A&B Healthcare Week in Review

by Alston & Bird
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I. REGULATIONS, NOTICES, & GUIDANCE

  • On April 21, 2016, CMS issued a proposed rule entitled, “Medicare Program: FY 2017 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements.” This proposed rule would update the hospice wage index, payment rates, and cap amount for fiscal year (FY) 2017. As proposed, hospices would see a 2.0 percent ($330 million) increase in their payments for FY 2017. The proposed 2.0 percent hospice payment update percentage for FY 2017 is based on an estimated 2.8 percent inpatient hospital market basket update, reduced by a 0.5 percentage point multifactor productivity adjustment and by a 0.3 percentage point adjustment set by the Affordable Care Act (ACA). In addition, this rule proposes changes to the hospice quality reporting program, including proposing new quality measures. The proposed rule also solicits feedback on an enhanced data collection instrument and describes plans to publicly display quality measures and other hospice data beginning in the middle of 2017. Finally, this proposed rule includes information regarding the Medicare Care Choices Model (MCCM). Public comments are due by June 20, 2016.
  • On April 21, 2016, CMS issued a proposed rule entitled, “Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2017.” This proposed rule would update the prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal FY 2017 as required by the statute. For FY 2017, CMS is proposing to update the IRF prospective payment systems (PPS) to reflect an estimated 1.45 percent increase factor (reflecting an IRF-specific market basket estimate of 2.7 percent, reduced by a 0.5 percentage point multifactor productivity adjustment and a 0.75 percentage point reduction required by law). As required by section 1886(j)(5) of the Act, this rule includes the classification and weighting factors for the IRF PPS’s case-mix groups and a description of the methodologies and data used in computing the prospective payment rates for FY 2017. CMS is also proposing to revise and update quality measures and reporting requirements under the IRF quality reporting program (QRP). Public comments are due by June 20, 2016.
  • On April 21, 2016, CMS issued a proposed rule entitled, “Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities Proposed Rule for FY 2017, SNF Value-Based Purchasing Program, SNF Quality Reporting Program, and SNF Payment Models Research.” This proposed rule would update the payment rates used under the PPS for skilled nursing facilities (SNFs) for FY 2017. Based on proposed changes contained within this proposed rule, CMS projects that aggregate payments to SNFs will increase in FY 2017 by $800 million, or 2.1 percent, from payments in FY 2016. The increase in payments is attributable to a 2.6 percent market basket update, less a 0.5 percent multifactor productivity adjustment. In addition, it includes a proposal to specify a potentially preventable readmission measure for the SNF Facility Value-Based Purchasing Program (VBP), and other proposals for that program aimed at implementing value-based purchasing for SNFs. Additionally, this proposed rule proposes additional polices and measures in the SNF QRP. This proposed rule also includes an update on the SNF Payment Models Research (PMR) project. Public comments are due by June 20, 2016.
  • On April 18, 2016, the Health Resources and Services Administration (HRSA) issued a notice entitled, “340B Drug Pricing Program Ceiling Price and Manufacturer Civil Monetary Penalties Regulation; Reopening of Comment Period.” HRSA states that in light of the comments received, the agency is reopening the comment period for 30 days for the purpose of inviting public comments on Ceiling Price for a Covered Outpatient Drug Exception, New Drug Price Estimation, and Definition of “Knowing and Intentional.” This document reopens the comment period for the June 17, 2015, proposed rule entitled “340B Drug Pricing Program Ceiling Price and Manufacturer Civil Monetary Penalties Regulation.” The comment period for the proposed rule, which ended on August 17, 2015, is reopened for 30 days. Public comments are due May 18, 2016.
  • On April 18, 2016, CMS issued an interim final rule entitled, “Medicare Program; Temporary Exception for Certain Severe Wound Discharges from Certain Long-Term Care Hospitals Required by the Consolidated Appropriations Act, 2016; Modification of Limitations on Redesignation by the Medicare Geographic Classification Review Board.” This interim final rule (IFC) provides for a temporary exception for certain wound care discharges from the application of the site neutral payment rate under the Long Term Care Hospital (LTCH) PPS for certain LTCHs. This IFC also amends CMS’ current regulations to allow hospitals nationwide to reclassify based on their acquired rural status, effective with reclassifications beginning with fiscal year 2018. Hospitals with an existing Medicare Geographic Classification Review Board (MGCRB) reclassification would also have the opportunity to seek rural reclassification for inpatient prospective payment systems (IPPS) payment and other purposes and keep their existing MGCRB reclassification. Public comments are due by June 17, 2016.
