Medicare Improvements For Patients Research Articles

The Impact Of Medicare's Mental Health Cost-Sharing Parity On Use Of Mental Health Care Services.

Before the implementation of cost-sharing parity in Medicare, beneficiaries faced higher cost sharing for mental health services than for other medical services. The Medicare Improvements for Patients and Providers Act of 2008 phased in cost-sharing reductions in Medicare for outpatient mental health services in the period 2010-14. Using data for 2006-15 from the Medical Expenditure Panel Survey and difference-in-differences analyses, we assessed whether this reduction in mental health cost sharing was associated with changes in specialty and primary care outpatient mental health visits and psychotropic medication fills. We compared people with Medicare and with private insurance before and after parity implementation. Medicare beneficiaries' use of psychotropic medication increased after the implementation of cost-sharing parity, but we did not detect a change in visits. Changes in the use of psychotropic medications were greater among people with probable serious mental illness and among Medicare beneficiaries who did not report having supplemental coverage. The increased medication use could signal improvements in mental health care access among Medicare beneficiaries, especially among the subgroups most likely to benefit from the policy change.

Do current quality measures truly reflect the quality of dialysis?

The US End Stage Renal Disease (ESRD) Program, which came into existence in 1973, was initially envisioned to provide needed financial coverage for about 50 000 patients through Medicare. Over the past 45 years the evolution of the ESRD program has been quite different, and it now serves over one half million dialysis and transplant patients. The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 Section 153(c) requires the Centers for Medicare and Medicaid Services (CMS) to develop and implement quality measures for dialysis patients as part of the ESRD Quality Incentive Program (QIP) beginning in payment year (PY) 2012. The annual ESRD Prospective Payment System (PPS) rulemaking process allows CMS to create ESRD QIP rules that specify the measures, scoring methods, and payment reduction ranges applicable to the respective PY. CMS assesses each facility's performance and calculates a score for each measure, according to the method detailed for that PY. Scores for each measure are combined to create the Total Performance Score (TPS) for each facility. If a facility's TPS does not meet or exceed the performance standards established during the earlier comparison period, the facility will incur a payment reduction of up to 2% for the entire PY. The QIP program has evolved over the several years since its inception. There have been deletions and additions of various measures. CMS uses additional measures in its Dialysis Facility Compare (DFC) website which is available to the public and forms the basis of the 5-star rating system for dialysis facilities. The evidence underlying inclusion many of these measures in the QIP and DFC remains an area of debate. In this review, we discuss the evolution of these measures and their appropriateness. We recommend that some of the current QIP and DFC measures should not be used for public reporting and/or payment as unintended consequences may occur. Nonetheless, all the current QIP and DFC measures and others are suitable for internal quality review.

E-Prescribing and Adverse Drug Events: An Observational Study of the Medicare Part D Population With Diabetes.

Although the adoption of e-prescriptions among physicians has increased substantially under the Medicare Improvements for Patients and Providers Act and Meaningful Use programs, little is known of its impact on patient outcomes. To examine the impact of e-prescribing on emergency visits or hospitalizations for diabetes-related adverse drug events (ADEs) including hypoglycemia. This is a prospective, observational cohort study with patient fixed effects. 2011-2013 fee for service Medicare. In total, 3.1 million Medicare fee for service, Part D enrolled beneficiaries over age 66 with diabetes mellitus and at least 90 days of antidiabetic medications. E-prescribing was measured as the percentage of all prescriptions a person received transmitted to the pharmacy electronically. The outcome measure was the occurrence of an emergency department (ED) visit or hospitalization for hypoglycemia or diabetes-related ADE. Unadjusted results show that there were 21 ADEs per 1000 beneficiaries that had ≥75% of their medications e-prescribed. Beneficiaries with lower e-prescribing levels had significantly higher numbers of ADEs. We found a robust association between the greater use of electronic prescriptions in the outpatient setting and the lower risk of an inpatient or ED visit for an ADE event among Medicare beneficiaries with diabetes in our adjusted analysis. At the e-prescribing threshold of 75% and above, significant reductions in ADE risk can be seen. As an observational study, the results show an association but do not prove causation. Use of e-prescribing is associated with lower risk of an ED visit or hospitalization for diabetes-related ADE.

