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Discern Health Shapes Medicare Payment Policy

July 2021

On July 13, Medicare released planned updates to its physician payment regulations. The proposed rule includes changes to value-based payment programs, including several proposed by Discern Health in partnership with its clients. One update relates to COVID. Last year, Discern’s staff discussed ways the organization could use its expertise in Medicare payment to respond to…

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CMS Report Shows that Quality Measures Matter

July 2021

CMS recently published their 2021 National Impact Assessment Report of Quality Measures. The triennial report, which scans the 26 different CMS programs, found progress in key priority areas. 91% of CMS’s analyzed measures demonstrated stable or increased performance, which shows that measuring quality improvement matters. For example, the “Patients over Paperwork” and “Meaningful Measures” efforts…

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Driving High-Value Care through Value-Based Hospital CEO Incentives

July 2021

A recent Health Affairs blog suggests that value data could be used to improve CEO incentive compensation systems to drive high-quality, affordable health care. Using risk-adjusted data from the CMS value-based purchasing (VBP) program, the authors looked at a cohort of 21 major west coast and southwest teaching hospitals. Analysis revealed that there was no…

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The Threat of Competition: Incumbent Drug Manufactures Raise Prices in Anticipation of Market Competition

July 2021

Traditional economic theory predicts that competition will counteract growth in drug prices. Surprisingly, success of competitor’s clinical trials and new drug application (NDA) submissions seem to represent exogeneous “pipeline shocks” that cause incumbent drug manufacturers to raise prices before rival candidates appear on the market. From 2007 to 2015, pharmaceutical companies raised the price of…

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Pfizer Challenges Medicare Anti-Kickback Statute Preventing Copay Relief to Patients

July 2021

Out-of-pocket expenses for patients are a hot topic and the rules of the road for whose out-of-pocket costs can be covered is the subject of a current lawsuit in federal courts. Pfizer filed the lawsuit challenging federal anti-kickback laws in Medicare to allow manufacturers to pay or provide some offset to a patient’s copays. Currently…

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NQF’s Measure Applications Partnership Forms a Health Equity Advisory Group

July 2021

The Measure Applications Partnership (MAP) issued a call for applicants for a new Health Equity Advisory Group. The MAP is a public-private partnership convened by the National Quality Forum (NQF) and CMS to provide input on the selection of performance measures for federal health programs. The Health Equity Advisory Group will provide input on the…

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CMS Begins Enforcement of Interoperability and Patient Access Rule

July 2021

Delayed several months for pandemic-related reasons, July 1st marks the beginning of enforcement by CMS of the CMS Interoperability and Patient Access Rule. In conjunction with the 2016 Cures Act, the CMS Interoperability and Patient Access Rule aims to bolster access by patients and providers to health records and other care-related data. Increased interoperability is…

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CMS Plans to Implement More Mandatory Value-Based Payment Models

June 2021

In a June 3rd interview with Health Affairs, CMS senior leader Liz Fowler stated the agency’s intent to shift to mandatory value-based payment models. Fowler was recently appointed as the head of the Center for Medicare and Medicaid Innovation (CMMI), which develops and tests new ways to improve care though innovative payment arrangements. She is…

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Novel Treatment Options for HCC in the Asia-Pacific Region Presents New Opportunities and Challenges

June 2021

Hepatocellular carcinoma (HCC) is the fourth highest cause of cancer-related death globally. There is great geographical variation in the distribution of HCC, with an estimate of 72% cases found in Asia. Sorafenib and Lenvatinib have been widely used as the only available first-line standard systematic therapy for advanced HCC. Recently, a group of clinicians, economists,…

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Radiologist Participation in MSSP ACOs Shows Major Growth

June 2021

A recent study found that radiologist participation in Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs) tripled from 2013, a year after the program started, to 2018. In 2013, 10.4% of radiologists participated in an ACO, while five years later, 34.5% of radiologists participated in an ACO. While the percent of ACOs that included…

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New Report: Recommendations for Patient and Family Engagement in Measure Development

Harnessing the stories, ideas, and innovations of patient and caregiver partners is the key to making measurement meaningful. With support from the Patient-Centered Outcomes Research Institute (PCORI)...
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Guy D’Andrea Speaks About Innovative Payment Models

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