  • On April 19, 2016, CMS issued a proposed rule entitled, “Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Proposed Policy Changes and Fiscal Year 2017 Rates; Quality Reporting Requirements for Specific Providers; Graduate Medical Education; Hospital Notification Procedures Applicable to Beneficiaries Receiving Observation Services; and Technical Changes Relating to Costs to Organizations and Medicare Cost Reports.” CMS is proposing to revise the Medicare hospital IPPS for operating and capital-related costs of acute care hospitals to implement changes arising from the continuing experience with these systems for FY 2017. Under the proposal, CMS would increase operating payments under the IPPS by 0.9 percent for FY 2017, which incorporates: (A) a positive 2.8 percent market basket update, (B) a negative 0.5 percent multifactor productivity adjustment, (C) a negative 0.75 percent additional reduction required under the ACA, (D) a positive 0.8 percent increase to remove the adjustment to offset the estimated costs of the “Two Midnight” policy and address its effects in FYs 2014, 2015, and 2016, and (E) a negative 1.5 percent to recoup expenditures associated with documentation and coding changes, as required under the American Taxpayer Relief Act of 2012. In addition, CMS is proposing to make changes relating to direct graduate medical education (GME) and indirect medical education (IME) payments to hospitals with rural track training programs. Public comments are due June 17, 2016.
  • On April 15, 2016, CMS issued a bulletin to notify issuers of qualified health plans (QHPs) that CMS has extended the final deadline for data submission of 2014 and 2015 cost-sharing reduction (CSR) reconciliation data to Friday, June 3, 2016 at 11:59 p.m. EDT. Additionally, to help ensure that issuers will be able to submit their CSR reconciliation data successfully by the Friday, June 3, 2016 deadline, CMS is establishing an interim data submission deadline of Monday, May 2, 2016, 11:59 p.m. EDT, by which time CMS is requiring all issuers to have submitted a data file. If an issuer has submitted a data file that has been processed by the interim deadline, the issuer will be deemed to be in compliance with the interim deadline, even if the file submitted fails CMS validations.
  • April 18, 2016, HRSA issued an update entitled, “340B Pricing System: Manufacturers 340B Database Verification and Other Updates.” HRSA continues to develop the 340B Pricing System which is designed to calculate, verify, and display 340B ceiling prices. A secure, web-based system will allow authorized users from covered entities the ability to view 340B ceiling prices for covered outpatient drugs. Manufacturers participating in the 340B Program will be able to easily upload their quarterly pricing data for their portfolio of covered outpatient drugs and validate their prices with the HRSA-verified 340B ceiling price. This new system will strengthen HRSA’s commitment to transparency and its ability to ensure manufacturer compliance with 340B requirements.
  • On April 15, 2016, CMS issued a notice entitled, “New Additional Inflation-Adjusted Rebate Requirement for Non-Innovator Multiple Source Drugs.” CMS will modify the Drug Data Reporting for Medicaid (DDR) system and Medicaid Drug Rebate (MDR) system to incorporate the new additional rebate portion of the Unit Rebate Amount (URA) calculation for N drugs. Upon implementation of the modifications to the MDR and DDR systems, CMS will include the URAs for N drugs as part of the quarterly rebate files to states beginning with the first quarter 2017. CMS will provide additional operational instructions to manufacturers and states regarding the status of the MDR and DDR system modifications. However, in accordance with section 1927(c)(3) of the Act, manufacturers will be responsible for calculating the additional rebates for N drugs effective first quarter 2017.
  • On April 21, 2016, CMS issued an information collection request (ICR) entitled, “Patient’s Request for Medicare Payment; Consumer Research Supporting Outreach for Health Insurance Marketplace.” The Form CMS-1490S form provides beneficiaries with a relatively easy form to use when filing their claims. Without the collection of this information, claims for reimbursement relating to the provision of Part B medical services and supplies could not be acted upon. This would result in a nationwide paralysis of the operation of the Federal Government’s Part B Medicare program, and major problems for the patients and beneficiaries inflicting severe physical and financial hardship on beneficiaries. Public comments are due by June 21, 2016.
  • On April 18, 2016, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued an ICR entitled, “Proposed Project: Opioid Drugs in Maintenance and Detoxification Treatment of Opioid Dependence--42 CFR part 8 (OMB No. 0930-0206) and Opioid Treatment Programs.” 2 CFR part 8 establishes a certification program managed by SAMHSA's Center for Substance Abuse Treatment (CSAT). The regulation requires that Opioid Treatment Programs (OTPs) be certified. “Certification'” is the process by which SAMHSA determines that an OTP is qualified to provide opioid treatment under the Federal opioid treatment standards established by the Secretary of HHS. To become certified, an OTP must be accredited by a SAMHSA-approved accreditation body. The regulation also provides standards for such services as individualized treatment planning, increased medical supervision, and assessment of patient outcomes. This submission seeks continued approval of the information collection requirements in the regulation and of the forms used in implementing the regulation. Public comments are due June 18, 2016.
  • On April 18, 2016, the National Institutes of Health (NIH) issued a notice entitled, “Exclusive Licenses: Development of MRI-1569, MRI-2213 and MRI-2214 as a Therapeutic to Treat Obesity, Diabetes, Fatty Liver Disease and Liver Fibrosis.” NIH is contemplating the grant of an exclusive patent license to practice the inventions embodied in the patent application, entitled “CB1 receptor mediating compounds” to Kalytera Therapeutics Inc. This technology, and its corresponding patent applications, is directed to methods of treating fibrosis, obesity and associated diseases such as type 2 diabetes by administering an agent that reduces appetite, body weight, hepatic steatosis, and insulin resistance. This technology may be useful as a means for treating various fibrotic diseases and metabolic syndromes without serious adverse neuropsychiatric side effects.
