The American Hospital Association criticized one component of the plan.
In addition to requiring hospitals to publish their chargemasters online in a machine-readable format, a set of proposals unveiled Tuesday by the Centers of Medicare & Medicaid Services would overhaul the way CMS handles electronic health records requirements.
Under the proposal, the "meaningful use" EHR incentive program would be rebranded "promoting interoperability" to emphasize its new direction. The goal, the agency said, is to boost flexibility under the program while reducing its burden and promoting data-sharing between providers.
The American Hospital Association praised the CMS plan overall as the beginning steps of a much-needed streamlining process.
"We are disappointed, however, that the agency will require use of 2015 Edition Certified EHR Technology beginning in 2019," AHA Executive Vice President Tom Nickels said in a statement.
The 2015 edition could help patients collect their health data from multiple providers using application programming interfaces (APIs), perhaps bringing all their health data together into a single digital place, the agency said.
"This can support a patient’s ability to share their information with another member of their care team or with a new doctor, which can reduce duplication and provide continuity of care," CMS saidin its announcementTuesday, noting that it is requesting stakeholder feedback on the possibility of incorporating interoperability requirements into the Conditions of Participation.
The planned changes, which are proposed as part of the Inpatient Prospective Payment System (IPPS) rule updates for fiscal year 2019, also call for the elimination of 18 quality-reporting measures.
The proposal will be published in the Federal Register on May 7 and open for comments through June 25.
The IPPS proposal calls for greater price transparency from hospital providers.
Hospitals will be required next year to publish their standard list of prices online in a machine-readable format, if the Centers for Medicare & Medicaid Services finalizes a proposed rule announced Tuesday afternoon.
The requirement, which aims to unleash competitive market forces in the healthcare sector by making pricing data more readily available to consumers, is among a list of changes proposed to the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) for 2019.
"This payment proposal takes important steps toward a Medicare system that puts patients in charge of their care and allows them to receive the quality and price information needed to drive competition and increase value," Health and Human Services Secretary Alex Azar said in a statement Tuesday.
CMS Administrator Seema Verma said the proposal demonstrates the government's commitment both to high-quality care for patients and reduced regulatory burden for providers.
"We envision a system that rewards value over volume and where patients reap the benefits through more choices and better health outcomes," Verma said in a statement.
The new request for information follows up on an RFI last fall that received more than 1,000 responses.
The Centers for Medicare & Medicaid Services announced Monday that it is looking to allow physicians to contract directly with the Medicare beneficiaries they serve.
The agency issued a request for information, giving the public a month to comment on details of how the CMS Innovation Center could design and release a direct provider contracting (DPC) payment model. The request follows up on an RFI last fall that received more than 1,000 responses.
“We recognize that the best ideas don’t come from Washington, so it’s important that we hear from the front lines of our healthcare system about how we can improve care,” CMS Administrator Seema Verma said in a statement.
Cathleen London, MD, who has an office in the town of Milbridge, Maine, said the DPC undertaking would save "a huge amount of money" and reduce hassle for physicians, according to comments CMS published Monday.
"I have not opted out of Medicare but am offering Direct Primary Care to an underserved population in rural Maine," London wrote. "I would like to be part of the CMS DPC Initiative for both Medicare and Medicaid (I have a large Medicaid population) as I think this would decrease my burden as a small office and give better patient satisfaction and care."
The follow-up RFI includes 22 specific questions for which CMS is seeking feedback. It asks how a DPC model could be designed to attract a wide variety of physicians and practices, what support physicians and practices would need from CMS in order to participate in such a model, and more.
The agreement ensures members can see their Piedmont physicians and hospitals as in-network visits, including for services delivered since the previous contract expired April 1.
Atlanta-based Piedmont Healthcare and Anthem Blue Cross Blue Shield of Georgia signed a new contract agreement, ending a prolonged dispute that had put hundreds of thousands of patients in limbo.
The impasse drew the attention of Georgia Gov. Nathan Deal, who tweeted an ultimatim last week threatening to use unspecified "executive action" if the parties didn't work out their differences by the close of business last Wednesday.
In a follow-up tweet, Deal announced that leaders from Piedmont and Anthem had reached a "handshake deal" in his office.
Piedmont announced Monday that the two organizations had officially "put ink to paper" on Friday, signing a contract that will last into 2021.
