Centers For Medicaid Research Articles

Do Press Ganey Scores Correlate With Total Knee Arthroplasty—Specific Outcome Questionnaires in Postsurgical Patients?

BackgroundThe purpose of this study was to assess whether Center for Medicaid and Medicare services–implemented satisfaction (Press Ganey [PG]) survey results correlate with established total knee arthroplasty (TKA) assessment tools. MethodsData from 736 patients who underwent TKA and received a PG survey between November 2009 and January 2015 were analyzed. The PG survey overall hospital rating scores were correlated with standardized validated outcome assessment tools for TKA (Short form-12 and 36 Health Survey; Knee Society Score; Western Ontario and McMaster Universities Arthritis Index; University of California, Los Angeles; and visual analog scale) at a mean follow-up of 1154 days post-TKA. ResultsThere was no correlation between PG survey overall hospital rating score and the above-mentioned outcome assessment tools. ConclusionOur study shows that there is no statistically significant relationship between established arthroplasty assessment tools and the PG overall hospital rating. Therefore, PG surveys may not be an appropriate tool to determine reimbursement for orthopedists performing TKAs.

A Review of the 2016-2017 Flu Season: Guidelines, Costs, and Barriers

In the United States (US), about 50,000 influenza-related deaths occur annually (Centers for Medicaid and Medicare Services [CMS], 2014). The most important preventive measure for the influenza virus is for people to obtain the influenza vaccine (Varsha et al., 2014; Uyeki, 2014). Of note, the vaccine is often underutilized; however, the influenza vaccine is recommended as an annual part of preventive care for people who are > 6 months of age (United States Government of Health and Human Services, 2015; Centers for Diseases Control and Prevention [CDC], 2016; World Health Organization [WHO], 2016). The under-vaccination of patients with the influenza vaccine is a profound issue, especially in rural communities, which is defined as locations populated by fewer than 50,000 people (United States Census Bureau [U.S. Census Bureau], 2015). In West Virginia, for example, a state where 38% of the population resides in rural areas, people who were insured by Medicare and whose insurance records did not manifest that they received the influenza vaccine, possessed a 170% increased risk of death during the influenza season in comparison to those who did receive the influenza vaccine (Schade & McCombs, 2000). This literature review discusses the increased need for influenza vaccination in rural communities; reviews the 2016-2017 influenza season's guidelines and costs; and in preparation for the 2017-2018 influenza season, the need to overcome barriers that are associated with influenza vaccination. Keywords : Rural, Influenza, Flu, Flu Shot, Flushot, Influenza Vaccine, Guidelines, Costs DOI: http://dx.doi.org/10.14574/ojrnhc.v17i1.428

Factors That Distinguish High-Performing Accountable Care Organizations in the Medicare Shared Savings Program.

To identify factors that promote the effective performance of accountable care organizations (ACOs) in the Medicare Shared Savings Program. Data come from a convenience sample of 16 Medicare Shared Savings ACOs that were organized around large physician groups. We use claims data from the Center for Medicaid and Medicare Services and data from 60 interviews at three high-performing and three low-performing ACOs. Explanatory sequential design, using qualitative data to account for patterns observed in quantitative assessment of ACO performance. A total of 16 ACOs were first rank-ordered on measures of cost and quality of care; we then selected three high and three low performers for site visits; interview data were content-analyzed. Results identify several factors that distinguish high- from low-performing ACOs: (1) collaboration with hospitals; (2) effective physician group practice prior to ACO engagement; (3) trusted, long-standing physician leaders focused on improving performance; (4) sophisticated use of information systems; (5) effective feedback to physicians; and (6) embedded care coordinators. Shorter interventions can improve ACO performance-use of embedded care coordinators and local, regional health information systems; timely feedback of performance data. However, longer term interventions are needed to promote physician-hospital collaboration and skills of physician leaders. CMS and other stakeholders need realistic timelines for ACO performance.

