Value-Based Care

Accountable Care Organizations have given little attention to surgery in the early years of the Medicare program, choosing to focus instead on managing chronic conditions and reducing hospital readmissions.

The American Society of Clinical Oncology's algorithm to help oncologists evaluate the clinical benefits, side effects and costs of a cancer drug or therapy will be fine-tuned over the summer and should be available for public comment by the fall, said Dr. Lowell Schnipper, chair of the society's Value in Cancer Care Task Force.

David B. Hoyt, MD, FACS, executive director, American College of Surgeons (ACS), says that his organization has studied the concept of improving and sustaining quality while lowering costs. They find there are a variety of results when it comes to hospitals creating, meeting, and maintaining quality standards.

Robert Gabbay, MD, PhD, discusses the changes he wishes to see in the healthcare system that he calls a "journey toward quality," and with his work at the Joslin Diabetes Center, he dreams of ridding the world of diabetes by implementing innovation.

For oncologists and other cancer care specialists, value-based care is essential.

The second day at the 50th annual meeting of the American Society of Clinical Oncology ended with a session entitled "Health Care in America in 2014: Current and Future Implications of the Patient Protection and Affordable Care Act" (PPACA). The presenters provided an overview of the recent and anticipated changes related to the PPACA as well as its timeline.

"The Value of Cancer Care and the Professional and Ethical Obligations of the Practicing Oncologist: A Debate" delved into the ethical issues raised by the economic reality of the rising costs of cancer care for the practicing oncologist.

While the incidence of cancer continues to grow, novel and targeted therapies being developed have seen much improved survival for even the deadliest of cancers. New innovations in cancer diagnosis and treatment are associated with high cost. Cancer therapy constitutes nearly 11% of the total healthcare budget, and it is rapidly growing.

The nation's healthcare system needs to follow the lead of the aviation and manufacturing industries and adopt a systems-engineering approach to quality improvement, but fee-for-service payments and an inadequate health data infrastructure are obstacles to doing so, according to a new report from the President's Council of Advisors on Science and Technology.

Medicare overpaid physicians $6.7 billion in 2010 for evaluation and management services, HHS' Office of Inspector General said in a study released Thursday.

Physicians are wary of new healthcare payment models emphasizing quality and efficiency metrics, but hospitals are likely to prove resilient.

As part of a contract extension with Tenet Healthcare, Cigna has established a first of its kind quality-based reimbursement agreement.

Anthony Slonim, MD, DrPH, CPE, FACPE, executive vice president, chief medical officer, at Barnabas Health says that being a member of The American Journal of Managed Care's ACO and Emerging Healthcare Coalition is valuable.

In an era of heavy-duty strategies and tough decisions, one healthcare expert urged providers to consider the accountable care organization (ACO) as part of their future.

NCCN Guidelines Updates

Three major insurers are partnering with a not-for-profit group to provide consumers with greater access to healthcare cost information, the group announced Wednesday morning.

The CMS has canceled its first scheduled round of end-to-end testing for ICD-10 in the wake of a recent, one-year reset of the compliance deadline to Oct. 1, 2015, according to knowledgeable sources.

Final rule reduces burdens to critical access hospitals, rural clinics; loosens physician supervision requirements.

Wayne J. Katon, MD, professor of psychiatry, director of the division of health services and epidemiology, and vice chair of the department of psychiatry and behavioral sciences at the University of Washington Medical School, says that people with psychiatric illness in primary care settings cost the system twice as much as those without mental illness. Comorbidities such as depression can add to those costs.

Roger Kathol, MD, president of Cartesian Solutions, Inc, and professor of internal medicine and psychiatry at the University of Minnesota, says that health reform presents several opportunities for psychiatrists.

Only 50 physicians and 4 hospitals that enrolled in the federal electronic health record (EHR) incentive payment program have reported achieving Stage 2 meaningful use of EHRs. Officials from the Centers for Medicare & Medicaid Services (CMS) said that due to these low numbers, many participating practitioners who did not achieve Stage 2 risk having their Medicare reimbursement payments lowered at the end of 2014.

Since the Obama administration launched its accountable care initiative as part of healthcare reform in 2012, the CMS has announced which hospital and physician networks in one of the programs have met cost targets and received shared savings. But so far, it has published little data on quality of care delivered by these networks, which were designed to deliver better care as well as lower costs for Medicare patients.

The Obama administration says the number of Medicare patients returning to hospitals within 30 days fell further in 2013, amounting to 150,000 fewer readmissions since January 2012.

Steven S. Sharfstein, MD, president and CEO of Sheppard Pratt, says that patients with mental illness who are insured under Medicare or Medicaid will feel the effect of health reform in terms of cost control and quality-focused care.

Wayne J. Katon, MD, professor of psychiatry, director of the division of health services and epidemiology, and vice chair of the department of psychiatry and behavioral sciences at the University of Washington Medical School, says that the type of patient a primary care physician sees can vary depending on the type of insurance the person has.

States did little to improve healthcare access, quality, costs and outcomes in the past five years, according to a Commonwealth Fund report. Researchers examined 42 health indicators between 2007 and 2012, and found that in many states, access and affordability of healthcare actually declined among adults younger than 65. Healthcare spending rose $491 billion, reaching $2.8 trillion nationally.