October 7, 2021 | CMMI appears ready to overhaul payment models
INDUSTRY NEWS
Predicting low-value services
Health systems with a lower share of primary care physicians or no affiliated teaching hospital are more likely to deliver low-value services, according to research published in JAMA Internal Medicine. Researchers found that preoperative laboratory testing in healthy patients before low-risk surgeries, prostate cancer screening in men over 70 and use of antipsychotic medications in patients with dementia were the most common examples. Health systems with a larger proportion of non-white patients, headquartered in the South or West, and stationed in geographies with higher health care spending also face greater odds of delivering unnecessary treatment. (JAMA Internal Medicine; announcement)
Unneeded ED use costs $47B/year
Misuse of the emergency department has led to least $47 billion in unnecessary health care spending each year, according to a new report from Accenture. This appears to be driven by individuals with low health care system literacy. Those with a chronic condition were twice as likely to have received care in the last year than their high literacy peers. For generally healthy people, those with with low health care system literacy were nearly three times more likely to visit the ED than their high literacy peers. (Modern Healthcare*; report)
INNOVATION & TRANSFORMATION
CMMI appears ready to overhaul payment models
The CMS Innovation Center (CMMI) is signaling its plans to restructure payment models to crack down on inappropriate coding, shift the focus of value-based programs to reduce patient inequities and cut down on initiatives that only serve to empower dominant providers with large market shares, Modern Healthcare reports. "Providers, once they're motivated by a risk budget or other incentive, they can get very creative with coding," says Dr. Mai Pham, former head of CMMI. MGMA’s Anders Gilberg says the shift represents a sharp departure from a previous “risk over everything else” approach. (Modern Healthcare*)
CMM’s benefits “without debate”
A piece in American Health & Drug Benefits authored by leaders of the Get the Medications Right Institute, articulates the value of comprehensive medication management. They conclude, “The benefits of including CMM in the services provided to primary care patients are without debate. […] It is time for the widespread inclusion of CMM services in healthcare coverage for patient care.” (American Health & Drug Benefits)
CONSUMERS & PROVIDERS
EHR messaging supports at-home health
Doctors say they’re overwhelmed by the volume of digital messages they’ve received from patients during the pandemic, and for good reason. The number of messages increased by over 150% and remained high throughout 2020, according to Epic data. Improvements could help support at-home health care initiatives. “You want to be able to message with your patients electronically before you start installing remote patient monitoring, or using wearables that automatically send you oxygen stats,” says Dr. A. Jay Holmgren, at the Center for Clinical Informatics and Improvement Research at the University of California San Francisco. (The Verge)
No Surprises update: Providers dismayed a recent rule
Provider groups are deeply critical of an HHS interim final rule released Thursday for the No Surprises Act. It spells out the arbitration process for determining out-of-network payments so that patients don't receive surprise bills. It establishes that existing rates in a provider's geographic area will be a strong anchor for final payment decisions by arbitrators, explains Healthcare Dive. Arbitrators cannot consider public reimbursement rates, the amount the provider would have billed if the law banning surprise billing didn't apply, or usual and customary charges. (Healthcare Dive)
NEW & NOTED
Know thy team: Patients want to know who their clinicians are, according to data presented at the ACC Quality Summit Virtual. They respond well when given a chance to know clinicians and understand their roles. (Cardiovascular Business)
Evolution in action? The coronavirus is evolving to spread more efficiently through air, studies suggest. (The New York Times*)
Going green: Women who added an avocado a day to meals showed a healthier distribution of visceral fat vs. subcutaneous fat around the abdomen after three months. (Axios)
MULTI-MEDIA
New approach: Pay users to stop
To combat meth, California is turning to an approach called “contingency management,” which includes small financial incentives for individuals to stay off drugs. (Kaiser Health News)
MARKETVOICES…QUOTES WORTH READING
“More and more Americans are getting care from health systems as opposed to standalone practices. Given actionable data, these systems have enormous potential to influence decision-making on low-value care. We hope this work might motivate systems to measure and intervene on low-value care internally.” —Ishani Ganguli, MD, a researcher in Brigham and Women’s Division of General Internal Medicine and Primary Care, lead author of a JAMA Internal Medicine study on low-value care, in a prepared statement.