2016 Annual Report of The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry

BackgroundThe Society of Thoracic Surgeons (STS)/American College of Cardiology Transcatheter Valve Therapy (TVT) Registry captures all procedures with Food and Drug Administration–approved transcatheter valve devices performed in the United States, and is mandated as a condition of reimbursement by the Centers for Medicaid & Medicare Services. ObjectivesThis annual report focuses on patient characteristics, trends, and outcomes of transcatheter aortic and mitral valve catheter-based valve procedures in the United States. MethodsWe reviewed data for all patients receiving commercially approved devices from 2012 through December 31, 2015, that are entered in the TVT Registry. ResultsThe 54,782 patients with transcatheter aortic valve replacement demonstrated decreases in expected risk of 30-day operative mortality (STS Predicted Risk of Mortality [PROM]) of 7% to 6% and transcatheter aortic valve replacement PROM (TVT PROM) of 4% to 3% (both p < 0.0001) from 2012 to 2015. Observed in-hospital mortality decreased from 5.7% to 2.9%, and 1-year mortality decreased from 25.8% to 21.6%. However, 30-day post-procedure pacemaker insertion increased from 8.8% in 2013 to 12.0% in 2015. The 2,556 patients who underwent transcatheter mitral leaflet clip in 2015 were similar to patients from 2013 to 2014, with hospital mortality of 2% and with mitral regurgitation reduced to grade ≤2 in 87% of patients (p < 0.0001). The 349 patients who underwent mitral valve-in-valve and mitral valve-in-ring procedures were high risk, with an STS PROM for mitral valve replacement of 11%. The observed hospital mortality was 7.2%, and 30-day post-procedure mortality was 8.5%. ConclusionsThe TVT Registry is an innovative registry that that monitors quality, patient safety and trends for these rapidly evolving new technologies.

Characteristics of Accredited Transcranial Doppler Ultrasound Laboratories in the United States.

The aim of this study was to describe in detail the characteristics and accreditation compliance of laboratories in the United States applying for Intersocietal Accreditation Commission (IAC) transcranial Doppler (TCD) accreditation. This was a retrospective study of all applicant laboratories from 2012 to 2015. We used the IAC database to extract laboratory characteristics and guideline compliance metrics. Evaluation of 97 laboratories demonstrated that 67% were hospital-based and located in the South (43.3%), corresponding to the location of "Stroke Belt" states. Cases from 186 interpreting physicians, of which 110 (59%) were neurologists, were evaluated during the accreditation process. Established practice was the most common training pathway (54.8%), and a majority had not obtained an additional vascular interpretation credential (72.6%). From 318 case studies, the most frequent indications were subarachnoid hemorrhage (31.0%), stroke (17.0%), and carotid stenosis (14.3%). Although most laboratories had been previously accredited, accreditation was delayed for 77.3% due to incomplete studies (33.0%), discrepant findings between the report and the laboratory's diagnostic criteria (23.7%), and discrepant findings between the report and the waveforms/images (17.5%). The results suggest that there are significant differences between IAC applicant laboratories and laboratories represented by Centers for Medicaid and Medicare Services (CMS) claims data. In addition, accurate study reporting, physician training, and ongoing quality improvement activities may not be optimized in laboratories applying for accreditation. With the information learned from this study, educational strategies by professional organizations, including the IAC, can be tailored to help improve TCD practice.

2016 Annual Report of The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry

The Society of Thoracic Surgeons (STS)/American College of Cardiology Transcatheter Valve Therapy (TVT) Registry captures all procedures with Food and Drug Administration-approved transcatheter valve devices performed in the United States, and is mandated as a condition of reimbursement by the Centers for Medicaid & Medicare Services. This annual report focuses on patient characteristics, trends, and outcomes of transcatheter aortic and mitral valve catheter-based valve procedures in the United States. We reviewed data for all patients receiving commercially approved devices from 2012 through December 31, 2015, that are entered in the TVT Registry. The 54,782 patients with transcatheter aortic valve replacement demonstrated decreases in expected risk of 30-day operative mortality (STS Predicted Risk of Mortality [PROM]) of 7% to 6% and transcatheter aortic valve replacement PROM (TVT PROM) of 4% to 3% (both p< 0.0001) from 2012 to 2015. Observed in-hospital mortality decreased from 5.7% to 2.9%, and 1-year mortality decreased from 25.8% to 21.6%. However, 30-day post-procedure pacemaker insertion increased from 8.8% in 2013 to 12.0% in 2015. The 2,556 patients who underwent transcatheter mitral leaflet clip in 2015 were similar to patients from 2013 to 2014, with hospital mortality of 2% and with mitral regurgitation reduced to grade≤2 in 87% of patients (p< 0.0001). The 349 patients who underwent mitral valve-in-valve and mitral valve-in-ring procedures were high risk, with an STS PROM for mitral valve replacement of 11%. Theobserved hospital mortality was 7.2%, and 30-day post-procedure mortality was 8.5%. The TVT Registry is an innovative registry that that monitors quality, patient safety and trends for these rapidly evolving new technologies.

