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Lokhande A, Painter DF, Vogt B, Shah A. Policy and Payment Decisions on Peritoneal Dialysis in the United States: A Review. Med Care Res Rev 2024:10775587241233614. [PMID: 38404115 DOI: 10.1177/10775587241233614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
End-stage kidney disease (ESKD) accounts for a sizable proportion of Medicare spending. Peritoneal dialysis remains an underutilized treatment modality for ESKD despite its quality of life and cost-saving benefits. Medicare policy on reimbursements and patient eligibility for dialysis coverage has been amended numerous times since its inception in 1972. Over the last two decades, Medicare policy on ESKD reimbursements has evolved from a primarily fee-for-service model to a prospective payment system, and within the past few years, it has begun including more experimental payment structures. While prior work has explored the evolution of Medicare's ESKD policy as a whole, we specifically outline the impact of Medicare policy changes on peritoneal dialysis reimbursement rates, uptake by physicians and dialysis facilities, and accessibility to patients. This narrative review offers historical insights, an overview of modern ESKD policy, actionable strategies, and policy opportunities to increase the accessibility of this treatment modality.
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Affiliation(s)
- Anagha Lokhande
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - David F Painter
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Braden Vogt
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Ankur Shah
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, USA
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2
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Ng GY, DiGiorgio AM. Performance of Neurosurgeons Providing Safety-Net Care Under Medicare's Merit-Based Incentive Payment System. Neurosurgery 2024:00006123-990000000-01014. [PMID: 38197638 DOI: 10.1227/neu.0000000000002824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/28/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Under the Merit-Based Incentive Payment System (MIPS), Medicare evaluates provider performance to determine payment adjustments. Studies examining the first year of MIPS (2017) showed that safety-net providers had lower MIPS scores, but the performance of safety-net physicians over time has not been studied. This study aimed to examine the performance of safety-net vs non-safety-net neurosurgeons in MIPS from 2017 to 2020. METHODS Safety-net neurosurgeons were defined as being in the top quartile according to proportion of dual-eligible beneficiaries and non-safety-net in the bottom quartile. Outcomes were total MIPS scores and dual-eligible proportion over time. In this descriptive study, we evaluated ordinary least squares regression models with SEs clustered at the physician level. Covariates of interest included safety-net status, year, and average Hierarchical Condition Category risk score of beneficiaries. RESULTS There were 2796-3322 physicians included each year between 2017 and 2020. Mean total MIPS scores were not significantly different for safety-net than non-safety-net physicians in 2017 but were greater for safety-net in 2018 (90.7 vs 84.5, P < .01), 2019 (86.4 vs 81.5, P < .01), and 2020 (90.9 vs 86.7, P < .01). Safety-net status (coefficient -9.11; 95% CI [-13.15, -5.07]; P < .01) and participation in MIPS as an individual (-9.89; [-12.66, -7.13]; P < .01) were associated with lower scores while year, the interaction between safety-net status and year, and participation in MIPS as a physician group or alternative payment model were associated with higher scores. Average Hierarchical Condition Category risk score of beneficiaries (-.011; [-.015, -.006]; P < .01) was associated with decreasing dual-eligible case mix, whereas average age of beneficiaries (.002; [.002, .003]; P < .01) was associated with increasing dual-eligible case mix. CONCLUSION Being a safety-net physician was associated with lower MIPS scores, but safety-net neurosurgeons demonstrated greater improvement in MIPS scores than non-safety-net neurosurgeons over time. Providers with higher-risk patients were more likely to decrease their dual-eligible case mix over time.