The ESRD Quality Incentive Program-Can We Bridge the Chasm?

The ESRD Quality Incentive Program (QIP) is the first mandatory federal pay for performance program launched on January 1, 2012. The QIP is tied to the ESRD prospective payment system and mandated by the Medicare Improvements for Patients and Providers Act of 2008, which directed the Centers for Medicare and Medicaid Services to expand the payment bundle for renal dialysis services and legislated that payment be tied to quality measures. The QIP links 2% of the payment that a dialysis facility receives for Medicare patients on dialysis to the facility's performance on quality of care measures. Quality measures are evaluated annually for inclusion on the basis of importance, validity, and performance gap. Other quality assessment programs overlap with the QIP; all have substantial effects on provision of care as clinicians, patients, regulators, and dialysis organizations scramble to keep up with the frequent release of wide-ranging regulations. In this review, we provide an overview of quality assessment and quality measures, focusing on the ESRD QIP, its effect on care, and its potential future directions. We conclude that a patient-centered, individualized, and parsimonious approach to quality assessment needs to be maintained to allow the nephrology community to further bridge the quality chasm in dialysis care.

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.

Creating Accountability in Image Quality Analysis. Part 2: Medical Imaging Accreditation

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requires all non-hospital providers of advance diagnostic imaging (ADI) submitting technical reimbursement claims to Medicare to undergo a formal accreditation in order to qualify for continued Medicare reimbursement (http://www.govtrack.us/congress/bills/110/hr6331/text). ADI includes MRI, CT, and nuclear medicine imaging and does not include X-ray, ultrasound, and fluoroscopy. Mammography is covered separately by the Mammography Quality Standards Act (http://www.fda.gov/CDRH/MAMMOGRAPHY). The quality standards which must be demonstrated by medical imaging providers in this accreditation process include the following (http://www.cms.gov/outreach-and-education/medicare-learning-network-MLN/MLNI): Qualifications of medical personnel who are not physicians Qualifications and responsibilities of medical directors and supervisory physicians Procedures to ensure equipment being used meets performance specifications Procedures to ensure the safety of both medical imaging beneficiaries and personnel Establishment and maintenance of a quality assurance and quality control program to ensure reliability, clarity, and accuracy of image technical quality The accreditation process is triennial and averages US$3,500 per imaging modality being evaluated. In the event that an applicant is determined to be noncompliant with the established standards, a corrective action plan is required, with the possibility of a site visit. After the accreditation process has been successfully completed, the provider is required to notify the accreditation organization of any change in service (e.g., equipment change).

Medicare Part D Prescription Drug Program: Benefits, Unintended Consequences and Impact on Health Disparities

Medicare Part D Prescription Drug Program: Benefits, Unintended Consequences and Impact on Health Disparities

TU‐A‐211‐01: ACR MRI Accreditation: Process and Pitfalls

ACR MRI accreditation was initiated in 1996. Over the years, the accreditation process and requirements have evolved in order to keep pace with the rapidly changing MRI technology. This presentation will briefly review changes that have been initiated in response to the changing technology along with the evolving changes in the responsibilities of the Medical Physicist for providing advice and support for system performance, quality assurance and safety. Specific differences in the accreditation process between conventional general‐purpose MRI systems and specialty (extremity) systems used for anatomical imaging and systems used for breast imaging will be discussed. Additional requirements that have resulted from the Medicare Improvements for Patients and Providers Act (MIPPA), common reasons for accreditation failure and the anticipated changes and updates to the 2004 ACR MRI Quality Control Manual will also be discussed.Learning Objectives:1. Review the responsibilities of the Medical Physicist in the accreditation process2. Discuss the CMS/MIPPA accreditation requirements as of January 1, 2012.3. Review differences in breast and specialty (extremity) system accreditation4. Discuss common reasons for accreditation failure5. Discuss anticipated changes and updates in the ACR MRI Quality Control Manual