  • On April 19, 2016, the Internal Revenue Service (IRS) issued the Form 1099-SA. When a beneficiary uses the funds from a Health Savings Account (HSA) or a medical savings account (MSA) such as an Archer MSA or Medicare MSA, the institution that administers the account must report all distributions on Form 1099-SA.
  • On April 18, 2016, CMS issued a notice entitled, “Extension of state-based Small Business Health Options Programs (SHOP) Direct Enrollment Transition.” CMS is extending the option for state-based SHOPs to use direct enrollment as a transitional measure for up to an additional two years for plan years beginning in 2017 and 2018. This extension is only for state-based SHOPs that currently utilize direct enrollment. 
  • On April 19, 2016, the Centers for Disease Control and Prevention (CDC) issued an ICR entitled, “Improving the Impact of Laboratory Practice Guidelines (LPGs): A New Paradigm for Metrics - College of American Pathologists (OMB Control No. 0920-1067).” The overall purpose of these cooperative agreements is to increase the effectiveness of LPGs by defining measures and collecting information to inform better LPG creation, revision, dissemination, promotion, uptake, and impact on clinical testing and public health. The project will explore how these processes and their impediments and facilitators differ among various intended users of LPGs. Through this demonstration project, CDC seeks to understand how to customize LPG creation and promotion to better serve these intended users of LPGs.
  • On April 19, 2016, the Food and Drug Administration (FDA) issued an ICR entitled, “Agreement for Shipment of Devices for Sterilization.” This notice solicits comments on requirements relating to shipment of nonsterile devices that are to be sterilized elsewhere or are shipped to other establishments for further processing, labeling, or repacking.
  • On April 19, 2016, FDA issued a guidance entitled, “Draft Guidance for Industry: Comparability Protocols for Human Drugs and Biologics--Chemistry, Manufacturing, and Controls Information.” The draft guidance provides recommendations to human drug and biologics manufacturers on implementing a chemistry, manufacturing, and controls (CMC) postapproval change(s) through the use of a comparability protocol (CP). By using a CP, manufacturers who fall within the scope of this guidance will not have to submit commercial-scale CMC information on postchange products to FDA before making the proposed change. This draft guidance is intended to establish a framework to promote manufacturing of quality drug products.
  • On April 19, 2016, CMS issued State Medicaid Director letter guidance entitled, “State Medicaid Directors Letter Clarifying 'Free Choice of Provider' Requirement in Conjunction with State Authority to Take Action against Medicaid Providers.". CMS issued the letter to provide guidance to state Medicaid agencies on protecting the right of Medicaid beneficiaries to receive covered services from any qualified provider willing to furnish such services when the state exercises its authority to take action against providers that affects beneficiary access to those providers, including but not limited to the denial or termination of provider enrollment, or the exclusion of providers from program participation.
  • On April 19, 2016, the Office of Inspector General (OIG) issued an advisory opinion entitled, “OIG Advisory Opinion No. 16-04.” OIG was writing in response to requests for an advisory opinion regarding the use of a “preferred hospital” network as part of Medicare Supplemental Health Insurance (“Medigap”) policies, whereby three insurance companies would indirectly contract with hospitals for discounts on the otherwise-applicable Medicare inpatient deductibles for their policyholders and, in turn, would provide a premium credit of $100 to policyholders who use a network hospital for an inpatient stay.
  • On April 20, 2016, CMS issued Frequently Asked Questions (FAQs) entitled, “FAQS About ACA Implementation Part 31, Mental Health Parity Implementation, and Women’s Health and Cancer Rights Act Implementation.” These FAQs answer questions from stakeholders to help people understand the laws and benefit from them, as intended.
  • On April 22, 2016, CMS issued a draft updated Federal standard notices of product discontinuation and renewal for the individual health insurance market. Once finalized, these notices will be used by individual market issuers to satisfy the requirement under the guaranteed renewability rules to provide notice of product discontinuation, coverage renewal, and non-renewal or termination based on enrollees’ movement outside a product’s service area. These draft notices generally include the same content as the Federal standard notices that were included in the September 2, 2014 Bulletin. The notices have been updated based on CMS’s experience communicating with consumers in the Marketplaces, which included consumer research, testing and feedback.
  • On April 22, 2016, FDA issued a proposed rule entitled, “Banned Devices; Proposal to Ban Electrical Stimulation Devices Used to Treat Self-Injurious or Aggressive Behavior.” FDA is proposing to ban electrical stimulation devices used to treat aggressive or self-injurious behavior. FDA has determined that these devices present an unreasonable and substantial risk of illness or injury that cannot be corrected or eliminated by labeling. FDA is proposing to include in this ban both new devices and devices already in distribution and use. Public comments are due by May 22, 2016.
  • On April 21, 2016, OMB received a final rule for review entitled, “Medicare Clinical Diagnostic Laboratory Test Payment System (CMS-1621-F).” This final rule requires Medicare payment for clinical laboratory tests to be based on private payor rates beginning January 1, 2017, as required by section 216(a) of the Protecting Access to Medicare Act of 2014.

