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Nearly all rheumatology slots filled on Specialty Match Day
Once again, rheumatology filled almost every slot offered in the annual Specialty Match.
The specialty had 221 open positions to be filled, with only 3 left open when the 2017 results were announced on Dec. 6.
The number of available positions was up from the 217 slots in 2016, with 7 positions unfilled last year. The number of applicants naming rheumatology as the preferred choice was virtually unchanged year over year, with 313 this year vs. 312 last year.
Of the 313 applicants who identified rheumatology as the preferred choice, 217 were matched to rheumatology, 3 were matched to a different specialty, and 93 did not match.
“Rheumatology did very, very well this year, even better than last year, although it was comparable,” Anne Bass, MD, rheumatology fellowship program director at the Hospital for Special Surgery, New York, said in an interview.
Dr. Bass, who also serves as chair of the American College of Rheumatology Committee on Rheumatology and Training and Workforce Issues, said she expects the remaining open slots to be filled.
“Usually what happens is something called the scramble, which is after the match is over, [the National Resident Matching Program] has a clearinghouse for fellows who haven’t matched and programs that still have slots,” she said in an interview. “It connects them together. I would guess the positions will either be filled or that they are positions that are really targeted, say, for research applicants and there wasn’t anybody appropriate for that position.”
“You do want some excess because not all applicants are necessarily qualified, so you don’t want to have just the right amount of spots if you want to have the best people filling them,” she said, noting that this year, like last, there was around 100 applicants who listed rheumatology as their first choice that did not get assigned as fellowship, about double the number from a few years ago. “At the same time, with the anticipated workforce shortage, what this is telling us is if we created more fellowship slots, we have lots and lots of applicants to fill those slots.”
Dr. Bass said funding issues were the primary stumbling block to training more fellows. She also said more needs to be done to address geographic disparities, as these programs tend to be at major academic institutions in dense urban areas and many fellows practice at sights where they are trained, magnifying shortages in rural areas.
The similarities between last year’s rheumatology fellowship match results and this year’s are in line with what is happening in other specialties.
“Overall, the percentages of programs and positions filled were almost identical to last year,” Mona Singer, president and CEO of the National Resident Matching Program, said. “The same fellowships were competitive this year when compared to last year.”
Specialties filling more than 90% of positions included cardiovascular disease, endocrinology, gastroenterology, hematology/oncology, pulmonary/critical care, and rheumatology.
Ms. Singer noted that infectious diseases and nephrology “have implemented the ‘all-in policy,’ which requires any program participating in the match to place all positions. This was the first year infectious diseases used the policy, and there was a modest improvement in the number of positions filled. Nephrology was unchanged.”
Overall, 4,831 fellowships were available and 4,242 filled. The 87.8% of positions filled is a slight uptick over the 87.5% of positions filled in 2016. A total of 1,249 applicants did not match.
Once again, rheumatology filled almost every slot offered in the annual Specialty Match.
The specialty had 221 open positions to be filled, with only 3 left open when the 2017 results were announced on Dec. 6.
The number of available positions was up from the 217 slots in 2016, with 7 positions unfilled last year. The number of applicants naming rheumatology as the preferred choice was virtually unchanged year over year, with 313 this year vs. 312 last year.
Of the 313 applicants who identified rheumatology as the preferred choice, 217 were matched to rheumatology, 3 were matched to a different specialty, and 93 did not match.
“Rheumatology did very, very well this year, even better than last year, although it was comparable,” Anne Bass, MD, rheumatology fellowship program director at the Hospital for Special Surgery, New York, said in an interview.
Dr. Bass, who also serves as chair of the American College of Rheumatology Committee on Rheumatology and Training and Workforce Issues, said she expects the remaining open slots to be filled.
“Usually what happens is something called the scramble, which is after the match is over, [the National Resident Matching Program] has a clearinghouse for fellows who haven’t matched and programs that still have slots,” she said in an interview. “It connects them together. I would guess the positions will either be filled or that they are positions that are really targeted, say, for research applicants and there wasn’t anybody appropriate for that position.”
“You do want some excess because not all applicants are necessarily qualified, so you don’t want to have just the right amount of spots if you want to have the best people filling them,” she said, noting that this year, like last, there was around 100 applicants who listed rheumatology as their first choice that did not get assigned as fellowship, about double the number from a few years ago. “At the same time, with the anticipated workforce shortage, what this is telling us is if we created more fellowship slots, we have lots and lots of applicants to fill those slots.”
Dr. Bass said funding issues were the primary stumbling block to training more fellows. She also said more needs to be done to address geographic disparities, as these programs tend to be at major academic institutions in dense urban areas and many fellows practice at sights where they are trained, magnifying shortages in rural areas.
The similarities between last year’s rheumatology fellowship match results and this year’s are in line with what is happening in other specialties.
“Overall, the percentages of programs and positions filled were almost identical to last year,” Mona Singer, president and CEO of the National Resident Matching Program, said. “The same fellowships were competitive this year when compared to last year.”
Specialties filling more than 90% of positions included cardiovascular disease, endocrinology, gastroenterology, hematology/oncology, pulmonary/critical care, and rheumatology.
Ms. Singer noted that infectious diseases and nephrology “have implemented the ‘all-in policy,’ which requires any program participating in the match to place all positions. This was the first year infectious diseases used the policy, and there was a modest improvement in the number of positions filled. Nephrology was unchanged.”
Overall, 4,831 fellowships were available and 4,242 filled. The 87.8% of positions filled is a slight uptick over the 87.5% of positions filled in 2016. A total of 1,249 applicants did not match.
Once again, rheumatology filled almost every slot offered in the annual Specialty Match.
The specialty had 221 open positions to be filled, with only 3 left open when the 2017 results were announced on Dec. 6.
The number of available positions was up from the 217 slots in 2016, with 7 positions unfilled last year. The number of applicants naming rheumatology as the preferred choice was virtually unchanged year over year, with 313 this year vs. 312 last year.
Of the 313 applicants who identified rheumatology as the preferred choice, 217 were matched to rheumatology, 3 were matched to a different specialty, and 93 did not match.
“Rheumatology did very, very well this year, even better than last year, although it was comparable,” Anne Bass, MD, rheumatology fellowship program director at the Hospital for Special Surgery, New York, said in an interview.
Dr. Bass, who also serves as chair of the American College of Rheumatology Committee on Rheumatology and Training and Workforce Issues, said she expects the remaining open slots to be filled.
“Usually what happens is something called the scramble, which is after the match is over, [the National Resident Matching Program] has a clearinghouse for fellows who haven’t matched and programs that still have slots,” she said in an interview. “It connects them together. I would guess the positions will either be filled or that they are positions that are really targeted, say, for research applicants and there wasn’t anybody appropriate for that position.”
“You do want some excess because not all applicants are necessarily qualified, so you don’t want to have just the right amount of spots if you want to have the best people filling them,” she said, noting that this year, like last, there was around 100 applicants who listed rheumatology as their first choice that did not get assigned as fellowship, about double the number from a few years ago. “At the same time, with the anticipated workforce shortage, what this is telling us is if we created more fellowship slots, we have lots and lots of applicants to fill those slots.”
Dr. Bass said funding issues were the primary stumbling block to training more fellows. She also said more needs to be done to address geographic disparities, as these programs tend to be at major academic institutions in dense urban areas and many fellows practice at sights where they are trained, magnifying shortages in rural areas.
The similarities between last year’s rheumatology fellowship match results and this year’s are in line with what is happening in other specialties.
“Overall, the percentages of programs and positions filled were almost identical to last year,” Mona Singer, president and CEO of the National Resident Matching Program, said. “The same fellowships were competitive this year when compared to last year.”
Specialties filling more than 90% of positions included cardiovascular disease, endocrinology, gastroenterology, hematology/oncology, pulmonary/critical care, and rheumatology.
Ms. Singer noted that infectious diseases and nephrology “have implemented the ‘all-in policy,’ which requires any program participating in the match to place all positions. This was the first year infectious diseases used the policy, and there was a modest improvement in the number of positions filled. Nephrology was unchanged.”
Overall, 4,831 fellowships were available and 4,242 filled. The 87.8% of positions filled is a slight uptick over the 87.5% of positions filled in 2016. A total of 1,249 applicants did not match.
MedPAC: Ditch meaningful use, patient measures under MIPS
WASHINGTON – Population-level outcomes measures are the key focus of a proposed program to replace the Merit-Based Incentive Payment System (MIPS) track in the Medicare Quality Payment Program.
The proposal, under consideration by the Medicare Payment Advisory Commission, also would forgo patient-level outcomes measures, practice-improvement measures, and all measures of the meaningful use of electronic health records.
The Centers for Medicare & Medicaid Services is estimating that the reporting burden for the MIPS program is $1 billion in 2017 alone, MedPAC staff member Kate Blonairz said at a Dec. 7 MedPAC meeting.
The decision to move to outcomes also would take away any reporting on process measures, leaving physicians with more freedom to choose how they reach the outcomes.
Certain previously discussed provisions remain in the proposal, such as withholding a percentage of Medicare fee-for-service payments for clinicians who are not part of an advanced Alternative Payment Model (APM) practice, and giving them the opportunity to earn the funds back via the new Voluntary Value Program (VVP).
The proposal also would remove certain income and beneficiary thresholds in the APM track to expand eligibility and improve retention.
The proposal, which is slated to be refined a little more before being voted on in a January meeting, continued to receive near consensus support from MedPAC commissioners, but concerns were raised.
In particular, the move to a population-based reporting scheme as the way to track and reward performance creates a scaling problem, noted Commissioner David Nerenz, PhD, of the Henry Ford Health System of Detroit.
