Pulse Check: Value-based Care Models and the New Administration
By GREG FULTON
From within the new leadership at Health & Human Services (HHS), some anticipated and current payment models tied to MACRA are advancing, while others not-yet-tied to MACRA are being delayed.
MSSP Track 1+ was officially unveiled post-election through a CMS webinar March 22, and CPC+ has moved to round two. Also, but prior to the presidential election, CMS put forth several new bundled payment models whose start dates have been delayed.
Track 1+
The CMS ACO Track 1+ is being designated as an advanced-alternative payment model (A-APM) for MACRA, meaning qualified participants would be eligible for the up-...
Source: The Health Care Blog - April 5, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
Key Mechanisms That Define Health City Cayman Islands ’ Value Innovation
Conclusion
Building on NH’s goal of delivering the highest quality care at the lowest possible cost, HCCI represents a refreshing and potentially highly disruptive approach to globally competitive medicine.
HCCI offers unquestionably high quality care at surprisingly affordable prices, but the model’s marketability is being tested by the US market, which is all but locked in by special interest structures. For example, health plans seeking to make health care cost more, rather than less – net earnings may be a percentage of total expenditures – may see nearshore care as counter to their interests. Brokers m...
Source: The Health Care Blog - April 4, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
RBBB with Transient ST Elevation
This case comes from Sam Ghali (@EM_RESUS). Thanks, Sam!An 60-something male with h/o CABG presented with chest pain. Here is his first ED ECG:Sinus rhythm with PVCs.There is right bundle branch block and left anterior fascicular block(Often a bad combination!--see this post)There is ST elevation in V1-V3 and upright T-waves in V2, V3.RBBB should never have ST elevation. Anywhere.Especially in leads V1-V3, there is usually up to 1 mm of ST depression with an inverted T-wave.This is diagnostic of LAD occlusion.There is no ST elevation in I and aVL, so this is not a proximal LAD occlusion and thus t...
Source: Dr. Smith's ECG Blog - April 2, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
In (Gasp) Defense of the Coronary Stent
By ANISH KOKA, MD
A kerfuffle ensued recently when an oncologist and expert on evidence based medicine took the field of cardiology to task over the evidence for placement of the ubiquitous coronary stent. What started with a lengthy article in Propublica that included coronary stenting for stable coronary disease as a prime example of a procedure done without evidence to back it up turned into this fiery twitter exchange between Drs. Kirtane (cardiology) and Prasad (oncology).
The crux of the debate revolves around placement of coronary stents in patients with stable coronary artery disease. Stable coronary artery d...
Source: The Health Care Blog - March 6, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
Cathlab misadventures : ” Protected left main ” and . . , unprotected patient !
It has become fashionable for many current generation cardiologists to stent the LAD with proximal end liberally extending into left main shaft in Medina 0, 1, 0 or (1,1,1 )lesions involving distal left main often jailing the LCX . This concept came into vogue as it helped bail out few hemo-dynamically unstable patients with true left main bifurcation lesions during primary PCI .Of course , it’s potentially useful strategy in emergency , if extended into routine situations (like all stable proximal LAD/Bifurcation ) we are bound to create few problems.
Rapidly p...
Source: Dr.S.Venkatesan MD - February 26, 2017 Category: Cardiology Authors: dr s venkatesan Tags: Left main disease Left main stenting -Tips and tricks Tips and tricks in cath lab left main pci left main stenting for lad disease safety issues in left main Tips and tricks in left main disease Source Type: blogs
CMS Releases Report to Congress on CMMI
The Centers for Medicare and Medicaid Services (CMS) released a new report to Congress prepared by the CMS Innovation Center (CMMI) highlighting its achievements since its start in 2010 and laying out plans for implementation of future models. In conjunction with the report to Congress, Dr. Patrick Conway, Acting CMS Principal Deputy Administrator, published a blog post on the CMS website, highlighting the CMMI.
According to both the report and the blog post:
Over 30 new payment models have been launched over the past six years;
Investments in electronic medical records and a data and analytics infrastructure are spar...
Source: Policy and Medicine - February 20, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
Newly Released CMS Payment Models – What is to Come?
Right before the inauguration of the new President, the Centers for Medicare & Medicaid Services (CMS) finalized new Innovation Center models. The announcement finalizes significant new policies related to: (1) cardiac care; three new payment models will support clinicians in providing care to patients who receive treatment for heart attacks, heart surgery to bypass blocked coronary arteries, or cardiac rehabilitation following a heart attack or heart surgery; (2) orthopedic care; one payment model will support clinicians in providing care to patients who receive surgery after a hip fracture, other than hip replacement...
Source: Policy and Medicine - February 19, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
The Changing Payment Landscape Of Current CMS Payment Models Foreshadows Future Plans
On June 6, 1944, 156,000 Allied forces, supported by 5,000 ships and 11,000 aircrafts, made an amphibious landing along Normandy’s coast. Although D-Day began the retaking of Western Europe, the famous battle at Omaha Beach initially appeared disastrous. Tanks sank, strong winds blew men to the wrong place, German firepower was significant, and Allied casualties mounted. By the end of the day, not a single objective had been reached. However, by June 11, the beaches were secured and by the end of August the Allies had liberated Paris and were prepared to march on Germany. The battle at Omaha beach had failed to achieve i...