"Preserving the relationship between the patient and their preferred healthcare provider has been our number one goal during this entire negotiation," said Piedmont President and CEO Kevin Brown in a statement. "We know this has been difficult for our patients, and we are glad to finally have a resolution that restores and protects patient care."
Piedmont and BCBS of Georgia each said in separate statements that the agreement ensures BCBS members can see their Piedmont physicians and hospitals as in-network visits, including for services delivered since the previous contract expired April 1.
"The thousands of businesses and 3.5 million consumers we serve across Georgia trusted us to reach an agreement with Piedmont that continues to deliver access to high quality health care that is affordable," BCBS of Georgia said in a statement Saturday.
"We are pleased that the new agreement will enable our consumers to continue to access affordable care through all Piedmont hospitals and physicians that are now back in our network
This year's data quantified hospital alignment within each system. Winners were slightly more consistent than non-winners.
After evaluating clinical quality data from 338 health systems, IBM Watson Health identified 15 top-performers for its 2018 list released Sunday.
Compared to last year's list, this year's line-up of health systems includes many repeat-honorees and some newcomers. Nine of the 15 systems named in the 2018 list had been named in 2017 as well, when the organization was known as Truven Health Analytics.
Jean Chenoweth, senior program director for IBM Watson Health's 100 Top Hospitals Programs, said this year's data quantified the degree of hospital alignment within each system. Winners were slightly more consistent in clinical and operational performance among their hospitals than systems that didn't make the list, and that difference was statistically significant over a five-year period.
"Put simply, we wanted to determine how well health systems are achieving the goal of delivering a consistent patient experience in each of their facilities, and start benchmarking that performance each year," Chenoweth said in a statement. "Based on our data, it is clear that better hospital alignment does indeed play a role in overall health system performance, and it is something we will be investigating further."
The winning health systems are listed below, organized by size. Systems marked with an asterisk (*) were also named on the 2017 list.
Large health systems
Mayo Foundation – Rochester, MN*
Mercy – Chesterfield, MO*
Sentara Healthcare – Norfolk, VA
St. Luke's Health System – Boise, ID*
UCHealth – Aurora, CO
Medium health systems
Aspirus Network – Wausau, WI
HealthPartners – Bloomington, MN*
Mercy Health, Cincinnati – Cincinnati, OH*
Mission Health – Asheville, NC*
TriHealth – Cincinnati, OH
Small health systems
Asante – Medford, OR*
CHI St. Joseph Health – Bryan, TX
Maury Regional Health – Columbia, TN*
Roper St. Francis Healthcare – Charleston, SC*
UPMC Susquehanna Health System – Williamsport, PA
IBM Watson Health reports that health systems who made its Top 15 list had 14.6% fewer in-hospital deaths, 17.3% fewer complications, 16.2% fewer healthcare-associated infections, 2.3% higher HCAHPS scores, and 5.6% lower spend than their non-winning peers.
The document outlines the terms to which Banner Health agreed under a settlement to end False Claims Act litigation brought by a whistleblower.
As part of an $18.3 million settlement announced last week by the Department of Justice, Phoenix-based nonprofit Banner Health signed a corporate integrity agreement in which it committed to fixing the way it handles claims submitted to federal healthcare programs.
That agreement, which was released Friday by the Health and Human Services Office of Inspector General, calls for a long list of reforms that Banner must implement then maintain for five years.
Banner's present legal trouble stemmed from a whistleblower complaint filed under the False Claims Act in 2013 by Cecilia Guardiola, who worked less than three months for the organization in 2012 as corporate director of clinical documentation.
Banner's settlement marks the third time Guardiola has squeezed a multi-million-dollar deal out of a former employer.
The agreement Banner signed is designed to ensure the organization's compliance efforts are up to snuff, as the DOJ acknowledged. Below are five requirements from the agreement:
Appoint compliance officer. Banner must designate one member of its senior management team as its compliance officer, who must report directly to the chief executive officer. That person cannot be the chief financial officer, the general counsel, or anyone who reports to the general counsel or who serves as Banner legal counsel in any capacity. A spokesperson for the system said Banner's vice president of ethics and compliance has served and will continue to serve as chief compliance officer (CCO).