Virtual reporting groups would be created, and the physicians would be rewarded or penalized based on the numbers reported by that group. However, to get meaningful differences in the reported populations outcomes, Dr. Nerenz noted that the groups will have to be very large.
For example, to detect a 13% difference in readmission rates, you would need 200 cases for each group, he pointed out.
“If I have 200 cases, I can detect a difference of 13% and 0 or I can detect a difference between 13% and 26%, but I sure as heck can’t detect a difference, say, between 13% and 16%,” Dr. Nerenz said, noting that if he wanted to get the difference between 13% and 16%, he would need approximately 7,000 discharges in each group.
The size of the virtual groups, the kinds of outcomes measures, and other fine details would be left to the Centers for Medicare & Medicaid Services to decide via rule making under the current MedPAC proposal.
Commissioner Alice Coombs, MD, of South Shore Hospital, Weymouth, Mass., continued to voice her objection to even the idea of repealing MIPS, noting that the APM reporting model might not line up with value-based purchasing, and process measures would still be in play for APMs; some process measures are actually good in improving quality of care, she argued.
Rita Redberg, MD, of the University of California, San Francisco, called for speedy action on the proposal.
“The time to get rid of MIPS is now because ... as I listen to people, the only thing people say is, well, they have already started getting ready for MIPS,” Dr. Redberg said. “It is not a good reason to continue a terrible system, but the longer it goes on, the more we will hear that.”
WASHINGTON – Population-level outcomes measures are the key focus of a proposed program to replace the Merit-Based Incentive Payment System (MIPS) track in the Medicare Quality Payment Program.
The proposal, under consideration by the Medicare Payment Advisory Commission, also would forgo patient-level outcomes measures, practice-improvement measures, and all measures of the meaningful use of electronic health records.
The Centers for Medicare & Medicaid Services is estimating that the reporting burden for the MIPS program is $1 billion in 2017 alone, MedPAC staff member Kate Blonairz said at a Dec. 7 MedPAC meeting.
The decision to move to outcomes also would take away any reporting on process measures, leaving physicians with more freedom to choose how they reach the outcomes.
Certain previously discussed provisions remain in the proposal, such as withholding a percentage of Medicare fee-for-service payments for clinicians who are not part of an advanced Alternative Payment Model (APM) practice, and giving them the opportunity to earn the funds back via the new Voluntary Value Program (VVP).
The proposal also would remove certain income and beneficiary thresholds in the APM track to expand eligibility and improve retention.
The proposal, which is slated to be refined a little more before being voted on in a January meeting, continued to receive near consensus support from MedPAC commissioners, but concerns were raised.
In particular, the move to a population-based reporting scheme as the way to track and reward performance creates a scaling problem, noted Commissioner David Nerenz, PhD, of the Henry Ford Health System of Detroit.
Virtual reporting groups would be created, and the physicians would be rewarded or penalized based on the numbers reported by that group. However, to get meaningful differences in the reported populations outcomes, Dr. Nerenz noted that the groups will have to be very large.
For example, to detect a 13% difference in readmission rates, you would need 200 cases for each group, he pointed out.
“If I have 200 cases, I can detect a difference of 13% and 0 or I can detect a difference between 13% and 26%, but I sure as heck can’t detect a difference, say, between 13% and 16%,” Dr. Nerenz said, noting that if he wanted to get the difference between 13% and 16%, he would need approximately 7,000 discharges in each group.
The size of the virtual groups, the kinds of outcomes measures, and other fine details would be left to the Centers for Medicare & Medicaid Services to decide via rule making under the current MedPAC proposal.
Commissioner Alice Coombs, MD, of South Shore Hospital, Weymouth, Mass., continued to voice her objection to even the idea of repealing MIPS, noting that the APM reporting model might not line up with value-based purchasing, and process measures would still be in play for APMs; some process measures are actually good in improving quality of care, she argued.
Rita Redberg, MD, of the University of California, San Francisco, called for speedy action on the proposal.
“The time to get rid of MIPS is now because ... as I listen to people, the only thing people say is, well, they have already started getting ready for MIPS,” Dr. Redberg said. “It is not a good reason to continue a terrible system, but the longer it goes on, the more we will hear that.”
WASHINGTON – Population-level outcomes measures are the key focus of a proposed program to replace the Merit-Based Incentive Payment System (MIPS) track in the Medicare Quality Payment Program.
The proposal, under consideration by the Medicare Payment Advisory Commission, also would forgo patient-level outcomes measures, practice-improvement measures, and all measures of the meaningful use of electronic health records.
The Centers for Medicare & Medicaid Services is estimating that the reporting burden for the MIPS program is $1 billion in 2017 alone, MedPAC staff member Kate Blonairz said at a Dec. 7 MedPAC meeting.
The decision to move to outcomes also would take away any reporting on process measures, leaving physicians with more freedom to choose how they reach the outcomes.
Certain previously discussed provisions remain in the proposal, such as withholding a percentage of Medicare fee-for-service payments for clinicians who are not part of an advanced Alternative Payment Model (APM) practice, and giving them the opportunity to earn the funds back via the new Voluntary Value Program (VVP).
The proposal also would remove certain income and beneficiary thresholds in the APM track to expand eligibility and improve retention.
The proposal, which is slated to be refined a little more before being voted on in a January meeting, continued to receive near consensus support from MedPAC commissioners, but concerns were raised.
In particular, the move to a population-based reporting scheme as the way to track and reward performance creates a scaling problem, noted Commissioner David Nerenz, PhD, of the Henry Ford Health System of Detroit.
Virtual reporting groups would be created, and the physicians would be rewarded or penalized based on the numbers reported by that group. However, to get meaningful differences in the reported populations outcomes, Dr. Nerenz noted that the groups will have to be very large.
For example, to detect a 13% difference in readmission rates, you would need 200 cases for each group, he pointed out.
“If I have 200 cases, I can detect a difference of 13% and 0 or I can detect a difference between 13% and 26%, but I sure as heck can’t detect a difference, say, between 13% and 16%,” Dr. Nerenz said, noting that if he wanted to get the difference between 13% and 16%, he would need approximately 7,000 discharges in each group.
The size of the virtual groups, the kinds of outcomes measures, and other fine details would be left to the Centers for Medicare & Medicaid Services to decide via rule making under the current MedPAC proposal.
Commissioner Alice Coombs, MD, of South Shore Hospital, Weymouth, Mass., continued to voice her objection to even the idea of repealing MIPS, noting that the APM reporting model might not line up with value-based purchasing, and process measures would still be in play for APMs; some process measures are actually good in improving quality of care, she argued.
Rita Redberg, MD, of the University of California, San Francisco, called for speedy action on the proposal.
“The time to get rid of MIPS is now because ... as I listen to people, the only thing people say is, well, they have already started getting ready for MIPS,” Dr. Redberg said. “It is not a good reason to continue a terrible system, but the longer it goes on, the more we will hear that.”
REPORTING FROM A MEDPAC MEETING
ABIM to allow do-overs for all subspecialties with Knowledge Check-In
ABIM previously announced that, beginning in 2018, physicians taking the Knowledge Check-In in 2018 would get another chance to take it in 2 years if they were unsuccessful, even if they were due to pass the maintenance of certification (MOC) exam later that year. In 2018, Knowledge Check-Ins will be offered in internal medicine and nephrology.
“Based on feedback ABIM has received from the physician community, we are happy to let you know that we are extending this policy to include all other internal medicine subspecialties in the future,” ABIM said in a Dec. 4 announcement on its website. “This means that if a physician takes the Knowledge Check-In in the first year it is offered in their subspecialty and is unsuccessful, they will get at least one additional opportunity to take and pass it 2 years later.”
The Knowledge Check-In is an alternative to the traditional MOC process, and is administered every 2 years rather than the standard decade between MOC exams. ABIM noted that a single failure on a Knowledge Check-In will not result in a status change to a physician’s certification status.
Separately, ABIM also announced that it will continue to make practice assessment activities (part IV of the MOC program) a part of the portfolio of options that can be used to satisfy MOC requirements.
“Our intent is to support physicians completing MOC activities that are most meaningful to their practice, including those that enhance and improve medical knowledge, as well as many existing quality improvement activities, and those that blend both,” ABIM said in its announcement.
ABIM previously announced that, beginning in 2018, physicians taking the Knowledge Check-In in 2018 would get another chance to take it in 2 years if they were unsuccessful, even if they were due to pass the maintenance of certification (MOC) exam later that year. In 2018, Knowledge Check-Ins will be offered in internal medicine and nephrology.
“Based on feedback ABIM has received from the physician community, we are happy to let you know that we are extending this policy to include all other internal medicine subspecialties in the future,” ABIM said in a Dec. 4 announcement on its website. “This means that if a physician takes the Knowledge Check-In in the first year it is offered in their subspecialty and is unsuccessful, they will get at least one additional opportunity to take and pass it 2 years later.”
The Knowledge Check-In is an alternative to the traditional MOC process, and is administered every 2 years rather than the standard decade between MOC exams. ABIM noted that a single failure on a Knowledge Check-In will not result in a status change to a physician’s certification status.
Separately, ABIM also announced that it will continue to make practice assessment activities (part IV of the MOC program) a part of the portfolio of options that can be used to satisfy MOC requirements.
“Our intent is to support physicians completing MOC activities that are most meaningful to their practice, including those that enhance and improve medical knowledge, as well as many existing quality improvement activities, and those that blend both,” ABIM said in its announcement.
ABIM previously announced that, beginning in 2018, physicians taking the Knowledge Check-In in 2018 would get another chance to take it in 2 years if they were unsuccessful, even if they were due to pass the maintenance of certification (MOC) exam later that year. In 2018, Knowledge Check-Ins will be offered in internal medicine and nephrology.
