D.C. Report: CHIME Reacts to Congressional Calls to Suspend Meaningful Use

Bundled Payment Model Gets Put on Hold A new payment reform designed to transition hospitals and other providers away from fee-for-service reimbursements to lump-sum payments that are centered on episodes of care has been halted, according to media reports this week.  Model 1 bundled payments, being run through the CMS Innovation Center (CMMI) will be put on hold because it had “fewer prospective participants and less diversity than originally anticipated when the model was designed,” CMS officials said.  In the first Model of bundled payments, Medicare would pay the hospital a discounted amount based on the payment rates established under the hospital Inpatient Prospective Payment System, and physicians would be paid separately for their services under the Medicare Physician Fee Schedule.  As a part of the initiative, providers would be able to share in savings that come from better care coordination.  Instead, CMMI says they will focus on Models 2, 3, and 4 which have a mix of reimbursement models and payment settings.  The go live for Model 1 bundled payments was January 1, 2013.

Studies Look at Policies’ Impact on Quality, Safety A pair of unrelated studies published this week looked at different policy levers Medicare is using to improve quality and safety.  One study focused on how electronic health records have impacted quality measures among primary-care doctors in the Hudson Valley region of New York.  The other study analyzed several years of billing data to determine if nonpayment programs through Medicare have incentivized better quality and safety.  The results were mixed.  According to findings reported in the Journal of General Internal Medicine, EHR use was associated with higher scores on four of nine quality measures, including:

·         90.1% of the EHR-using doctors vs. 84.2% of those keeping paper charts did appropriate hemoglobin A1c testing for diabetic patients;

·         78.6% of EHR-users vs. 74.2% of paper users met quality measures for breast cancer screening.

·         65.8% to 53% EHRs vs. paper for proper Chlamydia screening and

·         For colorectal cancer screening, it was EHR-using docs 51.3% and paper-using docs 48%

The story on payment reform methods used by Medicare was not as bright.  In October 2008, CMS discontinued additional payments for certain hospital-acquired conditions that were deemed preventable.  Authors of the New England Journal of Medicine study wanted to see if this nonpayment had any effect on the prevalence of two healthcare-associated infections, central catheter-associated bloodstream infections and catheter-associated urinary tract infections.  After using data spanning from 2008 to 2011 at 398 hospitals, the study found “no evidence that the 2008 CMS policy to reduce payments for [such infections] had any measurable effect on infection rates in U.S. hospitals.”  The authors note that “With attention already focused on preventing healthcare-associated infections, the incremental effect of adjusting payment may have been limited.”