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Affiliation(s)
- Grace Y Ng
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony M DiGiorgio
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
- Mercatus Center at George Mason University, Washington, District of Columbia, USA
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Tummalapalli SL, Struthers SA, White DL, Beckrich A, Brahmbhatt Y, Erickson KF, Garimella PS, Gould ER, Gupta N, Lentine KL, Lew SQ, Liu F, Mohan S, Somers M, Weiner DE, Bieber SD, Mendu ML. Optimal Care for Kidney Health: Development of a Merit-based Incentive Payment System (MIPS) Value Pathway. J Am Soc Nephrol 2023; 34:1315-1328. [PMID: 37400103 PMCID: PMC10400097 DOI: 10.1681/asn.0000000000000163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/17/2023] [Indexed: 07/05/2023] Open
Abstract
The Merit-based Incentive Payment System (MIPS) is a mandatory pay-for-performance program through the Centers for Medicare & Medicaid Services (CMS) that aims to incentivize high-quality care, promote continuous improvement, facilitate electronic exchange of information, and lower health care costs. Previous research has highlighted several limitations of the MIPS program in assessing nephrology care delivery, including administrative complexity, limited relevance to nephrology care, and inability to compare performance across nephrology practices, emphasizing the need for a more valid and meaningful quality assessment program. This article details the iterative consensus-building process used by the American Society of Nephrology Quality Committee from May 2020 to July 2022 to develop the Optimal Care for Kidney Health MIPS Value Pathway (MVP). Two rounds of ranked-choice voting among Quality Committee members were used to select among nine quality metrics, 43 improvement activities, and three cost measures considered for inclusion in the MVP. Measure selection was iteratively refined in collaboration with the CMS MVP Development Team, and new MIPS measures were submitted through CMS's Measures Under Consideration process. The Optimal Care for Kidney Health MVP was published in the 2023 Medicare Physician Fee Schedule Final Rule and includes measures related to angiotensin-converting enzyme inhibitor and angiotensin receptor blocker use, hypertension control, readmissions, acute kidney injury requiring dialysis, and advance care planning. The nephrology MVP aims to streamline measure selection in MIPS and serves as a case study of collaborative policymaking between a subspecialty professional organization and national regulatory agencies.
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Affiliation(s)
- Sri Lekha Tummalapalli
- Division of Healthcare Delivery Science & Innovation and Division of Nephrology & Hypertension, Weill Cornell Medicine, New York, New York
- The Rogosin Institute, New York, New York
| | - Sarah A. Struthers
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | | | - Amy Beckrich
- Renal Physicians Association, Rockville, Maryland
| | | | - Kevin F. Erickson
- Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, Texas
| | - Pranav S. Garimella
- Division of Nephrology-Hypertension, University of California San Diego, San Diego, California
| | - Edward R. Gould
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nupur Gupta
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Krista L. Lentine
- Saint Louis University Transplant Center, SSM-Saint Louis University Hopstial, St. Louis, Missouri
| | - Susie Q. Lew
- Division of Renal Diseases and Hypertension, George Washington University, Washington, DC
| | - Frank Liu
- The Rogosin Institute, New York, New York
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Michael Somers
- Division of Nephrology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel E. Weiner
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | | | - Mallika L. Mendu
- Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston Massachusetts
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4
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Shah RR, Bailey JP. Asymmetric Interoperability: Directional Analysis of Provider Group Health Information Exchange (Preprint). J Med Internet Res 2022; 25:e43127. [PMID: 37023418 PMCID: PMC10131629 DOI: 10.2196/43127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/30/2023] [Accepted: 02/13/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND High levels of seamless, bidirectional health information exchange continue to be broadly limited among provider groups despite the vast array of benefits that interoperability entails for patient care and the many persistent efforts across the health care ecosystem directed at advancing interoperability. As provider groups seek to act in their strategic best interests, they are often interoperable and exchange information in certain directions but not others, leading to the formation of asymmetries. OBJECTIVE We aimed to examine the correlation at the provider group level between the distinct directions of interoperability with regard to sending health information and receiving health information, to describe how this correlation varies across provider group types and provider group sizes, and to analyze the symmetries and asymmetries that arise in the exchange of patient health information across the health care ecosystem as a result. METHODS We used data from the Centers for Medicare & Medicaid Services (CMS), which included interoperability performance information for 2033 provider groups within the Quality Payment Program Merit-based Incentive Payment System and maintained distinct performance measures for sending health information and receiving health information. In addition to compiling descriptive statistics, we also conducted a cluster analysis to identify differences among provider groups-particularly with respect to symmetric versus asymmetric interoperability. RESULTS We found that the examined directions of interoperability-sending health information and receiving health information-have relatively low bivariate correlation (0.4147) with a significant number of observations exhibiting asymmetric interoperability (42.5%). Primary care providers are generally more likely to exchange information asymmetrically than specialty providers, being more inclined to receive health information than to send health information. Finally, we found that larger provider groups are significantly less likely to be bidirectionally interoperable than smaller groups, although both are asymmetrically interoperable at similar rates. CONCLUSIONS The adoption of interoperability by provider groups is more nuanced than traditionally considered and should not be seen as a binary determination (ie, to be interoperable or not). Asymmetric interoperability-and its pervasive presence among provider groups-reiterates how the manner in which provider groups exchange patient health information is a strategic choice and may pose similar implications and potential harms as the practice of information blocking has in the past. Differences in the operational paradigms among provider groups of varying types and sizes may explain their varying extents of health information exchange for sending and receiving health information. There continues to remain substantial room for improvement on the path to achieving a fully interoperable health care ecosystem, and future policy efforts directed at advancing interoperability should consider the practice of being asymmetrically interoperable among provider groups.
