« The Dual Agenda: August 11, 206 Issue

Noteworthy News

CMS Continues to Push Hospitals to Improve While Hospital Industry Objects to Rating Measures

The Centers for Medicare and Medicaid Services (CMS) released its first overall hospital quality ratings on July 27 with some well-known teaching hospitals with stellar reputations not receiving the highest rating of five stars, while a number of lesser-known hospitals did. CMS’ efforts to rate hospitals remain controversial, especially with hospital administrators, who complain that the measures do not adequately account for hospitals that serve low-income populations. In related news, the penalties imposed by CMS on hospitals with large numbers of avoidable readmissions will reach a new high next year. CMS is expected to assess penalties on more than half of the nation’s hospitals – about the same number as last year – but the amount of the penalties will increase by an average of 20 percent.

CMS Expands Bundled Payment Program for Medicare Enrollees

Following on its promising program to require bundled payments for Medicare patients receiving hip and knee joint replacements, the Centers for Medicare and Medicaid Services (CMS) has proposed a new pilot mandatory bundled payment program for patients who undergo bypass surgeries or who are treated for heart attacks. CMS will hold a randomly selected group of hospitals from 98 metropolitan areas accountable for the total cost and quality of care provided to Medicare patients receiving these cardiac services. CMS expects to save $170 million over five years under the program. CMS is also planning to expand its bundled payment program for lower extremity joint replacement to include fractures of the hip and femur.

CMS Launches New Primary Care Medical Home Model in 15 Regions

The Centers for Medicare and Medicaid Services launched a new nation-wide primary care medical home model, Comprehensive Primary Care Plus (CPC+), that aims to strengthen primary care through a regionally-based multi-payer payment reform and care delivery transformation initiative. Eligible practices may apply between Aug. 1 and Sept. 15 to participate for the five-year model, which will begin in January 2017. The following regions were selected for CPC+:

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