Name area compliance program directors. Banner must, within four months, pick area compliance program directors to assist the compliance officer with implementation and day-to-day monitoring. The agreement, which applies to 12 hospitals, does not specify how many directors must be appointed. The spokesperson said Banner has CCOs throughout the system to oversee compliance on a facility basis.
Conduct additional training. Banner must put together a written curriculum outlining how it will ensure that everyone covered by the agreement receives annual training on what Banner's legal requirements are, both generally and under the agreement. The training must address Stark Law and Anti-Kickback Statute requirements.
Hire an independent auditor. Banner must hire an independent review organization, such as an accounting, auditing, or consulting firm. That firm is to be tasked with evaluating Banner's admissions data and determining whether Banner's claims to Medicare are appropriately documented, coded, and billed.
Prepare for transparency. Banner must keep all reimbursement records for at least six years, and the HHS OIG has authority to conduct investigations and review Banner's books. If the organization makes a "false certification" while the agreement is in force, it will be on the hook for a $50,000 stipulated penalty per violation.
The agreement, which Banner Health President and CEO Peter S. Fine signed on March 29, notes that the organization had already complied voluntarily with some of the agreement's requirements.
Editor's note: The story was updated Monday, April 23, 2018, to include a response from a Banner Health spokesperson.
The retailer's Atlanta-area workers will be served by the plan, which aims to foster collaboration among hospitals, physicians, payers, and employers.
Emory Healthcare has teamed up with Walmart to launch a new accountable care organization (ACO) serving the retail behemoth's Atlanta-area employees.
The partnership between an established provider brand and a massive employer that has made its business aspirations in healthcare known could signal a shift in how traditional players in the healthcare sector think about newcomers.
Rather than viewing Walmart or Amazon purely as potential competition, hospitals and health systems may be growing more willing to accept the retailers as collaborators.
"When Walmart approached Emory about these opportunities, we were excited to partner with Walmart, a progressive company dedicated to transforming health care and its delivery process," Emory Healthcare Network CEO Patrick Hammond said in a statement.
"More and more large, self-insured employers like Walmart are looking for new and creative solutions as a potential way to decrease costs of health care plans for employees, while improving the overall quality of the care," Hammond added.
Lisa Woods, senior director of healthcare benefits for Walmart's U.S. operations, said joining forces with Emory makes sense because Walmart is constantly looking for new and better ways to support its workers and secure access to appropriate care.
"Not only does Emory offer a quality provider network, but Emory has also been a great partner in supporting payment reform initiatives," Woods said in the statement. "We appreciate Emory’s willingness to innovate with us as we evolve our programs."
Under the new program, Walmart employees who work at 55 locations throughout the Atlanta metro area will have the option to select Emory Accountable Care Plan as their primary health plan, the organizations said in their announcement.
Walmart employees in the area have access to more than 2,000 doctors in the Emory Healthcare Network. Covered workers will still make standard copayments for primary, specialist, and urgent care, but their preventive care visits will be offered for free.
The idea behind the collaboration is to improve quality of care while lowering overall costs.
Additionally, the organizations announced that the Emory University Orthopaedics & Spine Hospital and Emory Orthopaedics & Spine Center had been added to Walmart's Centers of Excellence programs for spine and joint replacement surgeries—which accept a fixed bundled payment for specified procedures.
Walmart workers enrolled in a company-sponsored plan will pay nothing out-of-pocket for certain surgeries at these Emory facilities—nor will they pay travel-related costs—thanks to the Centers of Excellence designations, the companies said.
In some ways, his shift from the private sector to the government resembles that of the HHS secretary, who overcame criticism to secure Senate confirmation earlier this year.
A former member of Anthem's leadership team has been hired by Health and Human Services to help the federal government transform the health insurance industry.
James "Jim" Parker, MBA, who worked more than two decades for Anthem, has been hired to address both the cost and availability of health plans, HHS Secretary Alex Azar said Wednesday in a written announcement naming Parker director of the HHS Office of Health Reform.
Azar—who was hospitalized Wednesday for the second time this week—said Parker's work for the government will be helped by his private-sector experience, which sought to provide Americans with access to insurance that was both high-quality and affordable.
"His knowledge and expertise will be vital to our work at HHS to ensure that Americans have access to insurance that meets their needs," Azar said.
In some ways, Parker's shift from a private-sector health plan to a government agency pushing for health plan reform resembles Azar's shift from the helm of Eli Lilly & Co.'s U.S. operations to the head of the federal government department overseeing healthcare.