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Affiliation(s)
- Rohin Rathin Shah
- The Robert H. Smith School of Business, University of Maryland, College Park, MD, United States
- Poolesville High School, Poolesville, MD, United States
| | - Joseph Peter Bailey
- The Robert H. Smith School of Business, University of Maryland, College Park, MD, United States
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Millar BC, Lim M. The Role of Visual Abstracts in the Dissemination of Medical Research. THE ULSTER MEDICAL JOURNAL 2022; 91:67-78. [PMID: 35722208 PMCID: PMC9200102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Medical research within the UK has continued to grow, most notably during the COVID-19 pandemic over the last two years, which highlights the importance of disseminating relevant research findings. For all researchers involved in clinical trials and scientific research, the end goal of success is not completed following the publication of the research findings, but ultimately true impact and significance is achieved when such research has a role in developing clinical practice. Each year between 2.5 - 3 million scientific papers are published and the number continues to rise, therefore it is becoming increasingly difficult to ensure that published research has such a targeted impact as it must first get noticed. Increasing time commitments result in difficulties for clinicians keeping up-to-date with the current literature and in order to address this, journals and researchers have developed approaches to share peer-reviewed research with the wider research community in an effective and efficient manner. One such approach has been the introduction of the visual abstract which comprises of an infographic style format, coupled with a shortened, limited word summary of the research abstract detailing the key question, methodology, findings and take home message of the research study. The visual abstract has characteristics which enable it to be shared on social media platforms and in turn increase the interest and impact within the research community. Visual abstracts are being increasingly introduced within medical journals and organisations to help disseminate valuable research findings. This review focuses on visual abstracts, what they are, their history, structure and role within research dissemination and medical education.
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Affiliation(s)
- Beverley C. Millar
- School of Medicine, Dentistry and Biomedical Sciences, The Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, UK,School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine, BT52 1SA,Northern Ireland Public Health Laboratory, Belfast City Hospital, Lisburn Road, Belfast, Northern Ireland, BT9 7AD, UK
| | - Michelle Lim
- James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
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Berkowitz ST, Siktberg J, Gupta A, Portney D, Chen EM, Parikh R, Finn AP, Patel S. Economic Evaluation of the Merit-Based Incentive Payment System for Ophthalmologists: Analysis of 2019 Quality Payment Program Data. JAMA Ophthalmol 2022; 140:512-518. [PMID: 35420641 PMCID: PMC9011174 DOI: 10.1001/jamaophthalmol.2022.0798] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The Merit-Based Incentive Payment System (MIPS) is intended to promote high-value health care through quality-related Medicare payment adjustments. Objective To assess the economic evaluation of MIPS scoring and reporting on ophthalmologists. Design, Setting, and Participants In this retrospective, cross-sectional, multicenter economic evaluation conducted from October 10 to November 30, 2021, MIPS performance and related payment adjustments were evaluated using the US Centers for Medicare & Medicaid Service (CMS) public data files for ophthalmologists. Participants were stratified by reporting affiliation. Analysis of variance and summary statistics were used to characterize and compare total and subcategory MIPS scores and adjustments received by participants. Reported CMS methodology and performance year (PY) 2019 payment percentages were used to estimate payment adjustments for the following categories: positive MIPS adjustment plus potential additional adjustment for exceptional performance, positive MIPS adjustment, neutral payment adjustment, negative MIPS payment adjustment, and maximum negative MIPS payment adjustment. Study participants included ophthalmologists registered for Medicare Part B with participation in the Quality Payment Program (QPP) in PY 2019. Main Outcomes and Measures Proportion of ophthalmologists qualifying for payment adjustments and payment adjustments. Results For PY 2019, 76.5% of ophthalmologists (13 621) who registered for Medicare participated in the MIPS pathway of the QPP. Ophthalmologists practiced in a predominantly large metropolitan area (12 302; 