Evaluation of the Utility of Centers for Medicaid &amp; Medicare Services (CMS) Claim Data for Early Detection of Increasing Influenza Activity

Evaluation of the Utility of Centers for Medicaid &amp; Medicare Services (CMS) Claim Data for Early Detection of Increasing Influenza Activity

Trends and regional variations in contraceptive use among women in the united states based on the center for Medicaid and children's health insurance program (CHIP) services (CMCS) proposed quality measures

Trends and regional variations in contraceptive use among women in the united states based on the center for Medicaid and children's health insurance program (CHIP) services (CMCS) proposed quality measures

Trends in Complication Rates Following Ankle Arthrodesis and Total Ankle Replacement.

This study provides an updated comparison of the reoperation rates following primary ankle arthrodesis and total ankle replacement on the basis of observational, population-based data from California. We previously reported data from 1995 to 2004, and our current study includes new data from 2005 to 2010. Our hypothesis was that total ankle replacement would demonstrate increasing utilization and lower complication rates given advances in implant design and growth in surgeon experience. California's hospital discharge database was used to identify patients who had undergone primary ankle arthrodesis or total ankle replacement between 1995 and 2010. Short-term outcomes examined were based on Centers for Medicaid & Medicare Services (CMS) surgical quality measures and included readmission for any cause, death, and readmission for 7 common surgical complications (acute myocardial infarction, pneumonia, sepsis, pulmonary embolism, mechanical complications, surgical-site bleeding, and periprosthetic joint infection or wound infection). Long-term outcomes analyzed included rates of major revision surgery (ankle arthrodesis or ankle replacement, adjacent joint procedures (subtalar arthrodesis, triple arthrodesis, tarsometatarsal arthrodesis, and total knee replacement), and below-the-knee amputation. Logistic and proportional hazard regression models were used to estimate the impact of ankle arthrodesis or total ankle replacement on the rates of adverse outcomes, with adjustment for patient factors such as age, sex, race, type of health insurance, and comorbidities. We also compared patients in the 2005 to 2010 cohort with those in the earlier cohort. In all, 8,491 ankle arthrodesis and 1,280 total ankle replacement cases were identified. Patients managed with ankle replacement were more likely to be female, white, and older and to have Medicare or private health insurance. Short-term complication risk was low for both procedures, and patients managed with total ankle replacement had significantly lower rates of readmission (p < 0.0001) and periprosthetic joint infection/wound infection (p = 0.02) compared with patients managed with ankle arthrodesis. The inclusion of new data on patients who underwent surgery between 2005 and 2010 demonstrates increasing utilization and lower complication rates for total ankle replacement compared with ankle arthrodesis. These findings suggest that there have been improvements in the clinical safety of total ankle replacement over time. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Challenges of development and implementation of point of care pharmacogenetic testing

ABSTRACTIntroduction: Just as technology was the underlying driver of the sequencing of the human genome and subsequent generation of volumes of genome sequence data from healthy and affected individuals, animal, plant, and microbial species alike, so too will technology revolutionize diagnostic testing. One area of intense interest is the use of genetic data to inform decisions regarding drug selection and drug dosing, known as pharmacogenetic (PGx) testing, to improve likelihood of successful treatment outcomes with minimal risks.Areas covered: This commentary will provide an overview of implementation research of PGx testing, the benefits of point-of-care (POC) testing and overview of POC testing platforms, available PGx tests, and barriers and facilitators to the development and integration of POC-PGx testing into clinical settings. Sources include the published literature, and databases from the Centers for Medicaid and Medicare Services, Food and Drug Administration.Expert commentary: The utilization of POC PGx testing may enable more routine test use, but the development and implementation of such tests will face some barriers before personalized medicine is available to every patient. In particular, provider training, availability of clinical decision supports, and connectivity will be key areas to facilitate routine use.

