On April 2-3, 2015, the Medicare Payment Advisory Commission (MedPAC) is meeting to discuss various Medicare policy issues, including: hospital short stay policy; polypharmacy/multiple drug use (focusing on Part D opioid use); Medicare Part D risk sharing; measuring low-value care; using episode bundles to improve care efficiency (including potential refinements to the Medicare spending per beneficiary measure); bundling oncology services; and synchronizing Medicare policy across payment models.
CMS is hosting a series of calls to discuss its new “Next Generation” ACO Model, which is intended to promote Medicare quality improvement and care coordination. The following upcoming calls are scheduled:
• March 31, 2015 -- Focusing on financial methodology and related issues;
• April 7, 2015 – Focusing on benefit enhancements and beneficiary care coordination reward; and
• April 14, 2015 – Focusing on letter of intent and application.
On March 10, 2015, CMS announced the Next Generation Accountable Care Organization (ACO) Model, its latest Affordable Care Act (ACA) innovation initiative intended to promote Medicare quality improvement and care coordination. The Next Generation ACO Model differs from the existing Medicare Shared Savings Program and Pioneer ACO models in several ways. For instance, the Next Generation ACO Model:
- Provides higher levels of risk and reward, using what CMS characterizes as more stable, predictable benchmarking methods that reward both attainment and improvement in cost containment and that move away from comparisons to an ACO’s historical expenditures;
- Offers a selection of payment mechanisms to shift from fee-for-service (FFS) reimbursement to capitation; and
- Includes “benefit enhancement” tools to improve engagement with beneficiaries, including (1) greater access to home visits, telehealth services, and skilled nursing facilities; (2) opportunities to receive a reward payment for receiving care from the ACO; (3) a process to allow beneficiaries to confirm their care relationship with ACO providers; and (4) CMS-ACO collaboration to improve communication with beneficiaries about the potential benefits of ACOs.
CMS plans two rounds of applications for the Next Generation ACO Model in 2015 and 2016, with participation expected to last up to five years. Letters of Intent for the 2015 cycle are due May 1, 2015, and applications are due June 1, 2015. CMS plans an “Open Door Forum” call to discuss the new model on March 17, 2015.
CMS Posts Deadlines for 2016 Medicare Shared Savings Program Application Cycle; Schedules Informational Calls
CMS is gearing up for the program year 2016 Medicare Shared Savings Program, under which physicians, hospitals, and certain other types of providers and suppliers may form Accountable Care Organizations (ACOs) to provide cost-effective, coordinated care to Medicare fee-for-service beneficiaries. CMS has posted the deadlines for applying to the program for 2016 (the notice of intent deadline is May 29, 2015, and the application deadline is July 31, 2015). In addition, CMS is hosting an April 7, 2015 call to discuss organizational structure and governance requirements, antitrust considerations, and the application process for January 2016 starters. An April 21 call will cover ACO participant agreements, ACO participant lists, and beneficiary assignment.
On April 1, 2015, the FDA is hosting a workshop entitled “Clinical Outcomes Assessment Development and Implementation: Opportunities and Challenges.” The workshop will update the public on ongoing efforts in the use of clinical outcome assessments (COAs), and plan for the future of COA development and utilization in drug development programs. The workshop will also discuss how to incorporate patient-centered outcome measures, standards for COA use, and collaborative processes for COA development and dissemination. Interested parties may participate in person or via webcast. The registration deadline is March 27, 2015.
On March 18, 2015, CMS is hosting a call to discuss how providers may report once across various 2015 Medicare Quality Reporting Programs, including the Physician Quality Reporting System (PQRS), the Medicare Electronic Health Record (EHR) Incentive Program, the Value-Based Modifier (VM) program, and the Medicare Shared Savings Program. Providers that satisfactorily report will avoid the 2017 PQRS negative payment adjustment, satisfy the Clinical Quality Measure component of the Medicare EHR Incentive Program, and satisfy requirements for the VM.
On March 11, 2015, CMS is hosting a call to discuss paper and clinical templates intended to assist physicians and practitioners in documenting patient eligibility for Medicare home health benefits. In announcing the call, CMS notes that the fiscal year 2014 Comprehensive Error Rate Testing (CERT) program identified a high proportion of claims with inadequate documentation supporting the face-to-face encounter requirement. Additional CMS calls on the templates will be held on April 8 and May 6, 2015.
