MACPAC urges Azar to pause, re-evaluate Arkansas’ Medicaid work requirements, Eli Richman, FierceHealthcare, Nov 9, 2018

Medicaid Expansion Opponent Picked to Lead Medicaid, Steven Porter, Health Leaders Media, Oct 16, 2018

Wisconsin Wins Federal Approval for Medicaid Work Requirements, Steven Porter, Health Leaders Media, Oct 31, 2018

Let’s just go nuts reading about all the places Medicaid expansion is on the ballot while we wait for the results to come in tonight. We will get back to our normal 3 article summary for the MMMRs next week..

If you haven’t — Vote!

MMMR 2018 11 06 Midterms Edition

Helping you consider differing viewpoints. Before it’s illegal. 

Article 1:  

Report Asks About Quality Assurance in Medicaid Managed Care for Children, AJMC, Allison Inserro, 2/27/2018

Clay’s summary: Studies like this are strong support for the national Medicaid Quality Rating System (still to be implemented under the Mega Reg as of the time of writing)

Key Passage from the Article

A new report questions what metrics policy makers are using to evaluate whether or not children enrolled in Medicaid managed care organizations (MCOs) are receiving quality care, given the public investment these programs receive.

The report, from the nonpartisan Georgetown University Center for Children and Families (CCF), said that state Medicaid agencies and CMS do not use 1 common measurement for measuring quality of care.

Data and transparency about the quality of care for children are scant, the report said. There is no publicly accessible national database with information on how well individual MCOs are serving enrolled children.

For instance, there is no national database regarding the performance of individual MCOs with respect to Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, which are a guaranteed benefit providing care to children with special needs.

  …

Read it here 

Article 2:   

How HEDIS, CMS Star Ratings, CQMs Impact Healthcare Payers, HealthPayer Intelligence, Thomas Beaton, 12/21/2017

Clay’s summary: Good overview for those just beginning to learn about quality rating systems in the space.

Key Passage from the Article

Quality performance metrics such as HEDIS, CMS Star Ratings, and standardized core quality measures (CQMs) can give consumers an objective indication of healthcare payer quality.

Standardized quality measures aggregate how well a payer has performed based on the regularity of services performed, improvements in patient health, and consumer satisfaction.  

Commercial, Medicaid, and Medicare payers can leverage quality metrics in order to position and market their health plans as ideal insurance options for beneficiaries.

HEDIS, CMS ratings, and CQMs measure similar healthcare services and consumer-facing operations, but some quality datasets are more specialized, including metrics such as consumer satisfaction rates or chronic disease screening activities.

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Read it here 

Article 3:   

CMS Scorecard for Medicaid, CHIP Measures Draws Scrutiny From State Directors, AJMC, Allison Inserro

Clay’s summary: So what’s your alternative? That the available data doesn’t support a meaningful dashboard is sort of the point, class…

Key Passage from the Article

CMS Monday released a scorecard that reports quality metrics voluntarily reported by states for Medicaid and the Children’s Health Insurance Program (CHIP), as well as federally reported measures, but the association that represents state Medicaid directors expressed some concerns with the scorecard’s data and what sorts of conclusions may be drawn from them, given the huge variability of state programs, essentially giving it a score of “needs improvement.”

CMS said that it is the “first time” it is publishing state and federal administrative performance metrics; the first 3 areas to be included are state health system performance, state administrative accountability, and federal administrative accountability. Health metrics include things like well-child visits, mental health conditions, children’s preventive dental services, and other chronic health conditions.

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Read it here 

Helping you consider differing viewpoints. Before it’s illegal. 

Article 1:  

AHCA Points to Gains in Quality as House Panel Weighs SNF Oversight, Patrick Connole, Provider Magazine, 9/5/2018

Clay’s summary: Big Nursing Home lobby cries Uncle; asks for less regulation, please.

Key Passage from the Article

Ahead of a congressional hearing to scrutinize federal oversight of skilled nursing care, the American Health Care Association (AHCA) on Sept. 5 urged lawmakers to recognize the steady and significant improvement in the quality of care for skilled nursing care center residents instead of considering more regulation of an “already overburdened sector.” 