Benefits of Developing an Individualized Quality Control Plan.

A clinical laboratory can benefit from developing an individualized QC plan (IQCP)2 in many ways. This editorial will explore some of the lessons we learned from developing our IQCPs and the advantages of interacting with clinical staff through the IQCP process. The Centers for Medicaid and Medicare Services adopted changes to the Clinical Laboratory Improvements Amendments (CLIA) interpretive guidelines on January 1, 2016, that give clinical laboratories the option to perform a minimum of two concentrations of QC each day or develop an IQCP (1, 2). An IQCP allows the laboratory to reduce the frequency of QC to the minimum recommended by the manufacturer provided the laboratory has conducted a thorough risk assessment. IQCPs apply to CLIA non-waived tests. Sites conducting CLIA waived testing only need to follow manufacturer instructions and pay a biennial fee for renewal of their CLIA certificate. The Clinical and Laboratory Standards Institute approved the EP23-A guideline to help laboratories develop an IQCP (3). Many newer laboratory and point-of-care testing (POCT) instruments have built-in and manufacturer-engineered control processes, some conducted with each test, that can monitor the quality of the sample, the instrument, and the chemistry of the reactions, making external QC redundant. An IQCP allows a laboratory to balance external QC with the quality …

Sunshine Act: shedding light on inaccurate disclosures at a gynecologic annual meeting

Physicians and hospital systems often have relationships with biomedical manufacturers to develop new ideas, products, and further education. Because this relationship can influence medical research and practice, reporting disclosures are necessary to reveal any potential bias and inform consumers. The Sunshine Act was created todevelop a new reporting system of these financial relationships called the Open Payments database. Currently all disclosures submitted with research to scientific meetings are at the discretion of the physician. We hypothesized that financial relationships between authors and the medical industry are underreported. We aimed to describe concordance between physicians' financial disclosures listed in the abstract book from the 41st annual scientific meeting of the Society of Gynecologic Surgeons to physician payments reported to the Center for Medicaid and Medicare Services Open Payments database for the same year. Authors and scientific committee members responsible for the content of the 41st annual scientific meeting of the Society of Gynecologic Surgeons were identified from the published abstract book; each abstract listed disclosures for each author. Abstract disclosures were compared with the transactions recorded on the Center for Medicaid and Medicare Services Open Payments database for concordance. Two authors reviewed each nondisclosed Center for Medicaid and Medicare Services listing to determine the relatedness between the company listed on the Center for Medicaid and Medicare Services and abstract content. Abstracts and disclosures of 335 physicians meeting inclusion criteria were reviewed. A total of 209 of 335 physicians (62%) had transactions reported in the Center for Medicaid and Medicare Services, which totaled $1.99 million. Twenty-four of 335 physicians (7%) listed companies with their abstracts; 5 of those 24 physicians were concordant with the Center for Medicaid and Medicare Services. The total amount of all nondisclosed transactions was $1.3 million. Transactions reported in the Center for Medicaid and Medicare Services associated with a single physician ranged from $11.72 to $405,903.36. Of the 209 physicians with Center for Medicaid and Medicare Services transactions that were not disclosed, the majority (68%) had at least 1 company listed in the Center for Medicaid and Medicare Services that was determined after review to be related to the subject of their abstract. Voluntary disclosure of financial relationships was poor, and the majority of unlisted disclosures in the abstract book were companies related to the scientific content of the abstract. Better transparency is needed by physicians responsible for the content presented at gynecological scientific meetings.