Source: Health Affairs Blog - February 3, 2017 Category: Health Management Authors: David Muhlestein, Natalie Burton and Lia Winfield Tags: Featured Health Policy Lab Medicaid and CHIP Medicare Payment Policy Accountable Care Organization Alternative Payment Models Bundled Payments MACRA value based care Source Type: blogs
HHS Releases Regulations on Alternative Pay Models in Last Weeks of Current Administration
Despite Republicans’ call for a suspension on new rules, the Department of Health and Human Services (HHS) pushed regulations regarding Medicare and Medicaid alternative pay models and insurance exchange stability out the door in the final weeks of the Obama administration. It is likely that the administration wanted to put final touches on changes to demonstrations, which test pay and delivery reforms in Medicare and Medicaid. However, the next administration might undo some of the biggest demonstrations for which the Centers for Medicare & Medicaid Services (CMS) published rules in December because they apply to po...
Source: Policy and Medicine - January 10, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
LITFL Review 264
Welcome to the 264th LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chunk of FOAM.
The Most Fair Dinkum Ripper Beauts of the Week
Another great set of talks from SMACCDub released this week: John Greenwood discussing assault on the RV and Haney Mallemat on the PEA Paradox. [AS]
The Best of #FOAMed Emergency Medicine
Rob Orman talks to a number of EPs about the prac...
Source: Life in the Fast Lane - January 8, 2017 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs
Inhibition of PAI-1 as a Potential Treatment for Atherosclerosis
Researchers are investigating a drug candidate that inhibits plasminogen activator inhibitor-1 (PAI-1) as a potential treatment to slow the progression of atherosclerosis, in which fatty deposits build up in blood vessel walls. This leads to narrowing, structural failure of blood vessels, or blockage when the deposits grow unstable and rupture. The publicity materials in this case fail to join some of the dots to explain why this is interesting in the broader context; the evidence points to influence on cellular senescence as a possible mechanism for the effect here. Past research has shown that PAI-1 is involved in steeri...
Source: Fight Aging! - December 22, 2016 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
Guest entry: Taking a stand for patient safety with the Hospital Readmissions Reduction Program
A number of my students at Keuka College have been working on policy and advocacy projects that I wanted to share. The students researched a topic of their interest, met with their legislators, and developed a broad action plan to increase awareness of their topics. This information in the form of a narrative blog post is provided courtesy of a graduate student who is interested in promoting increased awareness of impacts of the Hospital Readmissions Reduction Program. Because the author only has fieldwork experience and the facility or patient could be possibly identified, with the student ' s permi...
Source: ABC Therapeutics Occupational Therapy Weblog - November 29, 2016 Category: Occupational Health Tags: health insurance injury prevention OT practice Source Type: blogs
Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? No!
CONCLUSION:The variables that interplay in cases of severe aortic stenosis are what cause these patients to be so difficult to manage, and specific therapies targeted to fix one issue often worsen the effects of another issue. If someone is in respiratory distress, their airway and breathing needs to be secured, either through non-invasive or invasive means. Next, the patient ’s blood pressure needs to be stabilized. Oftentimes the most appropriate agent will be a positive inotrope, with consideration of a vasoactive agent in persistent hypotension. Once a patient is stabilized, determining the extent of damage to their ...
Source: Dr. Smith's ECG Blog - November 18, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
Chest Pain and Cardiogenic Shock with Profound ST Depression & STE in aVR. Activate the Cath Lab?
A middle-aged woman with known severe coronary disease had onset of substernal chest pain while at dialysis. 911 was called. A prehospital ECG was similar to the first ED ECG, which is shown below. The patient arrived with a systolic blood pressure of 90 mm Hg, too low to administer nitroglycerine. An initial lactate was elevated at 5.5.She was given aspirin, heparin, and ticagrelor.Here is her initial ED 12-lead ECG:There is atrial fibrillation with a rate of approximately 114.There is extreme ST depression in multiple leads and ST elevation in aVR, suggesting left main and/or 3 vessel disease ischemia...
Source: Dr. Smith's ECG Blog - November 15, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
LIMA to LAD coronary bypass graft (CABG)
LIMA (left internal mammary artery) is to date the most durable conduit for coronary artery bypass grafting. It has stood the test of time as the best graft for a coronary artery, being a live arterial graft with very little likelihood for atherosclerotic lesions. Here the LIMA graft is imaged in the lateral view. The image has been darkened a bit by post processing to visualize the LIMA and LAD (left anterior descending coronary artery) well. Since it was an injection into the left subclavian artery just near the LIMA ostium, the contrast density was a bit lower than that of a superselective LIMA injection. The sternal wi...
Source: Cardiophile MD - November 14, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Cardiology Source Type: blogs