The statement by Mark Parkinson, president and chief executive officer of AHCA, came before a House Energy and Commerce Subcommittee on Oversight and Investigations hearing titled “Examining Federal Efforts to Ensure Quality of Care and Resident Safety in Nursing Homes.”

He said while the discussion agenda is focused on whether the Centers for Medicare & Medicaid Services (CMS) and Office of Inspector General exercise enough oversight to ensure residents are free from abuse and receive proper care, such a debate is missing the point and continues a pattern of disrespecting the nursing care profession.

“At a time when Congress faces public criticism for its failure to work together and accomplish shared goals, this hearing seems like a misguided effort to find more ways to regulate an already overburdened sector,” Parkinson said. Long term care is one of the most regulated industries in the country, “yet we’ve shown some of the most dramatic improvement on both self-reported and government quality measures.”

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Read it here 

Article 2:   

Quality Improvement Projects Save Children’s Hospitals Millions, Jacqueline LaPointe, RevCycle Intelligence, 6/21/2018

Clay’s summary: Better management of asthma in pediatric populations can pay off. So can avoiding medical errors.

Key Passage from the Article

With their drive to deliver high-value care in mind, Nationwide Children’s Hospital in Ohio and Yale New Haven Children’s Hospital in Connecticut embarked on quality improvements efforts to address specific issues within their organizations that were impacting patient outcomes and cost.

Their quality improvement projects paid off in more ways than one. Nationwide has reported significant improvements in asthma control, resulting in $5.2 million in savings, while Yale New Haven Children’s Hospital has seen patient safety and error reporting increase, catching $3 million in savings for the hospital.

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Read it here 

Article 3:   

CMS Awards $5.5M to Develop Palliative Care Quality Measures, Kaitlyn Mattson, Home Health Care News, 9/30/2018

Clay’s summary: Efforts to bring palliative care into value-based care are in the early stages.

Key Passage from the Article

The American Academy of Hospice and Palliative Medicine (AAHPM), in partnership with the National Coalition for Hospice and Palliative Care and the RAND Corporation, has been awarded a three-year $5.5 million grant from Centers for Medicare & Medicaid Services (CMS) to develop patient-reported quality measures for community-based palliative care.

Filling the gaps in quality measurement of palliative care is one of the main sticking points for the three-year grant, according to AAHPM.

One of the many reasons to develop measures is because major gaps were observed in quality measurement for people with serious illness, according to a 2015 report measuring quality indictors for hospice and palliative carefrom AAHPM and the Hospice and Palliative Nurses Association.

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Read it here 

Helping you consider differing viewpoints. Before it’s illegal. 

Article 1:  

Insurers Are Using AI to Boost Risk Management, Jared Kaltwasser, Healthcare Analytics News, 10/2/2018

Clay’s summary: Pretty blatant press-release dressed up as “news,” but interesting read nonetheless.

Key Passage from the Article

“The growth of value-based care is driving the need for deeper healthcare insights, for key activities such as risk adjustment, quality reporting, care and utilization management,” Apixio CEO Darren Schulte, M.D., told Healthcare Analytics News™.

The company’s pitch looks something like this: The Centers for Medicare & Medicaid Services is increasing audits of health plans offering Medicaid Advantage (MA), to ensure correct payments. That means health plans have to keep careful tabs on coding and payments. But unless the health plan owns the clinic, providers don’t share the same financial risks as insurers.

Apixio says about 85-95 percent of MA risk-adjustment payments are based on diagnosis codes from clinics and hospitals. The remaining payments are from chart coding. Diagnosis codes are backed up by patient notes and physician codes, but those records aren’t often reviewed prior to payment by the health plans. Thus, any errors may go undiscovered, which could cause regulatory headaches for health plans — but usually not clinics.

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Read it here 

Article 2:   

Enhanced Patient Matching Is Critical to Achieving Full Promise of Digital Health Records, Pew Trusts, 10/2/2018

Clay’s summary: Care management only works if you are treating the right patient.. kind of makes me think about how they write “not this one” on the leg that is not to be cut off going into surgery..