TU‐D‐201‐01: 2016 Economics Update

The purpose of this session is to introduce attendees to the healthcare reimbursement system and how it applies to the clinical work of a medical physicist. This will include general information about the different categories of payers and payees, how work is described by CPT codes, and how various payers set values for this work in different clinical settings. 2016 is another year of significant changes to the payment system. This presentation will describe the work encompassed in these codes and will give attendees an overview of the changes for 2016 as they apply to radiation oncology. Finally, some insight into what can be expected during 2017 will be presented. This includes what information is typically released by the Centers for Medicaid and Medicare Services (CMS) during the year and how we as an organization respond. This will include ways members can interact with the AAPM professional economics committee and other resources members may find helpful. Learning objectives1) Basics of how Medicare is structured and how reimbursement rates are set.2) Basic understanding of proposed changes to the 2016 Medicare rules.3) Describe economics and policy resources that are available from the AAPM and how to interact with the professional economics committee.

Rates and Risk Factors for Unplanned Emergency Department Utilization and Hospital Readmission Following Bariatric Surgery.

To identify unplanned emergency resource utilization in the perioperative period following bariatric surgery. Avoidable emergency department (ED) utilization and hospital readmissions pose a significant economic burden to our healthcare system. The extent of this problem is poorly studied in the bariatric literature. Using New York statewide longitudinal administrative data, 38,776 patients, who underwent primary bariatric surgery from 2010 to 2013, were analyzed. Multiple logistic regression models analyzed all variables with P < 0.05 on univariate models. The 30-day unplanned ED utilization rate was 11.3% and 30-day hospital readmission rate was 5.3%. ED visits resulted in an inpatient admission 34.9% of the time. In total, 17.5% had 2 or more 30-day unplanned ED presentations. Patients presenting to the ED were more likely to be black, have pulmonary disease, be insured by the Centers for Medicaid and Medicare Services, travel further distances for index procedure, and have a surgical procedure other than gastric banding. In total, 46.7% presented to a nonindex hospital and 32.5% were admitted. Patients presenting to a nonindex hospital were significantly less likely to be admitted than those presenting to an index hospital. Unplanned perioperative healthcare utilization is a significant burden incurred by the bariatric population. A clear opportunity is identified for improvement in healthcare delivery-particularly for high-risk and high-frequency utilizers. Presentation to nonindex hospitals has important implications to the accuracy of current patient safety and quality outcomes measures. System measures designed to capture all unplanned resource utilization, not just those to index hospitals, are crucial for accurate evaluation.

The Legislative Momentum of Antimicrobial Stewardship: the US Perspective

The aim of this review is to describe new and evolving legislation concerning antimicrobial stewardship at both the state and national level. Antimicrobial resistance is a challenge to health worldwide. Recently, the US federal government has issued reports recognizing it as a serious threat to public health and national security acknowledging the need for judicious antimicrobial use. California has been a pioneer in mandating and implementing antimicrobial stewardship initiatives in healthcare institutions. With the White House Executive Order 13676, a number of healthcare organizations have committed to making antimicrobial stewardship policy and regulatory changes, and it will likely soon be mandatory for all states to comply with a newly created set of standards relating to antimicrobial stewardship in US hospitals and nursing homes. With numerous changes, including governmental and organizational mandates, on the horizon, it is crucial for healthcare institutions to understand and be prepared for this new era in antimicrobial stewardship. The adoption of these new standards by institutions is of an imminent nature. Key Points:• United States federal agencies and the executive branch have recently issued reports characterizing antimicrobial resistance as threats to public health and national security.• The state of California has implemented regulations requiring the establishment of antimicrobial stewardship programs (ASPs) in all acute-care hospitals and long-term care facilities.• A goal of the National Action Plan for Combating Antimicrobial Resistance is establishment of ASPs in acute care hospitals.• Veterans Affairs and Department of Defense facilities have already adopted the ASP requirement; for non-federal hospitals, this mandate will likely be achieved through regulators such as the Centers for Medicaid and Medicare Services.

