Physician-focused payment models recommended to Secretary Price
In April, the Physician-Focused Payment Models Technical Advisory Committee (PTAC) had its first meeting to review and vote on proposals it has received. Following an in-depth review and discussion with the physician leaders who had submitted the proposals, the PTAC voted to recommend two proposals to Health and Human Services Secretary Tom Price, MD, for limited testing.
The first, called Project Sonar, has been spearheaded by Lawrence Kosinski, MD, an Illinois gastroenterologist. With support from a private payer, it has demonstrated significant improvements in care for patients with inflammatory bowel disease (IBD). Project Sonar engages these patients in an interactive process that allows the gastroenterology team to take steps to reduce exacerbations that would otherwise lead to emergency visits and hospital admissions.
The second model recommended by PTAC for testing is the Episode Grouper for Medicare (EGM) developed by the American College of Surgeons and Brandeis University. The EGM model will provide data to teams of physicians managing episodes of care that can help them to improve quality and outcomes of care and lower avoidable spending.
Both models hold promise for improving patient care as well as providing a means for specialist physicians who have had few opportunities to participate in alternative payment models to effectively do so. In remarks at the PTAC meeting, Secretary Price strongly encouraged the physician community to submit additional proposals for new models to the PTAC. He emphasized the need to avoid a one-size-fits-all approach and noted that we are in a time of great innovation in clinical medicine that requires innovation in payment models as well.
Learn more about both of these models at AMA Wire, and listen to a podcast interview with Dr. Kosinski about Project Sonar. The AMA website offers additional details on APMs and how to develop APMs.
CMS releases 2018 Hospital Inpatient Prospective Payment System (IPPS) proposed rule
On April 14, 2017, the Centers for Medicare and Medicaid Services (CMS) released the 2018 Hospital IPPS and LTCH Prospective Payment System proposed rule (PDF) and a fact sheet on the proposed rule. The proposed rule would update payments to acute care hospitals that report quality data and Meaningful Use by 1.6 percent in 2018.
In the rule, CMS proposes to update the Hospital Inpatient Quality Reporting (IQR) Program by making several changes, including updating the Hospital Consumer Assessment of Healthcare Providers and Systems Survey measures by replacing the previous questions about Pain Management with three new questions that address "communication about pain during the hospital stay." In addition, CMS proposes to change the risk-adjustment methodology used in the hospital 30-day, all-cause, risk-standardized mortality rate following acute ischemic stroke hospitalization (Stroke 30-Day Mortality Rate) measure to include stroke severity codes (based on the NIH Stroke Scale), beginning with the fiscal year 2023 payment determination.
CMS also proposes adjustments to the Hospital Value-Based Purchasing (VBM) program, including removing one measure, PSI 90: Patient Safety for Selected Indicators, in 2019. CMS proposes to adopt one new measure, Hospital-Level, Risk-Standardization Payment Associated with a 30-Day Episode of Care for Pneumonia, in 2022, and adopt a second new measure, Patient Safety and Adverse Events Composite (NQF No. 0531), beginning in 2023. CMS also asks for comments on the appropriateness of accounting for social risk factors in both the Hospital VBM program and the Hospital IQR program, and feedback on which social risk factors should be included.
For the Medicare and Medicaid Meaningful Use (MU) programs, CMS is proposing to reduce the 2018 electronic health record (EHR) reporting period from a full year to 90 days. Note that in this rule CMS is not proposing changes to the advancing care information (ACI) reporting period in the Merit-based Incentive Payment System program, which will be dealt with in a separate rulemaking. CMS also proposes to add a new exception for the MU program for participants who cannot meet the MU requirements because their certified electronic health record technology has been decertified. CMS is also proposing changes to the clinical quality measures (CQMs) to better align them with other quality reporting programs.
In addition, the proposed rule includes two requests for information (RFI). The first RFI seeks public input on the appropriate role of physician-owned hospitals in the delivery system and how the current scope of and restrictions on physician-owned hospitals affect health care delivery. The second RFI asks for feedback on CMS flexibilities and efficiencies, including regulatory, subregulatory, policy, practice and procedural changes that could be made to improve the health care delivery system and reduce unnecessary burdens for physicians and patients.
The American Medical Association will continue to review CMS' proposals and provide detailed comments on the proposed rule.