Key Passage from the Article

This report focuses on the last problem—patient matching—while also recognizing that many other challenges remain for effective and robust interoperability.

Patient matching helps address interoperability by determining whether records—both those held within a single facility and those in different health care organizations—correctly refer to a specific individual. Unfortunately, patient matching rates vary widely, with health care facilities failing to link records for the same patient as often as half the time. Deficiencies in matching patients to their records can lead to safety problems: For example, if an allergy listed in one record is not documented in another, or if records for two different individuals are incorrectly merged, patient harm can occur. In a 2012 survey conducted by the College of Healthcare Information Management Executives (CHIME), 1 in 5 hospital chief information officers indicated that patients had been harmed in the previous year due to mismatches.

Failures to effectively match patients can also be costly, leading to repeat tests and delays in care. In an extreme example, the care for an 11-month-old twin was documented in her sister’s record, resulting in the failure of the health system to recoup $43,000 in costs from the insurer.

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Read it here 

Article 3:   

Patient-Centered Medical Home Evidence Increases With Time, Paul Cotton, Health Affairs, 9/10/2018

Clay’s summary: Still losing money in year 7 of your health home? Don’t give up just yet- Health Affairs says they work, so they must work!

Key Passage from the Article

There are clear differences between studies that do and do not find benefits. Positive evaluations assess PCMHs on advanced standards, after up to five years of transformation and with financial incentives to improve quality and efficiency, or—like the HIV study above, the impact with high-cost, high-needs patients. Studies showing little benefit assessed practices with no financial incentives to reward improvement. They also looked at PCMHs using our initial 2008 standards that we updated in 2011, 2014, and 2017. The 2011 updates further emphasize pediatrics, health information technology, and clinician-patient collaboration. We made 2014 updates to emphasize more behavioral health care integration, team-based care, focus on high-need populations care management, and patient and family involvement. We made 2017 updates to streamline our recognition process and better support practices. And we will continue making updates in the future as we continuously listen to stakeholder feedback on how to improve this powerful program. 

PCMHs do, in fact, work. That is why the Medicare Access and CHIP Reauthorization Act (MACRA), which rewards clinicians for value instead of volume, gives PCMHs automatic credit. That is why 27 public-sector initiatives across 23 states and many private insurers use the NCQA PCMH model. That is why key medical boards provide PCMH credit for Maintenance of Certification. And that is why approximately 20 percent of all primary care physicians in the US are in the NCQA-recognized PCMH practices.

  …

Read it here 

Helping you consider differing viewpoints. Before it’s illegal. 

Article 1:  

National Quality Forum identifies set of quality measures for rural providers, Paige Minemyer, FierceHealthcare, 9/18/2018

Clay’s summary: The specific needs of Rural Americans- finally a focus of pop health?

Key Passage from the Article

The set includes nine measures intended for a hospital setting—such as scores on the Hospital Consumer Assessment of Healthcare Providers (HCAHPS) survey and Cesarean section rates—and 11 for ambulatory care settings, such as medication reconciliation postdischarge and preventive screenings for diabetes, behavioral health issues and tobacco use.

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Read it here 

Article 2:   

Health Care Quality: It’s Motherhood and Apple Pie. Until You Start To Measure It. Lola Butcher, Managed Care, 9/3/2018

Clay’s summary: You mean the government can’t write a reg to improve quality of care? And actually focuses on minutia that can be counted versus outcomes that matter? Egads! #Resist!

Key Passage from the Article

When he’s using microsurgical techniques to treat unbearable facial pain, neurosurgeon Richard Zimmerman, MD, values precision above all. But as the chair of quality outcomes at Mayo Clinic in Arizona, he has come to accept that the government’s system for measuring health care quality is less than precise.

“If you’re a hematologist–oncologist, the survival rate of cancer patients might be a better indication of quality than how often you document that you have screened for depression,” he says.

But screening a patient for depression—or, more accurately, documenting that you have screened for depression, regardless of whether you actually remembered to do so—leads to higher pay from the Medicare program. Nobody’s paying more for high cancer-survival rates.

