This Week in Managed Care: June 23, 2017

The top managed care stories this week included proposed rule changes to the implementation of the Medicare Access and CHIP Reauthorization Act; a study found Medicaid expansion increased emergency department utilization; and a diabetes drug received a new cardiovascular indication.

CMS presents new rules for MACRA; a diabetes therapy gets a new indication; and a study shows Medicaid expansion brought new patients to emergency departments

Welcome to This Week in Managed Care, I’m Laura Joszt.

Proposed Changes to MACRA Implementation

CMS will exempt more small practices from having to comply with the Medicare Access and CHIP Reauthorization Act (MACRA), under a proposal released this week. The draft rule would exempt practices with less than $90,000 in Medicare revenue, which would leave about 834,000 doctors out of the quality reporting program.

CMS estimates only about 37% of doctors will be required to bill under the program. Said CMS Administrator Seema Verma:

"We've heard the concerns that too many quality programs, technology requirements, and measures get between the doctor and the patient. That's why we're taking a hard look at reducing burdens."

Under the rule, small practices would be allowed to create virtual groups to go after incentives under MACRA. Comments are due August 21.

ED Use With Medicaid Expansion

A new study finds that Medicaid expansion brought new patients to the emergency department, but more of them had insurance. The study from Vanderbilt University, published in the Annals of Emergency Medicine, examined data from the Agency for Healthcare Research and Quality.

It found that emergency department use increased by 2.5 visits per 1000 people in 14 Medicaid expansion states in 2014, compared with 11 states that did not expand Medicaid. However, compared with those states without Medicaid expansion, the share of visits not covered by insurance fell by 5.3 percentage points in states that expanded the program.

In an editorial, Ari Friedman, MD, PhD, asked whether this represents a failure, since the data show the increases were largest for injury related visits and greatest in states were benefits were leanest before expansion.

He wrote: “We need to move beyond the value judgments that have dominated so much of emergency department utilization towards a more rational basis for how we structure unscheduled visits in the health system.”