CMS has announced that it is holding series of meetings in May 2015 to discuss pending Healthcare Common Procedure Coding System (HCPCS) applications. The meeting dates are as follows:
May 7 & 8 -- Drugs/Biologicals/Radiopharmaceuticals/Radiologic Imaging Agents
May 21 & 22 -- Supplies and Other
May 27 -- Durable Medical Equipment (DME) and Accessories; and Orthotics and Prosthetics (O&P)
Deadlines and instructions for speaker and general registration and submission of comments are set forth in a notice to be published tomorrow. Additional information, include preliminary coding determinations, will be posted in advance of each meeting at the CMS HCPCS website.
CMS is hosting a call on Wednesday, February 25, to discuss implementation of the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). The IMPACT Act requires the submission of standardized data by long-term care hospitals, skilled nursing facilities, home health agencies, and inpatient rehabilitation facilities. On the call, CMS will provide an overview of the requirements related to the use of standardized data for both the quality measures and the assessment instrument domains. CMS will also accept comments on this topic. Additional information is posted on the CMS Impact Act web page.
Today CMS is hosting an Open Door Forum call to discuss several Medicare developments impacting hospitals, including changes CMS has made to the recovery audit program to strengthen oversight, reduce the provider burden, and enhance program transparency. The call begins at 2:00 eastern.
CMS has scheduled a series of provider calls in February and March on the following topics:
- February 3: Special Open Door Forum on the upcoming Prior Authorization of Non-Emergent Hyperbaric Oxygen Therapy model to be implemented in March in Illinois, Michigan, and New Jersey.
- February 4: Special Door Forum on the introduction of star ratings on Dialysis Facility Compare.
- February 5: Special Open Door Forum on the planned addition of star ratings to the Home Health Compare website.
- February 18: National provider call on payment of chronic care management services under the 2015 Medicare physician fee schedule.
- February 26: National provider call on ICD-10 implementation and Medicare testing.
- March 10: National provider call on National Partnership to Improve Dementia Care in Nursing Homes and Quality Assurance and Performance Improvement (QAPI) standards.
On February 24, 2015, the Federal Trade Commission and the Department of Justice Antitrust Division will hold a public workshop on health care provider organization and payment model developments that may affect competition in the provision of health care services. Topics for discussion include: accountable care organizations; alternatives to traditional fee-for-service payment models; trends in provider consolidation; provider network and benefit design strategies; and health insurance exchanges. The government also will accept comments on specific questions related to health care competition until April 30, 2015.
On January 15-16, 2015, the Medicare Payment Advisory Commission (MedPAC) is meeting to discuss a number of Medicare topics, including, among others: post-acute care trends; payment updates for a number of provider types; relative costs of Medicare Advantage, accountable care organizations, and fee-for-service Medicare; hospital short stay policy; and quality measurement.
On January 13, 2015, CMS is hosting a national provider call to provide an overview of the 2014 submission process for Medicare quality reporting programs, including the Physician Quality Reporting System (PQRS), Value-Based Payment Modifier, and the Electronic Health Record Incentive Program. This session will discuss how eligible professionals and PQRS group practices can earn the 2014 PQRS incentive and avoid the 2016 negative PQRS payment adjustment through these reporting mechanisms.
On February 20, 2015, the FDA is hosting a public workshop on “Optimizing FDA’s Regulatory Oversight of Next Generation Sequencing Diagnostic Tests.” The purpose of the workshop is to receive feedback from the community on FDA’s regulatory approach to diagnostic tests for human genetics or genomics using Next Generation Sequencing (NGS) technology. As pointed out in an FDA preliminary discussion paper, “NGS tests are unique among existing [in vitro diagnostics] in the amount of data that can be generated, the lack of an a priori definition of what will be detected, and the number of clinical interpretations that can be made from a single patient sample.” The FDA is considering several regulatory approaches to regulating NGS tests, including a standards-based approach to analytical performance of NGS tests and the use of centralized curated databases containing up-to-date evidence to support clinical performance.
On December 18-19, 2014, the Medicare Payment Advisory Commission (MedPAC) is meeting to discuss payment adequacy and payment update recommendations for Medicare payment systems.
On December 17, 2014, CMS is hosting a Special Open Door Forum (SODF) call to allow stakeholders to provide feedback on the planned addition of star ratings to the Medicare.gov Home Health Compare web site.
The FDA has scheduled a public workshop on the “Framework for Regulatory Oversight of Laboratory Developed Tests'' on January 8 – 9, 2015. The purpose of the workshop is to discuss FDA's proposal for a risk-based framework for addressing the regulatory oversight of “laboratory developed tests,” a subset of vitro diagnostic devices intended for clinical use and designed, manufactured and used within a single laboratory. Among other things, the FDA will address LDT labeling considerations; clinical validity and intended use; enforcement discretion; adverse event reporting; quality system regulation; and procedural issues. The workshop registration deadline is December 12, 2014. FDA will accept comments related to the public workshop until February 2, 2015.