Welcome to health care’s pay-for-value movement, in which public and private payers want to reward—and penalize—physicians based on the quality of care they provide.

It’s a good idea with a big problem: Physicians don’t believe in it.

  …

Read it here 

Article 3:   

CMS: Better Data Analytics, Quality Measures will Modernize Medicaid

Clay’s summary: Looking forward to seeing the creativity of haters in coming up with a way this is a bad thing.

Key Passage from the Article

Modernizing the Medicaid program environment will require investments in data analytics and a greater reliance on meaningful quality measures, says CMS Administrator Seema Verma in a new blog post. As spending on healthcare in general – and Medicaid in particular – continues to rise, providers and regulators will need to continue to create more effective partnerships around raising quality and cutting costs, Verma stated. “As program costs have continued to rise, we have failed to deliver a level of transparency and accountability for achieving positive outcomes commiserate with our significant investment,” she wrote. “But this is finally beginning to change. Over the last several years, CMS has collaborated with states to improve how we collect and use data to modernize and measure the Medicaid and CHIP program.”

  …

Read it here 

Helping you consider differing viewpoints. Before it’s illegal. 

Article 1:  

Jersey Community Hospital receives Small and Rural Award for quality improvement, RiverBender.com, 9/27/2018

Clay’s summary: Sometimes we forget that healthcare happens on the ground. Here’s an example of an IL hospital improving readmission rates.

Key Passage from the Article

Jersey Community Hospital’s all-cause readmission rate dropped from 16% to 7% with an estimated 63 readmissions prevented over a 12-month period and a total cost savings of $455,600.

“I’m happy that the high quality of care provided at JCH is being recognized for its consistency and reliability. I’m proud of the team here and they are deserving of this recognition” stated Jon Wade, CEO.

IHA President and CEO A.J. Wilhelmi recognized Jersey Community Hospital’s project team at the association’s annual Leadership Summit. Michael McNear, MD, Chief Medical Officer and Medical Group President, accepted the award on the team’s behalf.

IHA’s Institute for Innovations in Care and Quality spearheaded this effort to highlight the quality improvement work of IHA-member hospitals and health systems. The Institute is a strategic center actively engaged in implementing evidence-based quality and safety initiatives while creating innovative member programs to measurably strengthen the quality of healthcare across Illinois.

  …

Read it here 

Article 2:   

NURSING HOME QUALITY: Continued Improvements Needed in CMS’s Data and Oversight, GAO, 9/6/2018

Clay’s summary: When was the last time you were in a nursing home? There is a wide spectrum of quality out there…

Key Passage from the Article

About 15,600 nursing homes participate in Medicare and Medicaid. To help ensure that residents receive quality care, the Centers for Medicare & Medicaid Services (CMS) collect data (such as nurse staffing levels) on these nursing homes.

We testified that CMS’s data showed mixed results—they showed an increase in consumer complaints along with improvements in the quality of care. We found that data issues (e.g., different states using different data collection methods) complicated CMS’s ability to assess whether the results reflected actual changes. We made recommendations to address these issues in the report on which this testimony is based.

  …

Read it here 

Article 3:   

Amerigroup Ranked Among Top Medicaid Plans in Texas by NCQA, BusinessWire, 9/28/2018

Clay’s summary: It’s easy to forget that plans are staffed by people who care about people. They work hard to improve the quality of care delivered, and should get props when they do well. Yay, Amerigroup Texas!

Key Passage from the Article

“Amerigroup is pleased to be recognized by the NCQA as one of the highest performing Medicaid health plans in the state,” said Tisch Scott, plan president, Amerigroup Texas. “These ratings demonstrate that our consumers have timely access to care, and they’re receiving the right care at the right time. Quality is foundational to everything we do at Amerigroup, and we’re committed to building on our accomplishments to provide a better healthcare experience for all consumers.”

In recognizing Amerigroup, the NCQA evaluated the plan’s performance based on three areas — consumer satisfaction, prevention and treatment. Amerigroup received an overall score of 3.5 out of 5.

  …

Read it here