Event Notices

  • May 9 &10, 2016, HHS will convene a meeting with the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health. Teleconference information will be published closer to the meeting date.
  • May 9, 10 &11, 2016, the Department of Veteran Affairs (VA) will convene a meeting with the Commission on Care. The purpose of the Commission, as described in section 202 of the Veterans Access, Choice, and Accountability Act of 2014, is to examine the access of veterans to health care from the Department of Veterans Affairs and strategically examine how best to organize the Veterans Health Administration, locate health care resources, and deliver health care to veterans during the next 20 years.
  • May 17, 2016, CMS Healthcare Common Procedure Coding System (HCPCS) will convene a public meeting entitled, “Drugs/Biologicals, Radiopharmaceuticals/Radiologic Imaging Agents.” The meeting agenda may be found here. Meeting participants will hear presentations about each agenda item from the registered primary speaker and other speakers (if any). Presentations will be followed by an opportunity for questions regarding that particular agenda item. Participants must register before May 10, 2016.
  • May 24 &25, 2016, HHS will convene an advisory committee meeting with the National Committee on Vital and Health Statistics (NCVHS) Subcommittee on Privacy, Confidentiality & Security. Concerns have been raised about the sufficiency of the HIPAA de-identification methodologies, the lack of oversight for unauthorized re-identification of de-identified data, and the absence of public transparency about the uses of de-identified data. The purpose of this hearing is to gather industry input on existing guidance and possible limitations of the de-identification methodologies for making recommendations to the Secretary of HHS.
  • June 22 &23, 2016, CDC will hold a meeting with the Community Preventive Services Task Force. The Task Force is an independent, nonpartisan, nonfederal, and unpaid panel. During its meetings, the Task Force considers the findings of systematic reviews on existing research and issues recommendations.