Health Care Information Technology, Work Organization, and Nursing Home Performance

The authors investigate whether electronic medical record (EMR) systems are associated with higher levels of nursing home performance. Their difference-in-differences analysis is based on a survey of health care information technology (HIT) use in approximately 304 New York State nursing homes, combined with regulatory data from the Center for Medicaid and Medicare Studies (CMS) Nursing Home Compare database and the New York State RHCF-4 financial reports. For nursing home owners, the authors find a positive effect of EMR-system implementation, on the order of 1% higher productivity, 3% greater efficiency, but approximately 2.7% higher cost. They also find that EMR systems amplify the returns to modern workplace organization. Facilities that are one standard deviation higher on a work-organization scale—composed of practices that encourage employee collaboration, decision making, suggestions, and problem solving—have no adverse cost impact of adoption of HIT, and adoption of HIT is associated with a productivity increase of 1.5% or more. They find no evidence of an impact on health care quality.

Patient-Reported Outcome Measures—What Data Do We Really Need?

The Center for Medicaid and Medicare Services has recently announced the inclusion of several patient-reported outcome measures (PROMs), including the abbreviated Hip Disability and Osteoarthritis Outcome Score and Knee Injury and Osteoarthritis Outcome Score for joint replacement (HOOS, JR and KOOS, JR) for the purpose of quality assessment in total hip and total knee replacement (THR and TKR). Historically, Center for Medicaid and Medicare Services and other agencies have used measures of process (eg, % vaccinated) or adverse events (eg, infection rates, readmission rates) for quality assessment. However, the use of PROMs has become a priority based on stated goals by the National Quality Strategy and Institute of Medicine for a more patient-centered approach. Here, we review several general health and joint-specific PROMs, which have been extensively used in research to assess treatment efficacy and discuss their relevance to the new criteria for quality assessment, particularly for THR and TKR. Although we expect HOOS, JR and KOOS, JR to yield much useful information in the near term, these surveys are likely an interim solution. In the future, we anticipate that novel measurement platforms, such as wearable technologies or patient-specific surveys, may open new and exciting avenues of research to discover which types of data—perhaps not previously available—best represent patient quality of life and satisfaction after THR, TKR, or other orthopedic procedures.

Physician Quality Reporting System Program Updates and the Impact on Emergency Medicine Practice.

In 2007, the Centers for Medicaid and Medicare Services (CMS) created a novel payment program to create incentives for physician’s to focus on quality of care measures and report quality performance for the first time. Initially termed “The Physician Voluntary Reporting Program,” various Congressional actions, including the Tax Relief and Health Care Act of 2006 (TRHCA) and Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) further strengthened and ensconced this program, eventually leading to the quality program termed today as the Physician Quality Reporting System (PQRS). As a result of passage of the Affordable Care Act of 2010, the PQRS program has expanded to include both the “traditional PQRS” reporting program and the newer “Value Modifier” program (VM). For the first time, these programs were designed to include pay-for-performance incentives for all physicians providing care to Medicare beneficiaries and to measure the cost of care. The recent passage of the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act in March of 2015 includes changes to these payment programs that will have an even more profound impact on emergency care providers. We describe the implications of these important federal policy changes for emergency physicians.

Abstracts from ATTD 2016 9th International Conference on Advanced Technologies & Treatments for Diabetes Milan, Italy-February 3-6, 2016.

Abstracts from ATTD 2016 9th International Conference on Advanced Technologies & Treatments for Diabetes Milan, Italy-February 3-6, 2016.

Thirty-day readmissions after inpatient laparoscopic cholecystectomy: factors and outcomes

Background30-day readmissions are a considerable financial burden on medical institutions due to penalties faced from the Centers for Medicaid and Medicare. MethodsA retrospective review of 30-day readmissions was performed. The data were subdivided into medical severity–diagnostic related groups 417, 418, and 419, as categorized by the Centers for Medicaid and Medicare. Perioperative variables, diagnostic workup, operative interventions, and postoperative morbidity and outcomes were analyzed. ResultsForty-four (5.9%) readmissions were recorded, of 747 inpatient discharges. The data were further divided into DRGs 417, 418, and 419 with readmission rates of 13.6, 3.6%, and 5.4%, respectively. The highest rate of readmission was within the first 7 days. Etiology was divided into surgical (54.5%) and nonsurgical (45.4%). ConclusionsPatients with major comorbidities had a higher rate of readmission (P < .05). In 45.4% of the readmissions, the cause was found to be nonsurgical. The surgical team was not consulted in 31.8% of the readmissions.