“Based on feedback ABIM has received from the physician community, we are happy to let you know that we are extending this policy to include all other internal medicine subspecialties in the future,” ABIM said in a Dec. 4 announcement on its website. “This means that if a physician takes the Knowledge Check-In in the first year it is offered in their subspecialty and is unsuccessful, they will get at least one additional opportunity to take and pass it 2 years later.”
The Knowledge Check-In is an alternative to the traditional MOC process, and is administered every 2 years rather than the standard decade between MOC exams. ABIM noted that a single failure on a Knowledge Check-In will not result in a status change to a physician’s certification status.
Separately, ABIM also announced that it will continue to make practice assessment activities (part IV of the MOC program) a part of the portfolio of options that can be used to satisfy MOC requirements.
“Our intent is to support physicians completing MOC activities that are most meaningful to their practice, including those that enhance and improve medical knowledge, as well as many existing quality improvement activities, and those that blend both,” ABIM said in its announcement.
Medicare pay cut may loom in wake of tax bill passage
requiring that any spending increases be offset by other spending cuts.
At issue is the Senate bill’s repeal of the Affordable Care Act requirement that every individual have health insurance – the individual mandate.
In a Nov. 14 letter to the majority and minority leaders of the both the House and Senate, the American Medical Association, the American Academy of Family Physicians, the American Hospital Association, and the Federation of American Hospitals called on Congress to maintain the individual mandate. The four health provider groups were joined in the letter by America’s Health Insurance Plans and the Blue Cross Blue Shield Association.
“Eliminating the individual mandate by itself likely will result in a significant increase in premiums, which would in turn substantially increase the number of uninsured Americans,” the organizations warned.
The American College of Physicians also urged the Senate to not end the individual mandate, after the bill was passed out of the Senate Finance Committee along party lines.
“We are concerned that the bill approved by the Senate Budget Committee on a party-line vote would repeal the Affordable Care Act’s requirement that persons purchase qualified health insurance coverage. ... which will destabilize the individual insurance market and lead to 13 million Americans losing coverage, double-digit premium increases, and insurers dropping out of the individual insurance market, according to the Congressional Budget Office and other independent analyses,” the American College of Physicians wrote in a Nov. 30 letter to Senate Majority Leader Mitch McConnell (R-Ky.) and Senate Minority Leader Charles Schumer (D-N.Y.).
ACP leaders also voiced concern about the looming cuts to Medicare that could result from the bill, noting that the Congressional Budget Office estimated that $25 billion will be cut from Medicare as part of a larger sequestration – a 4% pay cut to the fee schedule – that would result if offsets are not found to keep the deficit from increasing.
The ACP noted that, along with other pay cuts on the books from other legislative action, physicians would be losing nearly 7% of their pay from the fee schedule, beginning in 2018.
The next step in the process is for a House and Senate conference committee to resolve differences between the two versions of the tax reform bills. Both chambers would then vote on a compromise bill. At some point, there would to be a vote to waive the pay-as-you-go rules to prevent the Medicare cuts from going into effect. However, such a vote requires 60 votes in the Senate and a simple majority in the House, neither of which are guaranteed.
“It’s hard to say right now whether or not that can be worked out,” Julius Hobson, a Washington-based health care lobbyist, said in an interview. “There is desire on the part of the Republican leadership in the two chambers, and I suspect it might pass the Senate. The problem may well be in the House with the conservatives, particularly the House Freedom Caucus, and whether they will go along with that.”
Mr. Hobson noted that GOP leadership has said they plan to move on to entitlement reform after tax reform is finished. So, even if the cuts are spared by a pay-as-you-go rules waiver, they could still come into effect in some way when GOP tackles Medicare, Medicaid, and Social Security reform.
“It looks interesting to be saving cuts in Medicare on the one hand, but on the other hand, reform really means cuts,” he said.
requiring that any spending increases be offset by other spending cuts.
At issue is the Senate bill’s repeal of the Affordable Care Act requirement that every individual have health insurance – the individual mandate.
In a Nov. 14 letter to the majority and minority leaders of the both the House and Senate, the American Medical Association, the American Academy of Family Physicians, the American Hospital Association, and the Federation of American Hospitals called on Congress to maintain the individual mandate. The four health provider groups were joined in the letter by America’s Health Insurance Plans and the Blue Cross Blue Shield Association.
“Eliminating the individual mandate by itself likely will result in a significant increase in premiums, which would in turn substantially increase the number of uninsured Americans,” the organizations warned.
The American College of Physicians also urged the Senate to not end the individual mandate, after the bill was passed out of the Senate Finance Committee along party lines.
“We are concerned that the bill approved by the Senate Budget Committee on a party-line vote would repeal the Affordable Care Act’s requirement that persons purchase qualified health insurance coverage. ... which will destabilize the individual insurance market and lead to 13 million Americans losing coverage, double-digit premium increases, and insurers dropping out of the individual insurance market, according to the Congressional Budget Office and other independent analyses,” the American College of Physicians wrote in a Nov. 30 letter to Senate Majority Leader Mitch McConnell (R-Ky.) and Senate Minority Leader Charles Schumer (D-N.Y.).
ACP leaders also voiced concern about the looming cuts to Medicare that could result from the bill, noting that the Congressional Budget Office estimated that $25 billion will be cut from Medicare as part of a larger sequestration – a 4% pay cut to the fee schedule – that would result if offsets are not found to keep the deficit from increasing.
The ACP noted that, along with other pay cuts on the books from other legislative action, physicians would be losing nearly 7% of their pay from the fee schedule, beginning in 2018.
The next step in the process is for a House and Senate conference committee to resolve differences between the two versions of the tax reform bills. Both chambers would then vote on a compromise bill. At some point, there would to be a vote to waive the pay-as-you-go rules to prevent the Medicare cuts from going into effect. However, such a vote requires 60 votes in the Senate and a simple majority in the House, neither of which are guaranteed.
“It’s hard to say right now whether or not that can be worked out,” Julius Hobson, a Washington-based health care lobbyist, said in an interview. “There is desire on the part of the Republican leadership in the two chambers, and I suspect it might pass the Senate. The problem may well be in the House with the conservatives, particularly the House Freedom Caucus, and whether they will go along with that.”
Mr. Hobson noted that GOP leadership has said they plan to move on to entitlement reform after tax reform is finished. So, even if the cuts are spared by a pay-as-you-go rules waiver, they could still come into effect in some way when GOP tackles Medicare, Medicaid, and Social Security reform.
“It looks interesting to be saving cuts in Medicare on the one hand, but on the other hand, reform really means cuts,” he said.
requiring that any spending increases be offset by other spending cuts.
At issue is the Senate bill’s repeal of the Affordable Care Act requirement that every individual have health insurance – the individual mandate.
In a Nov. 14 letter to the majority and minority leaders of the both the House and Senate, the American Medical Association, the American Academy of Family Physicians, the American Hospital Association, and the Federation of American Hospitals called on Congress to maintain the individual mandate. The four health provider groups were joined in the letter by America’s Health Insurance Plans and the Blue Cross Blue Shield Association.
“Eliminating the individual mandate by itself likely will result in a significant increase in premiums, which would in turn substantially increase the number of uninsured Americans,” the organizations warned.
The American College of Physicians also urged the Senate to not end the individual mandate, after the bill was passed out of the Senate Finance Committee along party lines.
“We are concerned that the bill approved by the Senate Budget Committee on a party-line vote would repeal the Affordable Care Act’s requirement that persons purchase qualified health insurance coverage. ... which will destabilize the individual insurance market and lead to 13 million Americans losing coverage, double-digit premium increases, and insurers dropping out of the individual insurance market, according to the Congressional Budget Office and other independent analyses,” the American College of Physicians wrote in a Nov. 30 letter to Senate Majority Leader Mitch McConnell (R-Ky.) and Senate Minority Leader Charles Schumer (D-N.Y.).
ACP leaders also voiced concern about the looming cuts to Medicare that could result from the bill, noting that the Congressional Budget Office estimated that $25 billion will be cut from Medicare as part of a larger sequestration – a 4% pay cut to the fee schedule – that would result if offsets are not found to keep the deficit from increasing.
The ACP noted that, along with other pay cuts on the books from other legislative action, physicians would be losing nearly 7% of their pay from the fee schedule, beginning in 2018.
The next step in the process is for a House and Senate conference committee to resolve differences between the two versions of the tax reform bills. Both chambers would then vote on a compromise bill. At some point, there would to be a vote to waive the pay-as-you-go rules to prevent the Medicare cuts from going into effect. However, such a vote requires 60 votes in the Senate and a simple majority in the House, neither of which are guaranteed.
“It’s hard to say right now whether or not that can be worked out,” Julius Hobson, a Washington-based health care lobbyist, said in an interview. “There is desire on the part of the Republican leadership in the two chambers, and I suspect it might pass the Senate. The problem may well be in the House with the conservatives, particularly the House Freedom Caucus, and whether they will go along with that.”
Mr. Hobson noted that GOP leadership has said they plan to move on to entitlement reform after tax reform is finished. So, even if the cuts are spared by a pay-as-you-go rules waiver, they could still come into effect in some way when GOP tackles Medicare, Medicaid, and Social Security reform.
“It looks interesting to be saving cuts in Medicare on the one hand, but on the other hand, reform really means cuts,” he said.
CMS looking to evolve QPP to measure outcomes, not processes
WASHINGTON – The Quality Payment Program, the value-based payment scheme created under the Medicare Access and CHIP Reauthorization Act, will focus on measuring clinical outcomes – instead of processes – if Seema Verma, administrator of the Centers for Medicare & Medicaid Services, has her way.
“I think the concept of paying for value is a good concept,” Ms. Verma told attendees at the annual meeting of the federal Office of the National Coordinator for Health Information Technology on Dec. 1. “A lot of the measures in terms of how we are evaluating providers aren’t necessarily around outcomes. There are a lot of process measures.”