Financial Implications of Choice of Dialysis Type of the Revised Medicare Payment System: An Economic Analysis

In 2011, the Medicare Improvements for Patients and Providers Act replaced the case-mix-adjusted composite payment system for Medicare outpatient dialysis facilities with a bundled end-stage renal disease prospective payment system (PPS). We assessed the economic implications for modality choice of the revised Medicare payment system. Microeconomic analyses. Patients eligible for dialysis in the United States. The perspective of this analysis is that of a financial administrator of a representative dialysis center in the United States. Data were obtained from the Medicare Payment Advisory Commission, the US Renal Data System, the DOPPS (Dialysis Outcomes and Practice Patterns Study) Practice Monitor, the US Bureau of Labor Statistics, and Medicare fee schedules. Recently implemented end-stage renal disease PPS versus the prior case-mix composite payment system. Medicare payment per month, center fixed and variable costs per month, net difference in revenue and variable costs (direct contribution), and net difference in revenue and total costs (operating margin). The direct contribution and operating margin for in-center hemodialysis and peritoneal dialysis are expected to be positive under the new bundled PPS. For Medicare fiscal intermediaries/administrators, paid treatments for home hemodialysis vary from 3.2 to more than 4.8 per week. The direct contribution and operating margin are expected to be negative for home hemodialysis if the number of paid treatments is similar between in-center and home hemodialysis; they are almost identical when the number of paid treatments increases for home hemodialysis by approximately 1 per week. Experience across centers and intermediaries/administrators may vary. Sensitivity analyses were conducted to assess the robustness of findings and determine which variables most influenced results. The new bundled PPS created a financial incentive for increased use of peritoneal dialysis. Use of home hemodialysis may be influenced by number of paid treatments per week.

Perspectives on the New Kidney Disease Education Benefit: Early Awareness, Race and Kidney Transplant Access in a USRDS Study

Education services for Stage-IV chronic kidney disease patients were added in 2010 as a Part B covered benefit under the Medicare Improvements for Patients and Providers Act. Desired outcomes include early pursuit of kidney transplantation by more patients and reduction of racial disparities in access to transplantation. During 2005-2007, a United States Renal Data System (USRDS) special study surveyed 1123 patients in a national cohort who had recently started dialysis, identified themselves as black or white, and were reported by their physician as potentially eligible transplant candidates. Patients were asked if kidney transplantation had been discussed with them before they initiated renal replacement therapy, and survey responses were linked with subsequent wait listing and transplant events in USRDS registry files. Kaplan-Meier analyses showed a significant association between early transplant awareness and subsequent wait listing. Adjusted Cox models showed a significant race/early transplant awareness interaction, however, with the impact of early awareness on wait listing much stronger for whites. Ongoing support and education about kidney transplantation for patients after dialysis start could help to build on early education and foster greater quality improvement in patient outcomes.

E-Prescribe Meaningful Use Requirement

In july 2008, congress passed HR 6331, also known as “Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)” (http://www.govtrack.us/congress/billtext.xpd?bill=h110-6331).1 Section 132, which introduced incentives for electronic prescribing (known as e-prescribe or eRx), is now becoming extremely relevant for hand surgeons. Compliance with this new program offered financial incentives from 2009 to 2010, but failure to comply is now costing practitioners future Medicare revenue. All eligible practitioners who failed to dispense 10 e-prescriptions during the first 6 months of 2011 will forfeit 1% of their 2012 Medicare reimbursement, and those who fail to reach 25 e-prescriptions by the end of 2011 will lose an additional 1.5% in 2013.

