP)…

Will MIPS work?

CMS in the past was on a value-based binge. They aimed to reward physicians based on quality of care (PQRS), based on cost (a component in the value modifier), based on use of EHR (meaningful use bonuses).  However, this imposed a large reporting bonus on physicians, pulling them away from patient care.  To solve the…

The market works!

In 2011, CMS created a demonstration to have competitive bidding for durable medical equipment (DME).   Prior to the implementation of this program, CMS used an administrative fee schedule, similar to how physicians are currently reimbursed.  How did this market-based solution fare?  A paper by Newman, Barrette, and McGraves-Lloyd (2017) answers this question. We compared…

Effect of Medicare Part D on Mortality

Huh and Reif (2017) have an interesting study of the effect of Medicare Part D on mortality.  The abstract is below. We investigate the implementation of Medicare Part D and estimate that this prescription drug benefit program reduced elderly mortality by 2.2% annually. This was driven primarily by a reduction in cardiovascular mortality, the leading cause of…

Innovative Cancer Care models

What does CMS consider to be innovative oncology care?  The following three programs won a CMS Health Care Innovation Award for their initiative. Community Oncology Medical Home (COME HOME).  This model relied on three key principles: (i) triage pathways to help first responders and nurses identify and manage patient symptoms; (ii) enhanced access to care through…

Did BPCI work?

BPCI is Medicare’s Bundled Payments for Care Improvement initiative.  For selected conditions, hospitals receive bundled payments that can include concurrent physician payments, post acute-care or other arrangements. The question is, does this payment approach improve quality and reduce cost? A study by Dummit et al. (2016) looked at lower extremity joint replacement at a BPCI-participating hospital.  They found the…

The coming U.S. debt crisis

The Congressional Budget Office provides some gloomy news on the fiscal health of the federal government in their recent 2016 Long Term Budget Outlook.  They state: If current laws governing taxes and spending did not change, the United States would face steadily increasing federal budget deficits and debt over the next 30 years, according to projections…

Do ACOs reduce spending?

Medicare’s Shared Savings Program (MSSP) is a program that created accountable care organizations (ACOs).  Providers in get bonuses if they are able to reduce health care costs and also maintain quality.  In theory, the program makes sense, increase reimbursement for high-quality, low-cost providers.  The key question, however, is whether it works. A recent study in NEJM…