“Many of us have used the health care system and can attest that it is also a lot of times confusing,” she said. “We don’t know where to go for our care. Who is the best doctor? We don’t always have the information about cost or quality or value, and it is difficult to navigate the health care system.”
She said she wants to “make sure that the data that we have at CMS is available to our beneficiaries, whether it be information about their claims data, information about quality, information about the health plan that they may pick, information about their provider directory, information about the quality ratings if they are seeking hospice care.”
Getting to that point will require addressing an ongoing and familiar problem for physicians: interoperability of health care IT systems.
Improved interoperability would allow for greater patient empowerment by providing patients with better access to their own medical data, she said, noting that the data also belongs to the patient.
“That is our information and the patient should have that,” Ms. Verma said. “When we talk about patient empowerment and patients first, this is what we are talking about. This is what I mean. I want to make sure the beneficiaries who are using the Medicaid program, the Medicare program have this information. That is important.”
She also noted that improved interoperability will allow for greater use of data across the health care spectrum, including in the area of drug pricing.
“We have some very high-cost new drugs coming,” she noted. “We are having discussions about how to pay for these drugs in a different way. Maybe we are going [toward] value-based pricing or indication-based pricing [and] so paying for the drug based on the outcomes.”
WASHINGTON – The Quality Payment Program, the value-based payment scheme created under the Medicare Access and CHIP Reauthorization Act, will focus on measuring clinical outcomes – instead of processes – if Seema Verma, administrator of the Centers for Medicare & Medicaid Services, has her way.
“I think the concept of paying for value is a good concept,” Ms. Verma told attendees at the annual meeting of the federal Office of the National Coordinator for Health Information Technology on Dec. 1. “A lot of the measures in terms of how we are evaluating providers aren’t necessarily around outcomes. There are a lot of process measures.”
“Many of us have used the health care system and can attest that it is also a lot of times confusing,” she said. “We don’t know where to go for our care. Who is the best doctor? We don’t always have the information about cost or quality or value, and it is difficult to navigate the health care system.”
She said she wants to “make sure that the data that we have at CMS is available to our beneficiaries, whether it be information about their claims data, information about quality, information about the health plan that they may pick, information about their provider directory, information about the quality ratings if they are seeking hospice care.”
Getting to that point will require addressing an ongoing and familiar problem for physicians: interoperability of health care IT systems.
Improved interoperability would allow for greater patient empowerment by providing patients with better access to their own medical data, she said, noting that the data also belongs to the patient.
“That is our information and the patient should have that,” Ms. Verma said. “When we talk about patient empowerment and patients first, this is what we are talking about. This is what I mean. I want to make sure the beneficiaries who are using the Medicaid program, the Medicare program have this information. That is important.”
She also noted that improved interoperability will allow for greater use of data across the health care spectrum, including in the area of drug pricing.
“We have some very high-cost new drugs coming,” she noted. “We are having discussions about how to pay for these drugs in a different way. Maybe we are going [toward] value-based pricing or indication-based pricing [and] so paying for the drug based on the outcomes.”
WASHINGTON – The Quality Payment Program, the value-based payment scheme created under the Medicare Access and CHIP Reauthorization Act, will focus on measuring clinical outcomes – instead of processes – if Seema Verma, administrator of the Centers for Medicare & Medicaid Services, has her way.
“I think the concept of paying for value is a good concept,” Ms. Verma told attendees at the annual meeting of the federal Office of the National Coordinator for Health Information Technology on Dec. 1. “A lot of the measures in terms of how we are evaluating providers aren’t necessarily around outcomes. There are a lot of process measures.”
“Many of us have used the health care system and can attest that it is also a lot of times confusing,” she said. “We don’t know where to go for our care. Who is the best doctor? We don’t always have the information about cost or quality or value, and it is difficult to navigate the health care system.”
She said she wants to “make sure that the data that we have at CMS is available to our beneficiaries, whether it be information about their claims data, information about quality, information about the health plan that they may pick, information about their provider directory, information about the quality ratings if they are seeking hospice care.”
Getting to that point will require addressing an ongoing and familiar problem for physicians: interoperability of health care IT systems.
Improved interoperability would allow for greater patient empowerment by providing patients with better access to their own medical data, she said, noting that the data also belongs to the patient.
“That is our information and the patient should have that,” Ms. Verma said. “When we talk about patient empowerment and patients first, this is what we are talking about. This is what I mean. I want to make sure the beneficiaries who are using the Medicaid program, the Medicare program have this information. That is important.”
She also noted that improved interoperability will allow for greater use of data across the health care spectrum, including in the area of drug pricing.
“We have some very high-cost new drugs coming,” she noted. “We are having discussions about how to pay for these drugs in a different way. Maybe we are going [toward] value-based pricing or indication-based pricing [and] so paying for the drug based on the outcomes.”
AT ONC 2017
Drug prices a key focus of Senate HELP examination of Azar nomination
WASHINGTON Escalating drug prices topped the agenda as members of the Senate Health, Education, Labor & Pensions Committee interviewed Alex Azar regarding his nomination as secretary of the Department of Health & Human Services.
Mr. Azar, a former HHS deputy secretary and general counsel during the Bush Administration and a former president of Eli Lilly’s U.S. operations, outlined his priorities to the Senate HELP committee during the Nov. 29 hearing.
Drug prices were the focus of many senators’ questions, and while many contentious questions came from panel Democrats, Sen. Rand Paul (R-Ky.) signaled he was not yet on board with his approval for Mr. Azar’s nomination.
“I think many [Americans] perceive [that drug companies use] their economic might to manipulate the system to maximize profits,” Sen. Paul said. “It’s not like they are selling a cheaper product to more people. They are using government to maximize their profits. Do you acknowledge that, under the current system, Big Pharma uses their economic clout to manipulate the patent system to increase drug prices?”
“There are clearly abuses, Senator, in the system, and that is why one of the steps that I mentioned ... that I believe we have to go after, is the gaming of that,” Mr. Azar responded. He suggested that although Hatch-Waxman rules give innovators a time frame to exclusively sell products “there should be a certain moment” when full generic competition should begin.
Sen. Paul also challenged Mr. Azar on the notion of drug importation.
There has not been a successful path to certify that drugs being imported are “safe and reliable,” Mr. Azar noted.
Sen. Paul countered that “you would have to sit there and say that the European Union has unsafe drugs. It would be unsafe for Americans to buy drugs from the European Union or from Canada or Australia. It’s just frankly not true.”
Sen. Paul told Mr. Azar that if he cannot come up with a way to reimport drugs as a means of addressing the high cost of pharmaceuticals in the United States, “I can’t support you.”
Sen. Paul continued that a lot of people have talked about how they are going to change the system, particularly patent issues that stand in the way of generic competition, and “you’ve got some convincing to make me believe that you are going to represent the American people and not Big Pharma, and I know that’s insulting, and I don’t mean it to be because I am sure you are an honest and upright person. But we all have our doubts because Big Pharma manipulates the system to keep prices high. ... We’ve got to fix it. We can’t tepidly go at it. We have to really fix it, and you need to convince those of us who are skeptical that you will be part of fixing it and won’t be beholden to Big Pharma.”
Regarding his other priorities, Mr. Azar noted that, through his “experience helping to implement [Medicare] Part D and with my extensive knowledge of how insurance, manufacturers, pharmacy, and government programs work together, I believe I can bring the skills and experiences to the table that can help us address these issues, while still encouraging discovery so Americans have access to high-quality care.”
He called for making health care “more affordable, more available, and more tailored to what individuals want and need. … Under the status quo, premiums have been skyrocketing year after year, and choices have been dwindling. We must address these challenges for those who have insurance coverage and for those who have been pushed out or left out of the insurance market by the Affordable Care Act.”
Mr. Azar signaled that he will continue the push toward value-based care and will use the power of Medicare to lead the rest of the health care delivery system to follow suit.
“We can better channel the power of health information technology and leverage what is best in our programs and in the private competitive marketplace to ensure the individual patient is the center of decision making and his or her needs are being met with greater transparency and accountability.”
Regarding the opioid crisis, Mr. Azar said that “we must heed President Trump’s call to action and tackle the scourge of the opioid epidemic that is destroying so many individuals, families, and communities. We need aggressive prevention, education, regulatory, and enforcement efforts to stop overprescribing and overuse of these legal and illegal drugs. And we need compassionate treatment for those suffering from dependence and addiction.”
Mr. Azar also was challenged on women’s health issues, particularly the ability of employers to exclude health insurance coverage of contraception because of religious objections. He noted that there needs to be a balance between the medical needs of the patient and the rights of an organization to follow its conscience.
When queried about making contraception available over the counter, he noted that the regulations regarding OTC conversion are outdated, and he was encouraged that FDA Commissioner Scott Gottlieb, MD, is looking into that.
Mr. Azar also committed during the hearing to working with improving interoperability of electronic health records as well as working with physicians to reduce the associated documentation burden.
He voiced his support of reforming the Affordable Care Act, adding that, “if it remains the law, my goal is to implement a way that leads to affordable insurance, leads to choice of insurance that leads to real access and not a meaningless insurance care, and insurance that has the benefits that people want, not what we say in D.C. for them.”
He also expressed support for the use of block grants to help fund Medicaid.
Mr. Azar’s appearance before the HELP committee was a courtesy as the Senate Finance Committee holds jurisdiction over his nomination. No confirmation hearing had been scheduled at press time.
WASHINGTON Escalating drug prices topped the agenda as members of the Senate Health, Education, Labor & Pensions Committee interviewed Alex Azar regarding his nomination as secretary of the Department of Health & Human Services.
