Published 8/1/2018

Second Look—Advocacy

CMS Open Payments data

The Centers for Medicare & Medicaid Services (CMS) released Open Payments data for 2017. Data were disclosed by 1,525 manufacturers and group purchasing organizations related to payments and transfers of value provided to physicians and teaching hospitals, as well as ownership or investment interests held by physicians and their immediate families. CMS reported an $8.40 billion value in more than 11.5 million records, which is slightly lower than the previous two years. Specific allocations included $2.82 billion in general payments, $4.66 billion in research payments, and $927.16 million in ownership or investment interests.

Opioid prescribing

The American Medical Association (AMA) and the Opioid Task Force, of which AAOS is a participant, issued a report noting that physician leadership may be advancing the fight against the opioid epidemic. The findings showed that total opioid prescribing has declined for five consecutive years, and between 2013 and 2017, the number of opioid prescriptions decreased by more than 55 million (a 22.2 percent decrease nationally). Prescription Drug Monitoring Program registration and utilization have also increased 121 percent since 2016, and nearly 550,000 physicians have received continuing medical education in pain management and related areas.

Projected Medicare solvency

A report from the Medicare Board of Trustees reveals that Medicare Part D drug spending is projected to lose solvency in 2026, three years earlier than 2017 predictions. CMS said this is due to higher manufacturer rebates, a decline in spending for hepatitis C drugs, and a slowdown in spending growth for diabetes medications. Total Medicare costs are expected to grow from 3.7 percent of the gross domestic product to 5.8 percent in 2038, and eventually to 6.2 percent by 2092. Lack of capital flowing into the hospital-care trust fund may be a result of this year’s tax-law change. In response to the report, Treasury Secretary Steven Mnuchin said Medicare is secure and “on track to meet its obligations to beneficiaries well into the next decade.”

CMS rule on joint replacement payment model

CMS published a final rule on extreme and uncontrollable circumstances—such as a hurricane—for Comprehensive Care for Joint Replacement Payment Model participant hospitals. The rule provides flexibility in the determination of episode spending in areas impacted by such circumstances for performance years three through five. The ruling was effective July 9.

CMS hospital star ratings

CMS postponed the release of hospital quality star ratings, originally scheduled for July. CMS said it needs time to analyze “the impact of changes to some of the measures on the star ratings and to address stakeholder concerns.” The agency did not indicate when the next update will be available, and the December 2017 ratings will remain on the Hospital Compare website until further notice. The most significant change proposed for the July ratings was how safety measures were calculated. Critics of the proposal support the delay to allow more time for analysis of the methodology and measures, as well as input from stakeholders.

Value-based payment models

Early value-based payment models did not reduce the total cost of care or improve clinical quality outcomes, according to a report from the Healthcare Financial Management Association, Leavitt Partners, and McManis Consulting, with support from the Commonwealth Fund. Researchers assessed commercial data from 2012 to 2014 and Medicare data from 2007 to 2015 and found no statistically significant correlation between the value-based payment models and change in the total cost of care for Medicare (2012–2015) or commercial payers (2012–2014) in more than 900 U.S. markets. Investigators said the findings were due to limited prevalence of these models in many markets, lack of strong financial incentives for managing the total cost of care, healthcare organizations’ preference for an incremental approach to risk, and employers’ reluctance to change benefit design. The study also indicated that the number of competitors in a market may be less important than the type of competitors.

Opioid shortage

U.S. hospitals frequently run out of injected opioids due to manufacturer shortages, according to a report from The Associated Press. To compensate, doctors and pharmacists report rationing injectable opioids, using slower-acting or less effective pain medications, or sedating patients. AMA said the drug shortages are a public health crisis, and other medical groups have asked regulators to step in, as some patients undergoing surgery, those with cancer, or patients with severe burns are not receiving optimal pain control. The shortage began last year and is expected to carry over into 2019, making it more severe than previous shortages. An April survey of 343 hospital pharmacists, conducted by the American Society of Health-System Pharmacists, found that 98 percent of respondents reported moderate or severe shortages of morphine, fentanyl, and hydromorphone.

CMS MIPS participation

CMS has reported that 91 percent of all clinicians eligible for the Merit-based Incentive Payment System (MIPS) participated in the first year of the program, exceeding the agency’s goal of 90 percent participation. CMS Administrator Seema Verma also highlighted that submission rates for accountable care organizations and clinicians in rural practices were 98 percent and 94 percent, respectively. The agency will use MIPS performance data to adjust providers’ Medicare reimbursement starting Jan. 1, 2019, and data for the first year were due April 3. Eligible physicians who did not participate in MIPS face penalties, including a 4 percent cut in Medicare reimbursement. Last year, some providers expressed concern over the MIPS deadlines due to technical difficulties and lack of information on program requirements. The agency said it is making changes to reduce the regulatory burden under MIPS to further increase participation.

CMS launches Data Element Library

CMS announced the launch of the Data Element Library (DEL), a free, centralized database to support the interoperability of electronic health records (EHRs). The public can use DEL to view specific data that long-term and post-acute care facilities are required to collect as part of patient health assessments. DEL includes information technology standards that support the collection of health information, which CMS says will allow for easier integration and data sharing. In addition, many of these data elements, including demographics, medical problems, and other types of health evaluations, are standardized. “Integrating these data elements into EHRs will ultimately allow health information to flow more easily from one provider to another,” CMS said in a press release.

Stark law feedback

CMS issued a request for information on the Stark law, or physician self-referral law, which prohibits a physician from making referrals for certain healthcare services to an entity with which he or she (or an immediate family member) has a financial relationship. “Many of the recent statutory and regulatory changes to payment models are intended to help incentivize value-based care and drive the Medicare system to greater value and quality,” said CMS Administrator Seema Verma in a blog post. “The Stark law and regulations, in its current form, may hinder these types of arrangements.” When CMS asked providers for comment about regulations that create burdensome regulatory hurdles, it received more than 2,600 comments. According to Ms. Verma, Stark law was one of the top areas identified. Comments are due Aug. 24, and AAOS will be commenting.