II. CONGRESSIONAL LEGISLATION & COMMITTEE ACTION

U.S. Senate

  • On April 20, 2016, Senate Armed Services Subcommittee on Personnel convened a hearing entitled, “Current State of Research, Diagnosis, and Treatment for Post-traumatic Stress Disorder and Traumatic Brain Injury.” The witnesses included Navy Capt. Walter Greenhalgh, Director, Walter Reed National Military Medical Center's National Intrepid Center of Excellence Directorate; Navy Capt. Michael Colston, Director, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; and Amy Street, Deputy Director of the National Center For Posttraumatic Stress Disorders.

House of Representatives

  • On April 19, 2016, the House Energy and Commerce Subcommittee on Health convened a hearing entitled, “Medicare Access and CHIP Reauthorization Act of 2015: Examining Physician Efforts to Prepare for Medicare Payment Reforms.” The witnesses included Dr. Jeffery W. Bailet, Executive Vice President Aurora Health Care, Co-President Aurora Health Care Medical Group; Dr. Barbara L. McAneny, Member, American Medical Association, Dr. Robert McLean, Member, American College of Physicians; and Dr. Robert Wergin, Board Chair, American Academy of Family Physicians. The background memo for the hearing may be found here.
  • On April 20, 2016, House Energy and Commerce Committee convened a markup of H.R.4641, to provide for the establishment of an inter-agency task force to review, modify, and update best practices for pain management and prescribing pain medication, and for other purposes; H.R.3680, the "Co-Prescribing to Reduce Overdoses Act of 2015"; H.R.3691, the "Improving Treatment for Pregnant and Postpartum Women Act"; H.R.1818, the "Veteran Emergency Medical Technician Support Act"; H.R.3250, the "DXM Abuse Prevention Act"; H.R.4969, the "John Thomas Decker Act of 2016"; H.R.4586, "Lali's Law"; H.R.4599, the "Reducing Unused Medications Act of 2016"; H.R.4978, the "Nurturing and Supporting Healthy Babies Act"; H.R.4976, the "Opioid Review Modernization Act"; the "Opioid Use Disorder Treatment Expansion and Modernization Act"; and the "Examining Opioid Treatment Infrastructure Act of 2016." All of the bills, as amended, were advanced to the full committee by a voice vote.
  • On April 19, 2016, the House Committee on Appropriations approved by a voice vote a bill that would increase FDA funding for FY 2017. The bill would give the FDA $2.7 billion in discretionary funding, an increase of $33 million over the FY 2016 enacted level. Total funding for the FDA, including revenue from industry-paid user fees, would be $4.78 billion, which would be $97.4 million above FY 2016. Within this total, medical product safety activities would increase by $9.4 million, and food safety activities would rise by $33.2 million.
  • On April 19, 2016, the House Committee on Veterans' Affairs convened a hearing entitled, “A Continued Assessment of Delays in Veterans' Access to Health Care.” The witnesses included David Shulkin, Undersecretary for Health; Thomas Lynch, Assistant Deputy VA Undersecretary for Health for Clinical Operations; Poonam Alaigh, senior Medical Adviser for the Veterans Affairs Department; Larry Reinkemeyer, Director of the Kansas City Office of Audits and Evaluations in the VA Office of Inspector General; Gary Abe, Acting Assistant Inspector General, VA Office of Inspector General; and Debra Draper, Director, Government Accountability Office.
  • On April 20, 2016, the House Energy and Commerce Subcommittee on Oversight and Investigations convened a hearing entitled, “How Secure are U.S. Bioresearch Labs? Preventing the Next Safety Lapse.” The witnesses included John Neumann, Director of Natural Resources, Government Accountability Office; Lawrence Tabak, Principal Deputy Director, the National Institutes of Health; Steve Monroe, Associate Director for Laboratory Science and Safety the Centers for Disease Control and Prevention; Segaran Pillai, Director of the Office of Laboratory Science and Safety, FDA; and Maj. Gen. Brian Lein, Commanding General for the U.S. Army Medical Research and Material Command.