Mr. Azar, a former HHS deputy secretary and general counsel during the Bush Administration and a former president of Eli Lilly’s U.S. operations, outlined his priorities to the Senate HELP committee during the Nov. 29 hearing.
Drug prices were the focus of many senators’ questions, and while many contentious questions came from panel Democrats, Sen. Rand Paul (R-Ky.) signaled he was not yet on board with his approval for Mr. Azar’s nomination.
“I think many [Americans] perceive [that drug companies use] their economic might to manipulate the system to maximize profits,” Sen. Paul said. “It’s not like they are selling a cheaper product to more people. They are using government to maximize their profits. Do you acknowledge that, under the current system, Big Pharma uses their economic clout to manipulate the patent system to increase drug prices?”
“There are clearly abuses, Senator, in the system, and that is why one of the steps that I mentioned ... that I believe we have to go after, is the gaming of that,” Mr. Azar responded. He suggested that although Hatch-Waxman rules give innovators a time frame to exclusively sell products “there should be a certain moment” when full generic competition should begin.
Sen. Paul also challenged Mr. Azar on the notion of drug importation.
There has not been a successful path to certify that drugs being imported are “safe and reliable,” Mr. Azar noted.
Sen. Paul countered that “you would have to sit there and say that the European Union has unsafe drugs. It would be unsafe for Americans to buy drugs from the European Union or from Canada or Australia. It’s just frankly not true.”
Sen. Paul told Mr. Azar that if he cannot come up with a way to reimport drugs as a means of addressing the high cost of pharmaceuticals in the United States, “I can’t support you.”
Sen. Paul continued that a lot of people have talked about how they are going to change the system, particularly patent issues that stand in the way of generic competition, and “you’ve got some convincing to make me believe that you are going to represent the American people and not Big Pharma, and I know that’s insulting, and I don’t mean it to be because I am sure you are an honest and upright person. But we all have our doubts because Big Pharma manipulates the system to keep prices high. ... We’ve got to fix it. We can’t tepidly go at it. We have to really fix it, and you need to convince those of us who are skeptical that you will be part of fixing it and won’t be beholden to Big Pharma.”
Regarding his other priorities, Mr. Azar noted that, through his “experience helping to implement [Medicare] Part D and with my extensive knowledge of how insurance, manufacturers, pharmacy, and government programs work together, I believe I can bring the skills and experiences to the table that can help us address these issues, while still encouraging discovery so Americans have access to high-quality care.”
He called for making health care “more affordable, more available, and more tailored to what individuals want and need. … Under the status quo, premiums have been skyrocketing year after year, and choices have been dwindling. We must address these challenges for those who have insurance coverage and for those who have been pushed out or left out of the insurance market by the Affordable Care Act.”
Mr. Azar signaled that he will continue the push toward value-based care and will use the power of Medicare to lead the rest of the health care delivery system to follow suit.
“We can better channel the power of health information technology and leverage what is best in our programs and in the private competitive marketplace to ensure the individual patient is the center of decision making and his or her needs are being met with greater transparency and accountability.”
Regarding the opioid crisis, Mr. Azar said that “we must heed President Trump’s call to action and tackle the scourge of the opioid epidemic that is destroying so many individuals, families, and communities. We need aggressive prevention, education, regulatory, and enforcement efforts to stop overprescribing and overuse of these legal and illegal drugs. And we need compassionate treatment for those suffering from dependence and addiction.”
Mr. Azar also was challenged on women’s health issues, particularly the ability of employers to exclude health insurance coverage of contraception because of religious objections. He noted that there needs to be a balance between the medical needs of the patient and the rights of an organization to follow its conscience.
When queried about making contraception available over the counter, he noted that the regulations regarding OTC conversion are outdated, and he was encouraged that FDA Commissioner Scott Gottlieb, MD, is looking into that.
Mr. Azar also committed during the hearing to working with improving interoperability of electronic health records as well as working with physicians to reduce the associated documentation burden.
He voiced his support of reforming the Affordable Care Act, adding that, “if it remains the law, my goal is to implement a way that leads to affordable insurance, leads to choice of insurance that leads to real access and not a meaningless insurance care, and insurance that has the benefits that people want, not what we say in D.C. for them.”
He also expressed support for the use of block grants to help fund Medicaid.
Mr. Azar’s appearance before the HELP committee was a courtesy as the Senate Finance Committee holds jurisdiction over his nomination. No confirmation hearing had been scheduled at press time.
WASHINGTON Escalating drug prices topped the agenda as members of the Senate Health, Education, Labor & Pensions Committee interviewed Alex Azar regarding his nomination as secretary of the Department of Health & Human Services.
Mr. Azar, a former HHS deputy secretary and general counsel during the Bush Administration and a former president of Eli Lilly’s U.S. operations, outlined his priorities to the Senate HELP committee during the Nov. 29 hearing.
Drug prices were the focus of many senators’ questions, and while many contentious questions came from panel Democrats, Sen. Rand Paul (R-Ky.) signaled he was not yet on board with his approval for Mr. Azar’s nomination.
“I think many [Americans] perceive [that drug companies use] their economic might to manipulate the system to maximize profits,” Sen. Paul said. “It’s not like they are selling a cheaper product to more people. They are using government to maximize their profits. Do you acknowledge that, under the current system, Big Pharma uses their economic clout to manipulate the patent system to increase drug prices?”
“There are clearly abuses, Senator, in the system, and that is why one of the steps that I mentioned ... that I believe we have to go after, is the gaming of that,” Mr. Azar responded. He suggested that although Hatch-Waxman rules give innovators a time frame to exclusively sell products “there should be a certain moment” when full generic competition should begin.
Sen. Paul also challenged Mr. Azar on the notion of drug importation.
There has not been a successful path to certify that drugs being imported are “safe and reliable,” Mr. Azar noted.
Sen. Paul countered that “you would have to sit there and say that the European Union has unsafe drugs. It would be unsafe for Americans to buy drugs from the European Union or from Canada or Australia. It’s just frankly not true.”
Sen. Paul told Mr. Azar that if he cannot come up with a way to reimport drugs as a means of addressing the high cost of pharmaceuticals in the United States, “I can’t support you.”
Sen. Paul continued that a lot of people have talked about how they are going to change the system, particularly patent issues that stand in the way of generic competition, and “you’ve got some convincing to make me believe that you are going to represent the American people and not Big Pharma, and I know that’s insulting, and I don’t mean it to be because I am sure you are an honest and upright person. But we all have our doubts because Big Pharma manipulates the system to keep prices high. ... We’ve got to fix it. We can’t tepidly go at it. We have to really fix it, and you need to convince those of us who are skeptical that you will be part of fixing it and won’t be beholden to Big Pharma.”
Regarding his other priorities, Mr. Azar noted that, through his “experience helping to implement [Medicare] Part D and with my extensive knowledge of how insurance, manufacturers, pharmacy, and government programs work together, I believe I can bring the skills and experiences to the table that can help us address these issues, while still encouraging discovery so Americans have access to high-quality care.”
He called for making health care “more affordable, more available, and more tailored to what individuals want and need. … Under the status quo, premiums have been skyrocketing year after year, and choices have been dwindling. We must address these challenges for those who have insurance coverage and for those who have been pushed out or left out of the insurance market by the Affordable Care Act.”
Mr. Azar signaled that he will continue the push toward value-based care and will use the power of Medicare to lead the rest of the health care delivery system to follow suit.
“We can better channel the power of health information technology and leverage what is best in our programs and in the private competitive marketplace to ensure the individual patient is the center of decision making and his or her needs are being met with greater transparency and accountability.”
Regarding the opioid crisis, Mr. Azar said that “we must heed President Trump’s call to action and tackle the scourge of the opioid epidemic that is destroying so many individuals, families, and communities. We need aggressive prevention, education, regulatory, and enforcement efforts to stop overprescribing and overuse of these legal and illegal drugs. And we need compassionate treatment for those suffering from dependence and addiction.”
Mr. Azar also was challenged on women’s health issues, particularly the ability of employers to exclude health insurance coverage of contraception because of religious objections. He noted that there needs to be a balance between the medical needs of the patient and the rights of an organization to follow its conscience.
When queried about making contraception available over the counter, he noted that the regulations regarding OTC conversion are outdated, and he was encouraged that FDA Commissioner Scott Gottlieb, MD, is looking into that.
Mr. Azar also committed during the hearing to working with improving interoperability of electronic health records as well as working with physicians to reduce the associated documentation burden.
He voiced his support of reforming the Affordable Care Act, adding that, “if it remains the law, my goal is to implement a way that leads to affordable insurance, leads to choice of insurance that leads to real access and not a meaningless insurance care, and insurance that has the benefits that people want, not what we say in D.C. for them.”
He also expressed support for the use of block grants to help fund Medicaid.
Mr. Azar’s appearance before the HELP committee was a courtesy as the Senate Finance Committee holds jurisdiction over his nomination. No confirmation hearing had been scheduled at press time.
AT A SENATE HELP COMMITTEE HEARING
CMS to enlist Medicare Part D plans to combat opioid abuse
The Centers for Medicare & Medicaid Services aims to enlist the help of Medicare Part D plan sponsors in fighting opioid abuse, under a proposed rule scheduled for publication in the Federal Register on Nov. 28.
The agency is proposing to expand monitoring of patients taking opioids in its current Part D Opioid Drug Utilization Review (DUR) and Overutilization Monitoring System (OMS). To do so, officials would like to extend the use the criteria for overutilizers to identify at-risk beneficiaries. Part D plans then would be allowed to restrict at-risk beneficiaries’ access to opioids to a selected prescriber and/or network pharmacy, according to a fact sheet on proposal, which is part of the proposed 2018 update to regulations governing Medicare Advantage and Medicare Part D.
Under the proposal, plans would not be required to use these tools. However, CMS expects they will.
