VHIG Digest: Volume 2, No. 2
In the News
1. U.S. House of Representatives Repeals PPACA
On Wednesday, January 19, the U.S. House of Representatives voted 245 to 189 to repeal the Patient Protection and Affordable Care Act (PPACA), voting on party lines. Three Democrats joined the unanimous Republican vote: Dan Boren (D-OK), Mike McIntyre (D-NC), and Mike Ross (D-AK). Though it is unlikely repeal will receive serious consideration in the democratic-controlled Senate, the vote was a symbolic campaign promise, delivered promptly by the new congress.
As reported by Washington Post, Senate Majority Leader Harry Reid (D-Nevada) has indicated he will not allow a similar vote on a repeal of PPACA. However, House GOP leadership has announced its committee agenda, through which it hopes to eliminate significant elements of the regulation, specifically the individual mandate. Could an adaptation of PPACA be the solution? The Commonwealth Fund’s Jane Norman discusses talk of a middle ground on healthcare reform in the latest edition of itsWashington Health Policy Week in Review. In a similar vein, former Senate Majority leaders Bill Frist (R-Tennessee) and Tom Daschle (D-South Dakota) have launched a two-year project, sponsored by the Bipartisan Policy Center, aimed at building bipartisan solutions to the implementation of the 2010 Healthcare Reform Bill. For the full article, access it here. Nonetheless, last week six states joined the Florida lawsuit against PPACA, bringing the total to 26. The new additions were Iowa, Ohio, Kansas, Wyoming, Maine, and Wisconsin. To date, four district courts have heard arguments about the constitutionality of the individual mandate and, in Florida, the constitutionality of the Medicaid mandate requiring states to establish eligibility at 133 percent of the federal poverty level (FPL) and “maintenance of effort” requirements around coverage, et al. It is likely arguments will next be heard in Circuit Courts and possibly end in the Supreme Court.
2. Comparative Effectiveness Institute Ramps Up
The Patient-Centered Outcomes Research Institute (PCORI), created under PPACA, will serve as a centralized source of funding for comparative studies. The newly formed nonprofit institute recently announced members of the Methodology Committee: GOA Announcement. “The Methodology Committee has the responsibility of helping PCORI develop and update methodological standards and guidance for comparative clinical effectiveness research. The men and women named [to the committee] bring impressive credentials and experience to this important task,” said Gene Dorado, Comptroller General of the United States and head of the U.S. Government Accountability Office (GAO), directed to appoint the committee members under PPACA. In addition to the 15 appointees, the Director of the Agency for Healthcare Research and Quality (AHRQ) and the Director of the National Institutes of Health (NIH) will also serve on the committee.
3. CMS Announces Value-Based Purchasing Incentive Plan
The Centers for Medicare & Medicaid Services proposal, issued January 7, incorporates 17 clinical process-of-care measures used in five health categories: acute myocardial infarction, heart failure, pneumonia, healthcare associated infections and surgical care improvement. It also will use eight measures from the hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey that reflects how patients view their care experiences. These 25 measures will be used to generate FY 2013 DRG payments.
By 2014, it will add mortality outcome measures for the three health conditions, eight hospital-acquired condition measures and nine Agency for Healthcare Research and Quality measures. The hospital-acquired condition measures include surgical foreign object retention, air embolism, blood incompatibility, pressure ulcer stages III and IV, falls and trauma such as burns or electrical shocks, catheter-associated urinary tract infections and manifestations of poor glycemic control. The regulations will apply to discharges at 3,000 acute care hospitals. All these hospitals will have their funding reduced starting with 1% in fiscal year 2013, rising to 2% by FY 2017, but will have a chance to earn that money back, and perhaps more, under the incentives algorithm. Algorithms will be calculated to derive a Total Performance Score or TPS for each hospital.
CMS director Don Berwick, in a statement, called the proposed regulations “a huge leap forward in improving the quality and safety of America’s hospitals for both Medicare beneficiaries and all Americans. The hospital value-based purchasing program will reward hospitals for improving patients’ experiences of care, while making care safer by reducing medical mistakes.” Access the full article here.
4. Medicare Pilot Project Reduces Readmissions by 9.3%
A 14-city Medicare demonstration project has successfully lowered patient readmission rates by 9.3 percent, according to The Denver Post. The article reports that the project links nurses, social workers and other healthcare workers to elderly hospital patients at discharge to help them to coordinate drugs, doctor follow-ups and home health care aids.
It is estimated that the program has saved Medicare $100 million dollars since it began 1.5 years ago.
In the Literature
1. Private Payer Innovation in Massachusetts: “The Alternative Quality Contract”
From the Commonwealth Fund:
In 2009, Blue Cross Blue Shield of Massachusetts began paying participating health care provider groups under the Alternative Quality Contract (AQC), an alternative to fee-for-service payment in which medical groups receive fixed payments for patient care, plus rewards based on savings generated and performance targets reached. At the end of the first year of the contract, spending in all the participating groups was below the budget targets and all earned “significant” quality bonuses.
Can innovations such as this one improve quality on a large scale? The Center for Medicare and Medicaid Innovation (the Innovation Center) was created to do just that. According to innovations.cms.gov, the Innovation Center will ultimately work with the business community to scale new care and payment models that improve quality and affordability.
2. German Study shows that Diabetes Management Programs Improve Quality of Care and Reduce Costs
A study in Germany found that patients enrolled in a diabetes management program had significantly lower mortality rates than those receiving routine care for their condition. There were also fewer complications and hospitalizations and a significant difference in costs between baseline and intervention groups.
- For patients enrolled in the disease management program, the overall mortality rate (2.30%) in 2007 was significantly lower than the rate for those in the control group (4.07%).
- There were fewer complications – including myocardial infarction, stroke, chronic renal insufficiency, and amputation of the lower leg or foot – among patients in the program, compared with those receiving routine care.
- Average overall drug and hospital costs in 2007 were more than $600 lower in the intervention group, mainly a result of lower hospital costs. Patients receiving routine care were more likely to be hospitalized than patients in the intervention group, and their hospital stays were 1.44 days longer, on average.
Access the full article in Health Affairs, here.
1. Can Regulations Limiting the Number of Hours Medical Students Work be Embraced without Compromising Continuity of Care or Education and Training?
Particularly relevant to students and anyone who practices in an academic setting, the latest set of regulations from the Accreditation Council for Graduate Medical Education (ACGME), focused especially on first-year residents, is scheduled to go into effect in July. Listen, learn, and weigh in during the next WIHI webcast, Thursday, January 27 from 2-3 pm ET. Doctors David Sweet, Program Director, Internal Medicine Residency, Summa Health System, and James Whiting, Surgical Director, Maine Transplant Program and Surgical Residency Program Director, Maine Medical Center, join host Madge Kaplan for an exploration of new, innovative approaches to residency training. Rounding out the discussion are Christopher Landrigan, MD, MPH, Director, Sleep and Patient Safety Program, Brigham and Women’s Hospital’s research on sleep deprivation and patient safety, and Don Goldmann, MD, IHI Senior Vice President, who brings his knowledge of hospital improvement and the goals of residency training.