III. REPORTS, STUDIES, & ANALYSES

  • On April 19, 2016, CMS released a report including data detailing the quality of care received by people with Medicare Advantage by racial or ethnic group. The report is entitled, “Racial and Ethnic Disparities in Health Care Medicare Advantage.” This document presents summary information on the quality of health care received by Medicare beneficiaries, including information about their experiences as patients obtaining care.
  • On April 18, 2016, OIG released a report entitled, “Inconsistencies in State Implementation of Correct Coding Edits May Allow Improper Medicaid Payments In this report, OIG found that the States' inconsistent implementation and use of the edits may reduce their ability to promote correct coding by providers and prevent improper Medicaid payments. Additionally, the report indicates that States' lack of reporting of cost savings estimates, and the limitations of the estimates that were reported, inhibit CMS's ability to meaningfully estimate national Medicaid National Correct Coding Initiative (NCCI) cost savings.
  • On April 15, 2016, OIG released a report entitled, “Medicare Contractor Payments to Providers for Hospital Outpatient Dental Services in Jurisdiction H Generally Did Not Comply With Medicare Requirements.” OIG found that Medicare contractor payments made to providers in Jurisdiction H (Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas) for hospital outpatient dental services generally did not comply with Medicare requirements. Of the 100 dental services in OIG’s stratified random sample, 91 did not comply with Medicare requirements. Using the sample results, OIG estimated that Medicare contractors improperly paid providers in Jurisdiction H at least $1.7 million from January 1, 2012, through August 31, 2014.

IV. OTHER HEALTH POLICY NEWS

  • On April 18, 2016, CMS announced that it will offer the awardees in the Bundled Payments for Care Improvement (BPCI) initiative the opportunity to extend their participation in Models 2, 3 and 4 through September 30, 2018. This extension means that they, along with other organizations that joined later in 2014, have the opportunity to continue their participation in the BPCI initiative up until September 30, 2018. As of April 1, 2016, the BPCI initiative has 1,522 participants, comprised of 321 Awardees and 1,201 Episode Initiators. In Models 2, 3 and 4, there are 48 clinical episodes from which participants are able to choose when considering their opportunities for care redesign, improving quality, and achieving savings.
  • On April 19, 2016, the CEO of UnitedHealth, Stephen Hemsley, announced that the insurance company would only remain in “only a handful” of Health Insurance Exchanges in 2017. He cited the “smaller overall market size and higher risk profile” of the exchange populations as the reasons for pulling out of most of the state exchanges. Officials at HHS stated that UnitedHealth’s plans were priced higher than most plans in the exchanges.
  • On April 19, 2016, the U.S. Supreme Court heard oral arguments on a substantive False Claims Act (FCA) case focusing on an issue with very real impact on whistleblower suits and providers. The case, Universal Health Services v. United States ex rel. Escobar, could have far-reaching implications for providers when responding to a whistleblower suit. Whistleblowers and the government are arguing for an "implied false certification" theory of FCA liability. Under the theory, providers, by submitting reimbursement claims to the federal government, would impliedly certify compliance with federal rules and could be found liable if they don't comply. The government's position is essentially that every violation of every regulation renders a claim false, whether it is or is not expressly part of the claim. Interestingly, the Supreme Court Justices asked very few questions on the dichotomy between conditions of payment and conditions of participation. Instead, they focused largely on the meaning of falsity and fraud (for example, whether “false” can mean misleading or deceptive, whether a failure to inform the government of noncompliance constitutes fraud) and the interplay between the statute’s elements of materiality and scienter (legal term that refers to intent or knowledge of wrongdoing). A ruling is anticipated in June, and many predictions are that a 4–4 split decision is very likely in this case.
  • On April 20, 2016, CMS announced that it would delay planned changes to its Hospital Compare website until July. CMS had planned to add overall hospital quality star ratings to the website this month, until the Agency received a letter from the Senate urging the delay the star ratings. The current Hospital Compare website has separate ratings for different quality measures, such as patient experience, outcomes and safety. Under the now-delayed overhaul of the system, Hospital Compare would use a five-star rating system for consistency and alignment with existing CMS star rating efforts for other health-care providers.
  • On April 21, 2016, CMS released the 2015 Mid-Year Quality and Resource Use Reports (QRURs) to physician groups and solo practitioners nationwide, including those who participated in the Shared Savings Program, the Pioneer Accountable Care Organization (ACO) model, or the Comprehensive Primary Care (CPC) initiative in 2015. The Mid-Year QRUR provides interim information about performance on the six cost and three quality outcomes measures that CMS calculates from Medicare claims.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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