“While plan sponsors would have the option to implement a drug management program, our proposal codifies a framework that would place requirements upon such programs,” according to the proposal. “We foresee that all plan sponsors will implement such drug management programs based on our experience that all plan sponsors’ are complying with the current policy as laid out in guidance, the fact that our proposal largely incorporates the CARA [Comprehensive Addiction and Recovery Act of 2016] drug management provisions into existing CMS and sponsor operations, and especially, in light of the national opioid epidemic and the declaration that the opioid crisis is a nationwide Public Health Emergency.”
According to the proposal, potentially at-risk and at-risk beneficiaries would be identified based on the type and frequency of prescriptions. Those include the use of opioids with an average daily morphine milligram equivalent (MME) greater than or equal to 90 mg for any duration during the most recent 6 months and either four or more opioid prescribers plus four or more opioid-dispensing pharmacies or six or more opioid prescribers, regardless of pharmacies.
CMS notes in the regulation that, if the proposed 2019 criteria were used against those enrolled in Medicare Part D in 2015, it would have identified as at-risk about 33,000 Part D beneficiaries, or 0.08% of the 42 million people enrolled at that time. The agency said this population should be manageable for oversight by Part D plan sponsors, noting that, in Medicaid in 2015, 0.37% were included in some kind of pharmacy/prescriber lock-in program.
The proposed regulation includes an exemption for patients diagnosed with cancer, those in hospice, and those in a long-term care facility. CMS also plans to limit the availability of the special enrollment period for dual-eligible beneficiaries (those who qualify for both Medicare and Medicaid) and those who receive the low-income subsidy who are identified as at risk or potentially at risk.
Beneficiaries would be allowed to appeal their at-risk/potential at-risk determination under the proposal.
The Centers for Medicare & Medicaid Services aims to enlist the help of Medicare Part D plan sponsors in fighting opioid abuse, under a proposed rule scheduled for publication in the Federal Register on Nov. 28.
The agency is proposing to expand monitoring of patients taking opioids in its current Part D Opioid Drug Utilization Review (DUR) and Overutilization Monitoring System (OMS). To do so, officials would like to extend the use the criteria for overutilizers to identify at-risk beneficiaries. Part D plans then would be allowed to restrict at-risk beneficiaries’ access to opioids to a selected prescriber and/or network pharmacy, according to a fact sheet on proposal, which is part of the proposed 2018 update to regulations governing Medicare Advantage and Medicare Part D.
Under the proposal, plans would not be required to use these tools. However, CMS expects they will.
“While plan sponsors would have the option to implement a drug management program, our proposal codifies a framework that would place requirements upon such programs,” according to the proposal. “We foresee that all plan sponsors will implement such drug management programs based on our experience that all plan sponsors’ are complying with the current policy as laid out in guidance, the fact that our proposal largely incorporates the CARA [Comprehensive Addiction and Recovery Act of 2016] drug management provisions into existing CMS and sponsor operations, and especially, in light of the national opioid epidemic and the declaration that the opioid crisis is a nationwide Public Health Emergency.”
According to the proposal, potentially at-risk and at-risk beneficiaries would be identified based on the type and frequency of prescriptions. Those include the use of opioids with an average daily morphine milligram equivalent (MME) greater than or equal to 90 mg for any duration during the most recent 6 months and either four or more opioid prescribers plus four or more opioid-dispensing pharmacies or six or more opioid prescribers, regardless of pharmacies.
CMS notes in the regulation that, if the proposed 2019 criteria were used against those enrolled in Medicare Part D in 2015, it would have identified as at-risk about 33,000 Part D beneficiaries, or 0.08% of the 42 million people enrolled at that time. The agency said this population should be manageable for oversight by Part D plan sponsors, noting that, in Medicaid in 2015, 0.37% were included in some kind of pharmacy/prescriber lock-in program.
The proposed regulation includes an exemption for patients diagnosed with cancer, those in hospice, and those in a long-term care facility. CMS also plans to limit the availability of the special enrollment period for dual-eligible beneficiaries (those who qualify for both Medicare and Medicaid) and those who receive the low-income subsidy who are identified as at risk or potentially at risk.
Beneficiaries would be allowed to appeal their at-risk/potential at-risk determination under the proposal.
The Centers for Medicare & Medicaid Services aims to enlist the help of Medicare Part D plan sponsors in fighting opioid abuse, under a proposed rule scheduled for publication in the Federal Register on Nov. 28.
The agency is proposing to expand monitoring of patients taking opioids in its current Part D Opioid Drug Utilization Review (DUR) and Overutilization Monitoring System (OMS). To do so, officials would like to extend the use the criteria for overutilizers to identify at-risk beneficiaries. Part D plans then would be allowed to restrict at-risk beneficiaries’ access to opioids to a selected prescriber and/or network pharmacy, according to a fact sheet on proposal, which is part of the proposed 2018 update to regulations governing Medicare Advantage and Medicare Part D.
Under the proposal, plans would not be required to use these tools. However, CMS expects they will.
“While plan sponsors would have the option to implement a drug management program, our proposal codifies a framework that would place requirements upon such programs,” according to the proposal. “We foresee that all plan sponsors will implement such drug management programs based on our experience that all plan sponsors’ are complying with the current policy as laid out in guidance, the fact that our proposal largely incorporates the CARA [Comprehensive Addiction and Recovery Act of 2016] drug management provisions into existing CMS and sponsor operations, and especially, in light of the national opioid epidemic and the declaration that the opioid crisis is a nationwide Public Health Emergency.”
According to the proposal, potentially at-risk and at-risk beneficiaries would be identified based on the type and frequency of prescriptions. Those include the use of opioids with an average daily morphine milligram equivalent (MME) greater than or equal to 90 mg for any duration during the most recent 6 months and either four or more opioid prescribers plus four or more opioid-dispensing pharmacies or six or more opioid prescribers, regardless of pharmacies.
CMS notes in the regulation that, if the proposed 2019 criteria were used against those enrolled in Medicare Part D in 2015, it would have identified as at-risk about 33,000 Part D beneficiaries, or 0.08% of the 42 million people enrolled at that time. The agency said this population should be manageable for oversight by Part D plan sponsors, noting that, in Medicaid in 2015, 0.37% were included in some kind of pharmacy/prescriber lock-in program.
The proposed regulation includes an exemption for patients diagnosed with cancer, those in hospice, and those in a long-term care facility. CMS also plans to limit the availability of the special enrollment period for dual-eligible beneficiaries (those who qualify for both Medicare and Medicaid) and those who receive the low-income subsidy who are identified as at risk or potentially at risk.
Beneficiaries would be allowed to appeal their at-risk/potential at-risk determination under the proposal.
Former pharma exec nominated for top HHS post
Alex M. Azar II, a former pharmaceutical executive and member of the George W. Bush administration, has been selected by President Donald Trump to lead the Department of Health & Human Services.
Mr. Azar served as president of Eli Lilly in the United States for 5 years from 2012 to 2017, after joining the company in 2007. Prior to that, he served President Bush at HHS from 2001 to 2007, serving first as general counsel and later as deputy secretary under Secretary Michael O. Leavitt.
“The challenges plaguing the American health care system are serious. For too long, hardworking, middle-class families have been forced to bear the brunt of Obamacare’s failures in the form of higher premiums and fewer choices,” Senate Finance Committee Chairman Orrin Hatch (R-Utah) said in a statement. “The leader of HHS will be at the tip of the spear, working to not only right the wrongs of this deeply flawed law but also ensure the long-term sustainability of both Medicare and Medicaid.”
The Senate Finance Committee must first approve the nomination before it is considered by the full chamber.
“We commend President Trump for nominating Alex Azar for secretary of Health & Human Services,” House Energy & Commerce Committee Chairman Greg Walden (R-Ore.) and Health Subcommittee Chairman Michael Burgess, MD, (R-Texas) said in a joint statement. “He is a veteran of HHS, bringing with him a wealth of institutional knowledge that will be instrumental in delivering patient-centered health care and combating the opioid crisis. We look forward to working with Mr. Azar on these critical issues and many others in the future.”
The Campaign for Sustainable Rx Pricing, a coalition of physicians and other stakeholders across the health care industry, was more measured in its reaction to the news.
“We sincerely hope that Secretary-nominee Azar will follow through on the President’s commitment to achieve lower drug prices for all Americans,” according to a statement from CSRxP. “We look forward to working with him, once confirmed, to end anticompetitive practices that artificially inflate drug prices, restore a functioning prescription drug market, and rein in the exorbitant price hikes that harm patients, job creators, and taxpayers alike.”
The nomination process could be bumpy, as Mr. Azar has made statements in the news in the past that were in support the dismantling of the Affordable Care Act. But keeping him from the post will be difficult, as he would only need a simple majority vote in the Senate to gain approval. With Republicans holding 52 seats, it would only require three dissenting GOP senators, assuming the Democrats vote against the appointment. If two crossed the aisle, Vice President Mike Pence would cast the deciding vote.
Finance Committee Democrats boycotted the committee vote on Mr. Azar’s predecessor, Secretary Tom Price, MD, forcing committee Chairman Hatch to suspend rules in order to move the appointment to the full chamber for consideration.
Alex M. Azar II, a former pharmaceutical executive and member of the George W. Bush administration, has been selected by President Donald Trump to lead the Department of Health & Human Services.
Mr. Azar served as president of Eli Lilly in the United States for 5 years from 2012 to 2017, after joining the company in 2007. Prior to that, he served President Bush at HHS from 2001 to 2007, serving first as general counsel and later as deputy secretary under Secretary Michael O. Leavitt.