2012 Revisions to Medicare Fee Schedule Proposed

2012 Revisions to Medicare Fee Schedule Proposed

CMS Adds Exemptions to Rules Requiring Electronic Prescribing

Back to table of contents Previous article Next article Government NewsFull AccessCMS Adds Exemptions to Rules Requiring Electronic PrescribingJonathan WolfeJonathan WolfeSearch for more papers by this authorPublished Online:19 Aug 2011https://doi.org/10.1176/pn.46.16.psychnews_46_16_6_2AbstractEligible individual physicians and group practices will have more time and greater flexibility in meeting new electronic prescribing standards under a proposed rule issued May 26 by the Centers for Medicare and Medicaid Services (CMS). APA joined the AMA in commending the federal agency for its efforts to clarify the requirements of the Electronic Prescribing (eRx) Incentive Program and address previously voiced concerns about physicians' ability to comply with the new regulations in the originally mandated time frame. The Medicare Improvements for Patients and Providers Act, which was implemented in 2009, requires that the new eRx procedures be implemented by June 30. Those meeting the electronicprescribing requirements are eligible for a 1 percent Medicare payment bonus in 2012, while those failing to meet the deadline will incur a 1 percent reduction in Medicare payments in 2012, increasing to 2 percent in 2014. The proposed rule would extend the deadline for compliance with the act to October 1, as well as offer additional hardship exemptions. Currently, the only valid exemptions from the eRx program's 2012 payment adjustments are for professionals practicing in rural areas with limited access to high-speed Internet connections or in locations with a limited number of pharmacies capable of receiving electronic prescriptions. CMS proposes four new hardship exemption categories in the revised rule: Physicians who register to participate in the Medicare or Medicaid Electronic Health Record (EHR) Incentive Programs and adopt certified EHR technology. These alternative electronic-prescribing programs are similar to the eRx program, and the proposed rule was introduced in part to "reduce redundant, inconsistent, or overlapping regulatory requirements." Physicians who are unable to prescribe electronically due to local, state, or federal laws or regulations. APA Medical Director and CEO James H. Scully Jr., M.D., noted in his comments to CMS that states such as New York and Ohio have regulations prohibiting physicians from electronically prescribing controlled substances. These laws would result in some physicians' incurring financial penalties under the federal eRx program while in the process of complying with state prescription regulations. Physicians who have limited prescribing activity. Scully noted that this exemption would apply to psychiatrists who primarily conduct outpatient psychotherapy and rarely prescribe medication for their patients. Physicians lacking sufficient opportunities to prescribe electronically due to patient interactions deemed ineligible for consideration under the program. As an example of this exemption, Scully cited a physician who regularly bills Medicare for medication-management visits in an inpatient setting, as opposed to in the outpatient setting specifically addressed in the eRx rule. More information on the 2010 eRx Incentive Program can be accessed at <www.cms.gov/ERxIncentive/02_Spotlight.asp>. APA's comments are posted at <www.psych.org/MainMenu/AdvocacyGovernmentRelations/GovernmentRelations/RegulatoryComments/ErX-Incentive-Program.aspx?FT=.pdf>. ISSUES NewArchived