Azar's critics worried that his background would make him too cozy with drug companies, but the Senate ultimately confirmed him with a 55-43 vote in January. Parker's position does not require Senate confirmation.
Parker's profile on LinkedIn says he worked for Anthem from 1995 through 2004, serving more than four years as president of Anthem Blue Cross and Blue Shield of Maine.
Parker then worked about five years for WellPoint after it was acquired by Anthem, serving as president of federal employee benefits, then president of federal government solutions, then chief of staff to President and CEO Angela Braly.
Parker spent more than three years as an independent healthcare consultant before landing his job as president and CEO of provider-sponsored IU Health Plans in 2012. Last year, he was named president and CEO of MDwise, an Indianapolis-based Medicaid managed care organization.
In announcing Parker's hiring, HHS noted that MDwise has more than 300,000 members and $1.4 billion in revenue.
Hoosier ties & strategy
By picking Parker, federal healthcare policymakers also deepened their ties to Indiana, where Vice President Mike Pence served as governor until after President Donald Trump won the 2016 presidential election.
Azar and Centers for Medicare & Medicaid Services Administrator Seems Verma both hail from the Hoosier state as well, as do a number of the staff members on their teams.
But the reason why Parker was picked, Azar said, was because he will support one of the four prongs in Azar's transformation agenda: to combat the opioid crisis, reduce prescription drug costs, address health insurance cost and availability, and transform healthcare delivery into a value-based system.
Two more prongs will be advanced by two other recently announced hires, Azar noted: Daniel M. Best as senior advisor to the secretary for drug pricing reform and Brett P. Giroir, MD, as senior advisor to the secretary for mental health and opioid policy (on top of his responsibilities as assistant secretary for health).
The interruption comes as hospitals and healthcare workers were still struggling seven months after hurricane Maria.
Still recovering from the havoc wreaked by hurricane Maria last September, Puerto Rico suffered another setback Wednesday, when the entire island lost electricity.
The U.S. territory's electric power authority said in a tweet that the outage is expected to last 24-36 hours for some customers. That's a long time for an island that was already struggling to restore not only fragile portions of its power grid but essential healthcare services that depend on it.
Hospitals, which the authority said are among the top priorities for the crews working to restore power, were forced to fire up their backup generatorsagain, as The New York Times reported.
The outage comes as some especially vulnerable Puerto Ricans have been grappling with added barriers to access care and healthcare workers have been pressured by the disaster's long tail.
Although this marks the first island-wide outage since the immediate aftermath of the hurricane, the repair efforts had not yet fully restored normal electricity service to certain areas.
Mainland U.S. hospitals were affected by Maria's devastation on the island as well. The hurricane disrupted Puerto Rico's production of intravenous (IV) saline solutions, sending facilities scrambling to avert a shortage, which was then exacerbated by a harsh flu season.
Food and Drug Administration (FDA) Commissioner Scott Gottlieb, MD, issued a statement earlier this month indicating that saline solution producers in Puerto Rico had been "back online for months" and buttressed by two additional firms.
"The supply situation continues to improve and #FDA continues to monitor it closely," Gottlieb wrote. "We’re also providing updates through our website, which includes the most current status and product availability as reported to us by the drug manufacturers."
Trade associations have chimed in with cybersecurity contract recommendations of their own.
The Food and Drug Administration (FDA) released an 18-page document Tuesday designed to help protect patients from the risks of unsafe medical devices in an increasingly interconnected world.
"Like computers and the networks they operate in, medical devices can be vulnerable to security breaches. Exploitation of device vulnerabilities could threaten the health and safety of patients," FDA Commissioner Scott Gottlieb said in a statement.
"We’ve already taken several steps to promote a multi-stakeholder, multi-faceted approach of vigilance, responsiveness, recovery, and resilience that applies throughout the life cycle of relevant devices," Gottlieb said, noting that his agency plans to seek additional money and cybersecurity-related authorization from Congress.
The action plan's release comes as the Healthcare Supply Chain Association (HSCA) released 12 recommendations of its own for cybersecurity terms and conditions on medical devices.
The top recommendation on the HSCA list calls for suppliers to "warrant their compliance with FDA premarket and post market guidance relative to cybersecurity risks throughout their product's lifecycle."