“The challenges plaguing the American health care system are serious. For too long, hardworking, middle-class families have been forced to bear the brunt of Obamacare’s failures in the form of higher premiums and fewer choices,” Senate Finance Committee Chairman Orrin Hatch (R-Utah) said in a statement. “The leader of HHS will be at the tip of the spear, working to not only right the wrongs of this deeply flawed law but also ensure the long-term sustainability of both Medicare and Medicaid.”
The Senate Finance Committee must first approve the nomination before it is considered by the full chamber.
“We commend President Trump for nominating Alex Azar for secretary of Health & Human Services,” House Energy & Commerce Committee Chairman Greg Walden (R-Ore.) and Health Subcommittee Chairman Michael Burgess, MD, (R-Texas) said in a joint statement. “He is a veteran of HHS, bringing with him a wealth of institutional knowledge that will be instrumental in delivering patient-centered health care and combating the opioid crisis. We look forward to working with Mr. Azar on these critical issues and many others in the future.”
The Campaign for Sustainable Rx Pricing, a coalition of physicians and other stakeholders across the health care industry, was more measured in its reaction to the news.
“We sincerely hope that Secretary-nominee Azar will follow through on the President’s commitment to achieve lower drug prices for all Americans,” according to a statement from CSRxP. “We look forward to working with him, once confirmed, to end anticompetitive practices that artificially inflate drug prices, restore a functioning prescription drug market, and rein in the exorbitant price hikes that harm patients, job creators, and taxpayers alike.”
The nomination process could be bumpy, as Mr. Azar has made statements in the news in the past that were in support the dismantling of the Affordable Care Act. But keeping him from the post will be difficult, as he would only need a simple majority vote in the Senate to gain approval. With Republicans holding 52 seats, it would only require three dissenting GOP senators, assuming the Democrats vote against the appointment. If two crossed the aisle, Vice President Mike Pence would cast the deciding vote.
Finance Committee Democrats boycotted the committee vote on Mr. Azar’s predecessor, Secretary Tom Price, MD, forcing committee Chairman Hatch to suspend rules in order to move the appointment to the full chamber for consideration.
Alex M. Azar II, a former pharmaceutical executive and member of the George W. Bush administration, has been selected by President Donald Trump to lead the Department of Health & Human Services.
Mr. Azar served as president of Eli Lilly in the United States for 5 years from 2012 to 2017, after joining the company in 2007. Prior to that, he served President Bush at HHS from 2001 to 2007, serving first as general counsel and later as deputy secretary under Secretary Michael O. Leavitt.
“The challenges plaguing the American health care system are serious. For too long, hardworking, middle-class families have been forced to bear the brunt of Obamacare’s failures in the form of higher premiums and fewer choices,” Senate Finance Committee Chairman Orrin Hatch (R-Utah) said in a statement. “The leader of HHS will be at the tip of the spear, working to not only right the wrongs of this deeply flawed law but also ensure the long-term sustainability of both Medicare and Medicaid.”
The Senate Finance Committee must first approve the nomination before it is considered by the full chamber.
“We commend President Trump for nominating Alex Azar for secretary of Health & Human Services,” House Energy & Commerce Committee Chairman Greg Walden (R-Ore.) and Health Subcommittee Chairman Michael Burgess, MD, (R-Texas) said in a joint statement. “He is a veteran of HHS, bringing with him a wealth of institutional knowledge that will be instrumental in delivering patient-centered health care and combating the opioid crisis. We look forward to working with Mr. Azar on these critical issues and many others in the future.”
The Campaign for Sustainable Rx Pricing, a coalition of physicians and other stakeholders across the health care industry, was more measured in its reaction to the news.
“We sincerely hope that Secretary-nominee Azar will follow through on the President’s commitment to achieve lower drug prices for all Americans,” according to a statement from CSRxP. “We look forward to working with him, once confirmed, to end anticompetitive practices that artificially inflate drug prices, restore a functioning prescription drug market, and rein in the exorbitant price hikes that harm patients, job creators, and taxpayers alike.”
The nomination process could be bumpy, as Mr. Azar has made statements in the news in the past that were in support the dismantling of the Affordable Care Act. But keeping him from the post will be difficult, as he would only need a simple majority vote in the Senate to gain approval. With Republicans holding 52 seats, it would only require three dissenting GOP senators, assuming the Democrats vote against the appointment. If two crossed the aisle, Vice President Mike Pence would cast the deciding vote.
Finance Committee Democrats boycotted the committee vote on Mr. Azar’s predecessor, Secretary Tom Price, MD, forcing committee Chairman Hatch to suspend rules in order to move the appointment to the full chamber for consideration.
FDA approves Cinvanti for chemo-induced nausea and vomiting
The Food and Drug Administration has approved aprepitant injectable emulsion for the prevention of acute and delayed chemotherapy-induced nausea and vomiting (CINV), Heron Therapeutics announced Nov. 9.
“CINV remains a high unmet medical need in the oncology community, and five full days of CINV coverage continues to be our goal,” Heron CEO Jeffrey Patton, MD, said in a statement. “NK1 receptor antagonists are recommended for routine use with [highly emetogenic chemotherapy] and are a recommended option with [moderately emetogenic chemotherapy]. Despite this, NK1 receptor antagonists are underutilized in CINV.”
Aprepitant injectable emulsion is indicated specifically for acute and delayed nausea and vomiting associated with initial and repeated courses of highly emetogenic chemotherapy, including high-dose cisplatin. Treatment is a single dose of 130 mg via intravenous infusion on day 1, approximately 30 minutes before chemotherapy is initiated. It is also indicated for use in moderately emetogenic chemotherapy; treatment of these patients is 100 mg on day 1, followed by oral aprepitant on days 2 and 3.
The most common adverse reactions with single-dose aprepitant injectable emulsion were headache and fatigue.
Aprepitant injectable emulsion will be marketed as Cinvanti and is expected to be available in January 2018, according to the company.
The Food and Drug Administration has approved aprepitant injectable emulsion for the prevention of acute and delayed chemotherapy-induced nausea and vomiting (CINV), Heron Therapeutics announced Nov. 9.
“CINV remains a high unmet medical need in the oncology community, and five full days of CINV coverage continues to be our goal,” Heron CEO Jeffrey Patton, MD, said in a statement. “NK1 receptor antagonists are recommended for routine use with [highly emetogenic chemotherapy] and are a recommended option with [moderately emetogenic chemotherapy]. Despite this, NK1 receptor antagonists are underutilized in CINV.”
Aprepitant injectable emulsion is indicated specifically for acute and delayed nausea and vomiting associated with initial and repeated courses of highly emetogenic chemotherapy, including high-dose cisplatin. Treatment is a single dose of 130 mg via intravenous infusion on day 1, approximately 30 minutes before chemotherapy is initiated. It is also indicated for use in moderately emetogenic chemotherapy; treatment of these patients is 100 mg on day 1, followed by oral aprepitant on days 2 and 3.
The most common adverse reactions with single-dose aprepitant injectable emulsion were headache and fatigue.
Aprepitant injectable emulsion will be marketed as Cinvanti and is expected to be available in January 2018, according to the company.
The Food and Drug Administration has approved aprepitant injectable emulsion for the prevention of acute and delayed chemotherapy-induced nausea and vomiting (CINV), Heron Therapeutics announced Nov. 9.
“CINV remains a high unmet medical need in the oncology community, and five full days of CINV coverage continues to be our goal,” Heron CEO Jeffrey Patton, MD, said in a statement. “NK1 receptor antagonists are recommended for routine use with [highly emetogenic chemotherapy] and are a recommended option with [moderately emetogenic chemotherapy]. Despite this, NK1 receptor antagonists are underutilized in CINV.”
Aprepitant injectable emulsion is indicated specifically for acute and delayed nausea and vomiting associated with initial and repeated courses of highly emetogenic chemotherapy, including high-dose cisplatin. Treatment is a single dose of 130 mg via intravenous infusion on day 1, approximately 30 minutes before chemotherapy is initiated. It is also indicated for use in moderately emetogenic chemotherapy; treatment of these patients is 100 mg on day 1, followed by oral aprepitant on days 2 and 3.
The most common adverse reactions with single-dose aprepitant injectable emulsion were headache and fatigue.
Aprepitant injectable emulsion will be marketed as Cinvanti and is expected to be available in January 2018, according to the company.
MedPAC offers more details of MIPS replacement
WASHINGTON – The Medicare Payment Advisory Commission continues to mull the specifics of its proposed recommendation to scrap the Quality Payment Program’s MIPS component.
The basics of the MIPS (Merit-based Incentive Payment System) replacement have not changed. The proposal calls for creation of a voluntary value program (VVP) that would withhold a percentage – currently 2% – of Medicare payments for physicians who are not part of an advanced alternative payment model (APM) under the Quality Payment Program of the Medicare Access and CHIP Reauthorization Act of 2015.
There would be two ways to recapture the withheld pay. The first would be to join an APM. The second would be to participate in a VVP by entering a voluntary reporting group. Under the proposal, VVPs would be at least 10 providers who would report together on population-based measures, patient experience, and cost measures, according to staff presentations given Nov. 2 at a meeting of the Medicare Payment Advisory Commission (MedPAC).
Proposed measures would be patient oriented, would encourage coordination across all providers, would promote positive change in the delivery system, and would be less burdensome to providers. Measures would be more in line with those employed by APMs – important because the overall goal would be encouraging participation in an APM rather than permanently lingering in the VVP.
To that end, MedPAC staff member Kate Bloniarz noted during the presentation of the VVP proposal that the total payments in the program “should be capped to be less attractive than joining an [advanced] APM. This comes from a general sense among commissioners that clinicians should not be able to receive large bonuses” for remaining in Medicare fee-for-service.
MedPAC staff recommended that the Centers for Medicare & Medicaid Services offer a fallback group that would provide an option to providers that would otherwise not have access to other groups to join.