ABFM's Physicians Quality Reporting System Registry

In 2006, Congress passed the Tax Relief and Health Care Act, which included provisions requiring the Centers for Medicare and Medicaid (CMS) to establish a quality reporting system, the Physicians Quality Reporting Initiative (now called the Physicians Quality Reporting System) for eligible health care providers, which would include financial incentives for participants.1 This system initially used a fairly cumbersome set of “G-Codes” for reporting quality indicators as part of the claims process. Subsequently, the Medicare, Medicaid, and SCHIP Extension Act of 2007 and the Medicare Improvements for Patients and Providers Act of 2008 provided an alternative registry method for reporting quality indicators in the incentive program.1 Under the registry method, quality organizations could apply to become approved registries and submit data on behalf of their clients. The application process included interviews by CMS staff, as well as a description of the organization’s proposed registry architecture and structure. The first registries approved became active in the second half of 2008. The American Board of Family Medicine (ABFM) was the only medical specialty board approved in the initial group of registries. ABFM built upon its Diabetes Performance in Practice Module (PPM) in implementing its registry.2 The registry program allows participating organizations to use “measures groups” for reporting quality information,3 and the indicators in the diabetes measures group correspond closely to those included in ABFM’s Diabetes PPM (eg measurement of HbA1c and LDL levels, foot examination etc.)4 Because the registry started in mid-year 2008, Diplomates who participated reported data for only the last 6 months of the year. In 2009 and 2010, participants collected patient information for the whole year. Participants are required to report measures information for 30 diabetic patients over the year, and the patients they select must include at least 2 Medicare part B recipients. ABFM provides templates that Diplomates use for extracting their measures information, and then submit these data (de-identified) online via a secure connection to ABFM servers. ABFM then submits these data on behalf of the Diplomates, using submission templates specified by CMS.5 The financial incentives for participants have been potentially substantial: in 2008, the incentive consisted of 1.5% of all of a participant’s Medicare billings; the incentive rose to 2% in 2009, fell back to 1.5% for 2010 and will equal 1% in 2011. Medicare doesn’t report to the registries the amounts paid to participants, but anecdotal information suggests that ABFM registry participants have averaged bonuses of approximately $1,200 (James Puffer, MD, personal communication 3/9/11.) The registry has experienced varied participation since inception. 383 Diplomates submitted data in 2008, 722 in 2009, and we expect to submit 2010 data for 867 participants. Our registry process includes an audit of 3% of participants’ submissions. ABFM selects at random 3% of the participants, and contracts with a third party to audit the charts used for abstracting and reporting performance data. The audit process consists of comparing actual chart entries with the data submitted to the registry. These reviews have indicated high concordance between the reported and chart data: the 2008 submissions indicated 96% concordance between the registry submission and medical record data. The 2009 audit revealed approximately 94% agreement. The 2010 audit will occur later this spring. In developing the registry, ABFM has striven to provide enhanced value for Diplomates who participate. Since the data elements correspond closely to those in the Diabetes PPM, Diplomates can choose to use their registry submissions for both the Physicians Quality Reporting System program and for the patient data required for the Diabetes PPM. Participants who select this option can use 1 year’s Physicians Quality Reporting System data as their PPM pre-intervention submission, and the next year’s Physicians Quality Reporting System data for their PPM post-intervention submission. This allows a Diplomate to accomplish a “threefer” for the same activities: 2 years of Physicians Quality Reporting System participation, as well as satisfaction of their MC-FP Part IV stage requirement. In summary, ABFM engaged in the Physicians Quality Reporting System program to provide a service to our Diplomates (ABFM does not charge for Diplomate participation in the registry), and to enhance the value of MC-FP in Diplomates’ ongoing professional activities. We hope more Diplomates will take advantage of this process!

Physician Quality Reporting Initiative

The 2006 Tax Relief and Health Care Act required the establishment of a physician quality reporting system, including an incentive payment for eligible professionals (EPs) who satisfactorily report data on quality measures for covered professional services furnished to Medicare beneficiaries during the second half of 2007 (the 2007 reporting period). The Centers for Medicare and Medicaid Services (CMS) named this program the Physician Quality Reporting Initiative (PQRI). The PQRI was further modified as a result of the Medicare, Medicaid, and SCHIP Extension Act of 2007 and the Medicare Improvements for Patients and Providers Act of 2008.

Mental Health Parity Legislation

Although recognition and treatment of mental health disorders have become integrated into routine medical care, inequities remain regarding limits on mental health outpatient visits and higher copayments and deductibles required for mental health services when accessed. Two federal laws were passed by Congress in 2008: The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act and the Medicare Improvements for Patients and Providers Act. Both laws became effective on January 1, 2010. The purpose of this article is to discuss provisions of each act and provide clinical examples describing how patients are affected by lack of parity and may potentially benefit from implementation of these new laws. Using available evidence, we examine the potential strengths and limitations of mental health parity legislation from the health policy perspectives of health care access, cost, and quality and identify the important role of nurses as patient and mental health parity advocates.