90.3%). Roughly 99% of participants (11 182) received nonnegative reimbursement adjustments, and 92.6% (10 367) received positive adjustments. Ophthalmologists filing as individuals were less likely to achieve exceptional performance scores compared with those who had a filing category of advanced alternative payment model (APM; odds ratio [OR], 0.0003; 95% CI, 0.00002-0.00481) or group (OR, 0.21013; 95% CI, 0.19020-0.23215). When analyzing participating ophthalmologists with available Medicare payment data (11 193), a total of 8777 (78.4%) achieved exceptional MIPS scores corresponding to mean (SD) adjustments per physician of $244.60 ($217.36) to $4864.78 ($4323.08), or 0.07% ($2 146 835.21 of $3 212 011 252.88) to 1.33% ($42 698 166.89 of $3 212 011 252.88), of the total nondrug Medicare payment. Conclusions and Relevance Results of this economic evaluation showed that although 78.4% of ophthalmologists received exceptional positive payment adjustments, roughly 84% (798916 of 954615) of all health care professionals nationally achieved this benchmark. Exceptional MIPS was associated with filing as group or APM, resulting in, on average, a relatively small additional payment per participant; this suggests that ophthalmologists who file as individuals should consider an alternative filing approach. Changes in MIPS methodology may disproportionately affect certain ophthalmologists, which warrants further study.
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Affiliation(s)
- Sean T Berkowitz
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan Siktberg
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Arulita Gupta
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David Portney
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor
| | - Evan M Chen
- Department of Ophthalmology, University of California, San Francisco
| | - Ravi Parikh
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York
| | - Avni P Finn
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shriji Patel
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee
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Tummalapalli SL, Mendu ML. Value-Based Care and Kidney Disease: Emergence and Future Opportunities. Adv Chronic Kidney Dis 2022; 29:30-39. [PMID: 35690401 PMCID: PMC9199582 DOI: 10.1053/j.ackd.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/16/2021] [Accepted: 10/05/2021] [Indexed: 01/03/2023]
Abstract
The United States health care system has increasingly embraced value-based programs that reward improved outcomes and lower costs. Health care value, defined as quality per unit cost, was a major goal of the 2010 Patient Protection and Affordable Care Act amid high and rising US health care expenditures. Many early value-based programs were specifically designed for patients with end-stage renal disease (ESRD) and targeted toward dialysis facilities, including the ESRD Prospective Payment System, ESRD Quality Incentive Program, and ESRD Seamless Care Organizations. While a great deal of attention has been paid to these ESRD-focused programs, other value-based programs targeted toward hospitals and health systems may also affect the quality and costs of care for a broader population of patients with kidney disease. Value-based care for kidney disease is increasingly relevant in light of the Advancing American Kidney Health initiative, which introduces new value-based payment models: the mandatory ESRD Treatment Choices Model in 2021 and voluntary Kidney Care Choices Model in 2022. In this review article, we summarize the emergence and impact of value-based programs on the quality and costs of kidney care, with a focus on federal programs. Key opportunities in value-based kidney care include shifting the focus toward chronic kidney disease, enhancing population health management capabilities, improving quality measurement, and leveraging programs to advance health equity.
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Affiliation(s)
- Sri Lekha Tummalapalli
- Division of Healthcare Delivery Science & Innovation, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY,The Rogosin Institute, New York, NY
| | - Mallika L. Mendu
- Division of Renal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA,Center for Population Health, Mass General Brigham, Boston, MA
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Riaz S, Erickson KF. Early Nephrologist Performance in the Merit-Based Incentive Payment System: Both Reassurance and Reason for Concern. Kidney Med 2021; 3:699-701. [PMID: 34693251 PMCID: PMC8515087 DOI: 10.1016/j.xkme.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Sohail Riaz
- Section of Nephrology, Baylor College of Medicine
| | - Kevin F. Erickson
- Section of Nephrology, Baylor College of Medicine
- Baker Institute for Public Policy, Rice University, Houston TX
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