Commission member Kathy Buto, former vice president of global health policy at Johnson & Johnson, suggested withholding be increased to perhaps 3%, with providers able to recoup 2% in the VVP and 3% in an APM, to further incentivize APM participation.
Staff noted that certain quality measures and process measures would be lost if MIPS were to go away, but they could be accounted for in other channels, such as through electronic health records and registries.
Most commissioners expressed support for both the repeal of MIPS and the conceptual framework for the new VVP, although many sought more details, particularly in the handling of specialists.
“I don’t know that we want to try to make the VVP do too much, especially when you get into the specialties that are very, very episodic,” said commission member Brian DeBusk, PhD, CEO of DeRoyal Industries. “The classic example would be a joint replacement. … I hope to see some specialist APMs developed in parallel and I think that is going to take some pressure off to try to make the VVP be all things to all people.”
Commission member Pat Wang, CEO of Healthfirst, offered a possible solution.
“I would suggest that we try to think about doing that in the context of something that is a little bit, perhaps, not full bore APM, but a VVP for specialists with their own metrics that are not big, gigantic readmissions,” she said. “Those are very broad population health metrics [that may not work for specialists].”
But at least two commission members voiced their dissent to the proposal as presented, with one going so far as to saying that MIPS should not be repealed.
David Nerenz, PhD, of the Henry Ford Health System, said that he had “very serious concerns about the VVP part of this proposal [and] they are such that if it comes to us as a recommendation in more or less its current form I will not support it.”
He called it “pretty significant social engineering in the structure of medical practice and I think we are doing it in the absence of what to me would be compelling evidence that this large group structure we are talking about is good.
“I also don’t see any evidence that beneficiaries find value in the set of measures we are talking about,” Dr. Nerenz added. He is on the record as supporting the repeal of MIPS.
Commission member Alice Coombs, MD, of Weymouth, Mass., was the lone voice speaking in support of MIPS: “I think MIPS has a lot of problems … but there are some things that are coming out of MIPS that are actually good.”
She called the VVP proposal “inadequate” and took issue with the measures. As a practicing physician, she said that she favors more population health measures that will affect patient outcomes.
MedPAC staff expect to have a draft recommendation prepared for discussion at the December meeting, with a final vote on what will be presented to Congress coming as soon as January.
WASHINGTON – The Medicare Payment Advisory Commission continues to mull the specifics of its proposed recommendation to scrap the Quality Payment Program’s MIPS component.
The basics of the MIPS (Merit-based Incentive Payment System) replacement have not changed. The proposal calls for creation of a voluntary value program (VVP) that would withhold a percentage – currently 2% – of Medicare payments for physicians who are not part of an advanced alternative payment model (APM) under the Quality Payment Program of the Medicare Access and CHIP Reauthorization Act of 2015.
There would be two ways to recapture the withheld pay. The first would be to join an APM. The second would be to participate in a VVP by entering a voluntary reporting group. Under the proposal, VVPs would be at least 10 providers who would report together on population-based measures, patient experience, and cost measures, according to staff presentations given Nov. 2 at a meeting of the Medicare Payment Advisory Commission (MedPAC).
Proposed measures would be patient oriented, would encourage coordination across all providers, would promote positive change in the delivery system, and would be less burdensome to providers. Measures would be more in line with those employed by APMs – important because the overall goal would be encouraging participation in an APM rather than permanently lingering in the VVP.
To that end, MedPAC staff member Kate Bloniarz noted during the presentation of the VVP proposal that the total payments in the program “should be capped to be less attractive than joining an [advanced] APM. This comes from a general sense among commissioners that clinicians should not be able to receive large bonuses” for remaining in Medicare fee-for-service.
MedPAC staff recommended that the Centers for Medicare & Medicaid Services offer a fallback group that would provide an option to providers that would otherwise not have access to other groups to join.
Commission member Kathy Buto, former vice president of global health policy at Johnson & Johnson, suggested withholding be increased to perhaps 3%, with providers able to recoup 2% in the VVP and 3% in an APM, to further incentivize APM participation.
Staff noted that certain quality measures and process measures would be lost if MIPS were to go away, but they could be accounted for in other channels, such as through electronic health records and registries.
Most commissioners expressed support for both the repeal of MIPS and the conceptual framework for the new VVP, although many sought more details, particularly in the handling of specialists.
“I don’t know that we want to try to make the VVP do too much, especially when you get into the specialties that are very, very episodic,” said commission member Brian DeBusk, PhD, CEO of DeRoyal Industries. “The classic example would be a joint replacement. … I hope to see some specialist APMs developed in parallel and I think that is going to take some pressure off to try to make the VVP be all things to all people.”
Commission member Pat Wang, CEO of Healthfirst, offered a possible solution.
“I would suggest that we try to think about doing that in the context of something that is a little bit, perhaps, not full bore APM, but a VVP for specialists with their own metrics that are not big, gigantic readmissions,” she said. “Those are very broad population health metrics [that may not work for specialists].”
But at least two commission members voiced their dissent to the proposal as presented, with one going so far as to saying that MIPS should not be repealed.
David Nerenz, PhD, of the Henry Ford Health System, said that he had “very serious concerns about the VVP part of this proposal [and] they are such that if it comes to us as a recommendation in more or less its current form I will not support it.”
He called it “pretty significant social engineering in the structure of medical practice and I think we are doing it in the absence of what to me would be compelling evidence that this large group structure we are talking about is good.
“I also don’t see any evidence that beneficiaries find value in the set of measures we are talking about,” Dr. Nerenz added. He is on the record as supporting the repeal of MIPS.
Commission member Alice Coombs, MD, of Weymouth, Mass., was the lone voice speaking in support of MIPS: “I think MIPS has a lot of problems … but there are some things that are coming out of MIPS that are actually good.”
She called the VVP proposal “inadequate” and took issue with the measures. As a practicing physician, she said that she favors more population health measures that will affect patient outcomes.
MedPAC staff expect to have a draft recommendation prepared for discussion at the December meeting, with a final vote on what will be presented to Congress coming as soon as January.
WASHINGTON – The Medicare Payment Advisory Commission continues to mull the specifics of its proposed recommendation to scrap the Quality Payment Program’s MIPS component.
The basics of the MIPS (Merit-based Incentive Payment System) replacement have not changed. The proposal calls for creation of a voluntary value program (VVP) that would withhold a percentage – currently 2% – of Medicare payments for physicians who are not part of an advanced alternative payment model (APM) under the Quality Payment Program of the Medicare Access and CHIP Reauthorization Act of 2015.
There would be two ways to recapture the withheld pay. The first would be to join an APM. The second would be to participate in a VVP by entering a voluntary reporting group. Under the proposal, VVPs would be at least 10 providers who would report together on population-based measures, patient experience, and cost measures, according to staff presentations given Nov. 2 at a meeting of the Medicare Payment Advisory Commission (MedPAC).
Proposed measures would be patient oriented, would encourage coordination across all providers, would promote positive change in the delivery system, and would be less burdensome to providers. Measures would be more in line with those employed by APMs – important because the overall goal would be encouraging participation in an APM rather than permanently lingering in the VVP.
To that end, MedPAC staff member Kate Bloniarz noted during the presentation of the VVP proposal that the total payments in the program “should be capped to be less attractive than joining an [advanced] APM. This comes from a general sense among commissioners that clinicians should not be able to receive large bonuses” for remaining in Medicare fee-for-service.
MedPAC staff recommended that the Centers for Medicare & Medicaid Services offer a fallback group that would provide an option to providers that would otherwise not have access to other groups to join.
Commission member Kathy Buto, former vice president of global health policy at Johnson & Johnson, suggested withholding be increased to perhaps 3%, with providers able to recoup 2% in the VVP and 3% in an APM, to further incentivize APM participation.
Staff noted that certain quality measures and process measures would be lost if MIPS were to go away, but they could be accounted for in other channels, such as through electronic health records and registries.
Most commissioners expressed support for both the repeal of MIPS and the conceptual framework for the new VVP, although many sought more details, particularly in the handling of specialists.
“I don’t know that we want to try to make the VVP do too much, especially when you get into the specialties that are very, very episodic,” said commission member Brian DeBusk, PhD, CEO of DeRoyal Industries. “The classic example would be a joint replacement. … I hope to see some specialist APMs developed in parallel and I think that is going to take some pressure off to try to make the VVP be all things to all people.”
Commission member Pat Wang, CEO of Healthfirst, offered a possible solution.
“I would suggest that we try to think about doing that in the context of something that is a little bit, perhaps, not full bore APM, but a VVP for specialists with their own metrics that are not big, gigantic readmissions,” she said. “Those are very broad population health metrics [that may not work for specialists].”
But at least two commission members voiced their dissent to the proposal as presented, with one going so far as to saying that MIPS should not be repealed.
David Nerenz, PhD, of the Henry Ford Health System, said that he had “very serious concerns about the VVP part of this proposal [and] they are such that if it comes to us as a recommendation in more or less its current form I will not support it.”
He called it “pretty significant social engineering in the structure of medical practice and I think we are doing it in the absence of what to me would be compelling evidence that this large group structure we are talking about is good.
“I also don’t see any evidence that beneficiaries find value in the set of measures we are talking about,” Dr. Nerenz added. He is on the record as supporting the repeal of MIPS.
Commission member Alice Coombs, MD, of Weymouth, Mass., was the lone voice speaking in support of MIPS: “I think MIPS has a lot of problems … but there are some things that are coming out of MIPS that are actually good.”
She called the VVP proposal “inadequate” and took issue with the measures. As a practicing physician, she said that she favors more population health measures that will affect patient outcomes.
MedPAC staff expect to have a draft recommendation prepared for discussion at the December meeting, with a final vote on what will be presented to Congress coming as soon as January.
AT A PUBLIC MEETING OF MEDPAC