Medicare Payment Advisory Commission Report to the Congress, March 2010

EDITOR'S ABSTRACTThe Medicare Payment Advisory Commission is required to report to Congress each March. A summary of the 2010 report is presented including payment policy recommendations for 10 payment systems and the Commission response to the Medicare Improvements for Patients and Providers Act. The status of Medicare Advantage and prescription drug plans also are addressed.

ASN End-Stage Renal Disease Task Force

For the first time in nearly 30 years, the Centers for Medicare and Medicaid Services (CMS) will implement a new payment system for dialysis patients. Since 1983, Medicare has reimbursed each dialysis session with a prospective payment—known as the composite rate—designed to cover the cost of center or home dialysis.1 Since implementation of the composite rate, however, new therapies—including erythropoietin, vitamin D, and iron—have emerged as new additional costs for standard dialysis care. These therapies are reimbursed separately from the composite rate and now compose approximately 40% of the total Medicare payment for each dialysis treatment.2 To improve the efficiency and flexibility of the ESRD Program, the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 mandated implementation of a comprehensive, case mix–adjusted, bundled-rate payment system for ESRD that includes therapies currently reimbursed outside the composite rate.3 The ESRD Prospective Payment System will be phased in on January 1, 2011, and fully implemented by 2014. Although MIPPA outlines the basic approach to bundling, the legislation grants CMS authority to finalize the components of the bundle and generate a detailed implementation plan. In September 2009, CMS released for public comment a proposed rule on ESRD bundling and is expected to issue a final rule on ESRD bundling in 2010. In addition, CMS is projected to release a proposed rule on a quality improvement program for ESRD care. Given the monumental significance of the new payment system, the American Society of Nephrology (ASN) formed an ESRD task force to assess and respond comprehensively to the proposed rule changes. Eight ASN members from diverse specialties and practice settings served on this task force, including early-career and established nephrologists as well as ASN policy staff. ASN's foremost concerns relate to preservation of patient access to optimal dialysis care and related …

TH-B-201C-01: Nuclear Medicine Accreditation Acceptance Testing and Annual Surveys

With the passing of the Medicare Improvements for Patients and Providers Act (MIPPA) MIPPA requires facilities that are billing for these services under Medicare B to be accredited by January 1 2012. CMS has recognized the American College of Radiology the Intersocietal Accreditation Commission and the Joint Commission as the three organizations approved for accrediting facilities. This talk will focus primarily on understanding the ACR requirements and procedures for accreditation of (PET and Nuclear Medicine imaging services) with a focus on the Physicist's role in the process Accreditation by the ACR requires both Acceptance testing and Annual performance testing be performed by a qualified individual. The procedures for performing these tests will be reviewed with a focus on avoiding many of the common pitfalls that may cause facilities to fail the process. The recently modified ACR procedures for acquiring and submitting Quality Controlimages for review will be discussed. Other areas that will be covered include the following: 1. Physicist Personnel Qualifications 2. Quality Control Requirements 3. ACR review of clinical and phantom images Learning Objectives: 1. Understand common pitfalls associated with annual and acceptance testing. 2. Understand the personnel qualifications for physicists. 3. Understand the ACR protocol for acquiring and submission of QC images. Conflict of Interest: The company that I work for conducts annual performance testing of Nuclear Medicine equipment for facilities in support of ACR accreditation. I am a physics reviewer for the American College of Radiology. I do not speak on behalf American College of Radiology.

Guest Editorial: Patient safety and errors in the application of medical radiation: our responsibility

Guest Editorial: Patient safety and errors in the application of medical radiation: our responsibility